Assignment 4 of 9

After reading chapters 2 and 3 from TIP 35 I've found a new appreciation for clinicians and substance abuse counselors. I agree with the elements of current motivational approaches and found all approaches to be of great value for a substance abuse provider. I did not know that there are so many elements of effective motivation intervention. I feel that the frame approach, decisional balance exercises, discrepancies between personal goals and current behavior, flexible pacing, and personal contact with clients not in treatment are all excellent approaches in providing help to clients. The brief interventions used in emergency medical situations are also critical. I thought that the methods used in interviewing clients, giving responses to clients' questions, and allowing clients to make decisions on their own, by providing them with the necessary tool and information needed. I've always thought that the decision to seek help should be left up to the person needing the help. The reading says that a client's ambivalence should not be mistaken for denial. I think that most of the times when people are abusing drugs and/or alcohol there are underlining problems that need to be addressed, before a successful recovery can take place, and we should not prejudge clients based on their culture and positions in society. I did not know that there are certain ways to express empathy with clients based on their cultural background. I think this makes sense, especially since African Americans are apprehensive about dealing with the counselors and medical providers, due to past experiences, such as the Tuskegee Experiment. I found the methods in which the reading suggests that counselors avoid arguments with clients clever. Methods such as; "rolling with the resistance", and "agreeing with a twist". I think this really gives the client a sense of control over their treatment, and shows that its not about the counselors or medical providers. I remember when I use to work for a youth rehabilitation center in Memphis, TN. Our turn-over rate was so high, because the counselors could not deal with having a child talking back or using profanity towards them. I guess that they did not realize that it was not about them, and had they only applied the methods that they were taught they may have been able to deal with the situations that were presented to them. I found chapters 2 and 3 of TIP 35 to be a great motivation in improving relationships and treatment plans for the clients and the providers. I would want the principles and approaches used on me or my family members.

Assignment 3 of 9

I want to start by expressing my thoughts on the use of screening instrument/tool from the "Clinician's Desk Reference TIP 24. I have heard the questions from "The Audit Questionnaire", from clinicians at the VA(Veterans Affairs) Medical Center when I've gone there to receive my annual check up in the past. I did not know that the clinicians were using my answers to determine whether or not I was at risk for developing drug or- alcohol abuse- or dependency. I found it interesting that no 1 instrument is used in the examination of every patient. The reading states that, "certain instruments may work better for different age, gender, racial, and ethnic groups." I also found it interesting that the screening could reveal if a person in the patients family has problems with alcohol or other drugs. I chose the "TWEAK" test to practice my questioning methods on my sister-in-law. "TWEAK" is an acronym which stands for: T(tolerance), W(worried), E(eye-opener), A(amnesia), and K(c)(cut down); it has a sliding scale of seven, with 2 points going to positive answers for tolerance and worried, and 1 point going to positive answers for the final three letters. A woman scoring 2 or more is more likely to be a risk drinker. I also chose the "TWEAK" Test, because my sister- in- law is pregnant, and the reading state that this test is preferred by a panel from the Institute of Medicine for the best results for pregnant women. I am happy to say that my sister-in-law scored a one out of a possible seven, which indicates that she is not a risk drinker. The reading also mentions that a positive screening does not mean that a clinician has to give a diagnosis. The clinician should discuss the results with the patient, and explain the implications of including the results in the medical records. I would think that this would be a wise decision, because maybe that patient has had a bad week or month, and trying to diagnose a patient would be unreasonable, if the person is not a long time patient.

