Addictions TreatmentPlanning for Effectiveness

CSD 5970

Issues to Consider

• Safety– Withdrawal Potential– Suicidality– Medical Issues (Immediate)– Domestic Violence– Risk Behaviors

Issues to Consider

• Basic Needs– Food– Clothing– Shelter– Transportation– Medical Care

Issues to Consider

• Engagement– Motivation (external & internal)– Contingencies– Stage of Change– Stage of Engagement– Treatment history (successes and “failures”)

Issues to Consider

• Diagnoses

• Identified Problems

• Client’s Perception of Problems & Goals

• Environment

• Support System

• Strengths & Resilience

Treatment Planning

• Licensure Guidelines– Initial plan approved by a physician– Written & Individualized– Gender & culturally appropriate – Within 24 hours, Level IV– Within 7 days, Level III & Level II– Within 14 days, Level I

Treatment Planning

• Problem list

• Goals (a statement to guide resolution or reduction of the problem)

• Objectives (observable & measurable)

• Methods (Services)– intensity, duration, frequency, referrals for

client, family & significant other

Toolbox

• Community resources– Shelters– Food pantries– Government aid programs– Domestic violence programs– Psychiatric services– Medical clinics– Family service providers, etc

Toolbox

• Education & Information– Drug information– Disease process– Family issues– Resources– Treatment options

Toolbox

• Skill Building– Problem solving skills– Anger management– Relaxation– Recreation & hobbies– Relapse prevention

Toolbox

• Support– 12-step recovery groups (AA,NA,CA)– Online AA– Women for Sobriety– Rational Recovery– Church (Structured addiction groups)

Toolbox

• Insight & Clinical resources– Structured groups (step groups, skill-building

groups)– Process groups– Specialized groups based on gender, sexual

orientation, age, or education

Toolbox

• Insight & clinical resources– 12-step facilitation– Cognitive-behavioral counseling– Motivational interviewing– Gestalt therapy– Narrative therapy– Strength-based counseling– Therapeutic recreation

Toolbox

• Misc. Tools– Journaling– Drug & alcohol testing– Contingencies (recovery birth dates,

celebrations)

Guidelines

• “What do you want”? treatment plans.

• Guides our efforts until the next revision.

• Incorporate additional information into psycho-social history & revised plans

• Creative & affirming

• Strength-based

• The client owns their treatment plan!

Exercise

• Robert– 48 year old African-American male, warehouse worker– Divorced, lives alone in a house he owns– Referred by EAP after on the job accident– Multiple treatment episodes including 3 residential

treatment admissions. – Drinks 8-24 beers daily, no drug history– Alcohol dependence– 2 DUIs, 3 illegal transportation, 1 battery charge – “I really want to want to stop, but I don’t”. “I have to

keep my job and work or I will lose my house”.

Exercise

• Evelyn– 25 year old Caucasian female, unemployed & homeless– Referred by homeless shelter– Intermittently works as sex worker or “mules” for a

dealer.– Heroin & Cocaine “sometimes uses needles”.– No treatment history– Heroin dependence– “I have to get off the streets or I am going to die. I

have to find another way to live but I am trapped”.

Exercise

• Nate– 19 year old Native-American male– Student, lives in dormatory– Referred by college after 2 mandatory alcohol ed

classes. Faces expulsion hearings in 60 days.– Alcohol, Marijuana, Ecstasy– Alcohol & Marijuana abuse– “Do what you have to do, collect your money from my

insurance, and leave me to my own devices – I will be fine/ Just get the damned Dean off my back”.

Exercise

• Sylvia– 14 year old Caucasian female student– Referred by father who stayed during the session. – Alcohol and occasionally Inhalants– Alcohol abuse– No previous treatment history – history of acting out in

school and poor academic performance.– “Father, give her whatever she needs, I will pay for it”.

Sylvia, “I will do whatever you say, I didn’t mean to cause all of these problems”.

Exercise

• Jerry– 50 year old African-American male– Self-referred – Self-employed musician– Divorces, lives with girlfriend– Extensive drug history including hallucinogens,

marijuana, alcohol, cocaine. Multiple treatment episodes and periods of abstinence the longest about 2 years.

– Heroin dependence– “I am tired, I can’t live that life anymore. I want to

quit”.

Exercise

Helen• 26 year old Chinese-American female• Single, lives alone in rented home• Referred by physician• Employed as electrical engineer• Cocaine & rarely alcohol• Cocaine dependence• “I can’t let my employer find out. My career would be

over. I am expecting a 30 million dollar research grant in a few months”.