1. Terrence D. Walton Terrencewalton@aol.com Treatment: Doing The Right Thing …In The Right Way Terrence D Walton, MSW, ICADC

2. Terrence D. Walton Terrencewalton@aol.com

3. Treatment Is … Organized, professional helping A professional relationship Based on theory and protocol Governed by legal, professional and ethical standards

4. Terrence D. Walton Terrencewalton@aol.com Treatment Must Enhance Motivation – Why change? Insight – What to change? Skills – How to change?

5. Terrence D. Walton Terrencewalton@aol.com What Works? Treatment outcome research reveals a number of effective treatment approaches or types to consider Family Group Individual

6. Terrence D. Walton Terrencewalton@aol.com For the BEST OUTCOMES Provide a Puzzle of Evidence Based Approaches Cognitive Behavioral Pharmacological Interventions Motivational Approaches Case Management Continuing Care Community Reinforcement

7. Terrence D. Walton Terrencewalton@aol.com Gender and Cultural Competence

8. Terrence D. Walton Terrencewalton@aol.com Family/Community Interventions 1) Structural-Strategic Family Therapy 2) Multi-Systemic Therapy (MST) 3) Systematic Training for Effective Parenting (STEP) 4) Community Reinforcement Approach (CRA)

9. Terrence D. Walton Terrencewalton@aol.com Group Interventions 1) Multi-Family Therapy Groups 2) Psychoeducational Groups 3) Self Help Groups

10. Terrence D. Walton Terrencewalton@aol.com Individual Interventions 1) Pharmacotherapy/Acunpuncture 2) Cognitive Behavioral 3) Motivational Enhancement Approaches

11. Terrence D. Walton Terrencewalton@aol.com Pharmacological Interventions Goals – Provide: – relief from withdrawal symptoms * – prevent drugs from working – reduce craving* – aversive reactions * Acupuncture found effective

12. Terrence D. Walton Terrencewalton@aol.com Pharmacological Interventions Methadone – Opiate addiction – reduces craving, mediates withdrawal symptoms, Buprenorphine – similar to methadone, may be prescribed by an MD with special training Antabuse – produces adverse reaction with alcohol use Naltrexone – stops opiates from working, changes alcohol action for some – reduction in relapse Baclofen – possible reduction in cocaine cravings

13. Terrence D. Walton Terrencewalton@aol.com Understanding C-B Approaches Cognitions affect: other cognitions, emotions, and behavior. Cognitions lead to behavioral changes. Cognitions play a major role in the development and maintenance of addiction and criminality.

14. Terrence D. Walton Terrencewalton@aol.com Understanding C-B Approaches Behavior is developed and maintained by external events (cues or reinforcement ) and by internal processes (cognitions) De-emphasizes early child hood experiences and emphasizes the here and now Social learning (How a person came to think as he or she does)

15. Terrence D. Walton Terrencewalton@aol.com Three C-B Approaches Cognitive Restructuring Models (e.g. criminal thinking models) Coping Skills Models (e.g. stress management models) Problem Solving Models

16. Terrence D. Walton Terrencewalton@aol.com Reality Therapy: WDEP System W________________ D________________ E________________ P________________

17. Terrence D. Walton Terrencewalton@aol.com Direction/Doing W________________ A________________ Y________________ D________________

18. Terrence D. Walton Terrencewalton@aol.com Motivational Approaches How People Change

19. Terrence D. Walton Terrencewalton@aol.com Why people change W_______ A_______ R________

20. Terrence D. Walton Terrencewalton@aol.com How People Change 1. Pre-contemplation 2. Contemplation 3. Preparation 4. Action 5. Maintenance

21. Terrence D. Walton Terrencewalton@aol.com Not at all ready to change Thinking about change Preparing to change Actively working on or maintaining a change PreContem- plation Contem- plation Prepar- ation Action Maintenance The “Readiness Ruler"

22. Terrence D. Walton Terrencewalton@aol.com PRE-CONTEMPLATION

23. Why people don’t change Reveling Reluctance Rebellion Rationalizing Resignation

24. Terrence D. Walton Terrencewalton@aol.com CONTEMPLATION

25. The Decisional Balance 1. What do you want that you… 2. What do you want that you… 3. What are you getting that you…

26. Terrence D. Walton Terrencewalton@aol.com PREPARATION

27. ACTION

28. MAINTENANCE

29. Traps to Avoid Question – Answer – (“the interrogation”) Taking Sides (arguing for change) Expert Trap Labeling Trap Premature Focus Blaming Trap

30. Terrence D. Walton Terrencewalton@aol.com GENERAL PRINCIPLES 1. Express Empathy 2. Develop Discrepancy 3. Roll with Resistance 4. Support Self-Efficacy

31. Terrence D. Walton Terrencewalton@aol.com Express Empathy Acceptance facilitates change Skillful reflective listening is fundamental Ambivalence is normal

32. Terrence D. Walton Terrencewalton@aol.com Develop Discrepancy The client, rather than the officer should present the arguments for change. Change is motivated by a perceived discrepancy between present behavior and important personal goals or values.

33. Terrence D. Walton Terrencewalton@aol.com Roll with Resistance Avoid arguing for change. Resistance is not directly opposed. New perspectives are invited, but not imposed. The client is the primary resource in finding answers and solutions. Resistance is a signal to respond differently.

34. Terrence D. Walton Terrencewalton@aol.com Support Self-Efficacy A person’s belief in the possibility of change is an important motivator. The client, not the officer, is responsible for choosing and carrying out change. The officer’s own belief in the person’s ability to change becomes a self- fulfilling prophecy.