DrHollieWilson,QUTAssociateProfessorLynneMagor‐Blatch,UOW

• Assumptions– don’tassume!• Whatdoyouknow?

– CBT– Motivationalapproaches,includingtheTranstheoreticalModel(StagesofChange)

– Self‐help– Otherapproaches– ACT

• Theroleofvalues• Assessmentandreferral• Uniqueroleforpsychology

“Peoplearegenerallybetterpersuadedbythereasonswhichtheythemselveshavediscoveredthanbythosewhichhavecomeintothemindsofothers”

Pascal’sPansees,17thCentury

• The3PsofSubstanceuse1.Purpose(thereisareasonforthesubstanceuse)2.ProvideemotionalPainrelief3.Pleasurable(it’snotallbad!)

• Clientsusesubstancesforavarietyofreasons– includingasacopingmechanismformanysituations

• Don’tassumepeoplewillwanttochangejustbecauseotherswantthemto

• Clientswithcomorbidityaretheexpectation ratherthantheexception

• Relapseiscommon• Sustainedbehaviouralchangeispossible

Evidencebasedsubstanceuseinterventions:Adult Adolescents

Level1 Level1

CBT(includingMI) CBTFamilytherapy

Level2 Level2

Self‐helpSolution focusedtherapyDBT

Self‐help

• GrowingevidencebaseforACTandwell‐establishedevidenceforMotivationalInterviewing(MI)

• Remember– therewilllikelybeco‐morbidconditions– thereforetreatmentalsoneedstobeconsideredinthiscontext(trauma,PTSD)

AustralianPsychologicalSociety.(2010).Evidencebasedpsychologicalinterventionsinthetreatmentofmentaldisorders:Aliteraturereview(3rd ed).

• Drugusenotsimplyanindividualbehaviour,butpartofawiderissue,shapedbymacro‐environmentalfactors.

• Psychologists provideanimportantresourceintermsofprogramdesignandevaluation.

Primaryapproachesinclude:‐ Functionalanalysis‐ Copingskillstraining‐ Fosteringchangemotivation‐ Managingunpleasanteffects‐ Interpersonalfunctioningandsocialsupport

Functionalanalysisofsubstanceuse Individualtraininginrecognising andcopingwithcravings,andmanagingthoughtsaboutsubstanceuse

Examinecognitiveprocessessurroundingsubstanceuse Identifyandupack pastandfuturehighrisksituations Encourageandreviewskilluseoutsideofsessions Skillrehearsalinsessions

“Itsoonbecameapparentthatclientopennessversusdefensiveness,changetalkversussustaintalk,isverymuchaproductofthetherapeutic

relationship...Bythewayinwhichonecounselsitispossibletoincreaseanddecreaseclientmotivation(orreticence)likethevolumecontrolonaradio.”

‐ BillMiller

• Atheoreticalmodelofbehaviourchange

• Aimedtodevelopeffectiveinterventionstopromotehealthbehaviourchange

• DevelopedbyProchaska,DiClemente &Norcross(1992)

• Modelofintentionalchange

• Focusesonthedecisionmakingprocess

Motivationisastate notatrait Resistanceisnotaforcewemustovercome Ambivalenceisnormal Personseekinghelpshouldbeanallyratherthananadversary

Recoveryandchangeareinnate,constantandintrinsictothehumanexperience

MIisaparticularkindofconversationaboutchange(counselling,therapy,consultation,methodofcommunication).

MIiscollaborative(person‐centered,partnership,honoursautonomy,notexpert/recipient).Itstrengthensaperson’sownmotivationandcommitmenttochange.

MIisagoal‐orientedstyleofcommunicationwithparticularattentiontothelanguageofchange.

MIisevocative.Itseekstocallforththeperson’sownmotivationandcommitmenttoaspecificgoalbyelicitingandexploringtheperson’sownreasonsforchangewithinanatmosphereofacceptanceandcompassion.

Oneofthechallengesforahealthprofessional/psychologististofindtherighttechniqueorinterventiontofitthestageofchangeinwhichthepersoniscurrentlysitting.

Needtothinkaboutthecharacteristicsofthepersonatthatstageanduseanappropriateresponse.

OftenacombinationofCBT,ACTandMIstrategies Manualisedoronlineinterventions Alsoavarietyofgroups– includingSMARTRecovery,NAandAA

Don’tforgetfamilies!Substanceuseaffectstheentirefamily– notjustthepersonusing

Solutionfocusedtherapy◦ Grouporindividual,goaloriented‐ focusesonwhatclientwantstoachieveintherapy◦ Miraclequestion

Dialecticalbehaviourtherapy◦ Specifictypeofcognitivebasedtherapy,emphasisespsychosocialaspectssuchasrelationshipinteractions◦ Individualandgroupcomponents

Acceptancecommitmenttherapy(ACT)

Basedonassumptionthatmanyunwantedinternalexperiencescannotbeeliminated,sotheymustbeaccepted

Isabehavioural therapy,withanexistentialcomponent Byusingmindfulness andacceptancestrategies,wecanstepbackfrominstantaneousemotionalreactionsratherthanuseoverthem

Byaccepting,ratherthanfighting/strugglingwithaspectsofourinnerworldsoverwhichwehavenocontrol,wecaninvesttimeandeffortinwhatwecancontrol– practicerecoverystrategies

Persist whenpersistenceisuseful Desistwhenwhatwearedoingisn’tworking

• ACTresonateswithsubstance‐useclients.• CBTpushesforchange,oftenresultinginresistance.• SerenityPrayer:“God,grantmetheserenitytoaccept thethingsIcannotchange,thecouragetochange thethingsIcan,andthewisdomtoknowthedifference.”

ACTMantra:

A

•Acceptone’sthoughtsandfeelings;bepresent

C

• Chooseavalueddirection

T

•Takeaction

Valuesarethefuel;thedangerofrunningonempty

Valuesgetlostintheshuffleofliving

Valuesandadjustmentdisorder• Ifnot“living”ourvalues,wewillbegintofeeluncomfortable• Iffeelinguncomfortable Mayincorrectlyappraiseastressor Maytryto“fightthefeeling” Endupfeelingworse,notbetter

• Importantforpsychologiststounderstandthatwearepartofaprimaryhealthresponse,whichoftenmeanswearethefirst‘portofcall’whenchangeiscontemplated.

• Itisimportantthatathoroughassessmentisundertakenandsubstanceuseproperlyassessed.

• Theclientmayneedspecialisedtreatmentthatweaspsychologistscannotprovide– e.g.pharmacotherapy.

• Knowwhereandwhentorefer!

• UnderstandDSM‐5DifferentialDiagnosis forSubstanceUseDisorders.

• Findoutwhatisavailableasreferraloptionsinyourjurisdiction– andwiderafieldifneedbe– e.g.,Residential(therapeuticcommunitytreatmentforfamilieswithchildrenislimited– OdysseyHouseinVictoriaandNSW,CyrenianHouseinWA,KarralikaFamilyPrograminACT,FreshHopeinQld)

– AvailabilityofservicesforAboriginalandTorresStraitIslanderclients

• Developanunderstandingofdetoxificationandwithdrawalservices –specificdangersofalcoholandbenzodiazepinewithdrawal.

• Managingclinicalservices,providinggroupandindividualcounselling,administrationofavarietyofpsychometrictesting,casemanagementandclinicalsupervisionandtrainingofotherstaff.

• Treatingtheclient"asanindividual,beingwelcoming,empathic,understanding,anddemonstratingrespectandactive,persistentcaring,areamongthetrademarksofservicesthathangontoclients".

• Psychologistsoffertheirtraininginresearchandevaluation,andunderstandingofhumanbehaviourandemotionalprocessestoencourageevidence‐based,impartialdebateonpotentialstrategiesandsolutions.

• Roletoplayinassessmentandtreatmentofproblematicsubstanceabusebehaviours,aswellasapplyingskillstobetterunderstandingandpreventionofsubstancemisuse.

• PsychologistsbringtotheAODfieldauniquecontributionintermsofassessmentandtreatmentplanning.Thismaybefurtherenhancedthroughtheuseofpsychometrictesting.

• Demonstrateefficacyandeffectivenessofinterventions.

• Non‐judgemental andcompassionateapproachrecommendedandrespectful.

• Peopleareactiveshapersoftheirownchangeprocessesandempoweringclientsisfundamentaltosustainableandongoingchange.

• Positivetherapeuticrelationshipismajorcomponentofeffectivepsychologicaltreatment.

• Promotionofsocialandemotionalwellbeing.

• Broaderviewofprevention,druguseisoneofarangeofproblembehaviours,andshouldnotbeseeninisolation.

• Workcollaborativelywithothersconcernedwithproblembehaviours,includingcrime,suicideandeducationalproblems,toaddressthesharedpathwaystotheseoutcomes.

Questions?http://eqip.psychology.org.au/

hollie.wilson@qut.edu.au /lynnemb@uow.edu.au