The videos I thought were very interesting and informative. Dr. Carl Hart video (Alcohol: A Women's Health Issue) was informative, because I learned that women are more pron to alcoholism than men and face more issues, such as breast cancer, hepatitis,though I disagree with the notion that alcoholism is a disease I do agree with someone getting help and if calling it a disease helps someone admit they have a problem with alcoholic, then I don't think it could do any more harm than allowing them to continue abusing the substances. I also do not agree with genetics being a factor for some one becoming an alcoholic. I think that its the up bring and surroundings that influences a child to drink ,and then continuous drinking is transforms into drinking habits which leads to alcohol abuse. Like the woman in the video said she had a lot of curiosity from seeing her family drink as well as pressure from her peers, just like the woman in the video says genetics is not your destiny. I disagree with the statement from the video that said, "there is no shame in being an alcoholic." I think it should be, I see no shame in being a recovering alcoholic, and Americans should make being an alcoholic shameful in some positive way. I think we as Americans want to find the the quick fix, so we give explanations for our mistakes and failures in life, and instead of working on the problems we want to diagnose and prescribe drugs. I' not saying that diagnosis and drugs are bad, I'm saying that we need to take responsibility for some of our problems.
The video states that alcohol kills more teenagers that all the illicit drugs put together, and yet getting alcohol is easier than taking the drugs off the streets. I heard some one say that if a child says they are going to be like their parents, or family members, who abused drugs and alcohol, their setting themselves up for failure, if the don't find someone positive to look up to.

Which brings me to the video on Dr. Nora Volkow, the director of The National Institute on Drug Abuse. I think that this woman really made the students feel like they have a voice in this video. One male student near the beginning of the video says, "They say, 'just say no', but they don't really care what I have to say." I know from experience, coming in drug infested projects and schools, sometimes its hard to believe that some one cares about what you say or do. For someone like Nora to take time to come and speak to a group of inner city students is a blessing indeed; they must have felt special. I think the approach of coordinating the students ideas into solving the problems students face when dealing with drugs is excellent. I thought that her explanation on why students who do marijuana on a regular basis do so poorly in school was simple and to the point. She said, that marijuana targets Cannabinoid receptors(modulating the pleasure center of the brain) and cannabinoids receptors are also located in the memory sensors of the brain; which allows you to learn,and can be completely taken over by marijuana. I guess I can start giving up on the reasons to legalize marijuana, because after taking these classes and learning that there are so many side effects to using it, I would not want my children to be able to use it. If I knew half of what I know now. I would not have used marijuana.

assignment #2of9

First I want to start by answering the questions from the beginning of chapter 1 of TIP 35; which asks, Why do people change?, What is motivation?, Can individuals' motivation to change their substance using behavior be modified?, and Do clinicians have a role in enhancing substance using clients' motivation for recovery? I think that people change for many reasons, but perhaps the most profound reason is self fulfillment. For example, drug abusers can see that they can cause pain and harm not only to themselves but also to their family, but the pleasure received from the drugs and/or alcohol overthrows their desire to stop causing this pain. I think when the abuser find something that motivates them more than the pleasures of substance abuse they can be encouraged to change the way in which they live their life. To answer the question of what is motivation? We would have to asked the person in question. Motivation to me is any thing or person that uplifts or inspires me to accomplish a goal; whether the motivation is negative someone telling I'll never amount to any thing, or positive someone congratulating me for receiving my high school diploma. I think that individuals' motivation to change their substance using behavior can be modified. Take for instance, the medical model of abuse; which describes substance abuse as an illness; although I don't agree with this model I think that if this diagnosis helps substance abuser to address their problems then I see no harm in the use of the diagnosis, because now the abuser may not look at themselves as being a problem for their family or community but as a sick person trying to get help. I think that clinicians do have a role in enhancing motivation for recovery, because most of the time the family or community has failed or abandoned the substance. Clinicians can educate, be that partner the abuser needs, and be that motivational counseling needed to help lead them into steps toward recovery. We have to remember that we all have problems just like the girl in the (Crackberry Addiction) commercial, who was suppose to be relaying a message about drug addiction, but could not handle her own addiction with her blackberry phone. We can't shelter our children or family members from all that is wrong in the world; like in the (Cannonball Rez PSA) we have to teach them respect and be positive role models for them.

The best of the class

I would like to wrap up what I loved about this class in three words, tools, tools, and tools. After going through my notes for the final exam, what shined the most was personal experiences and hands on examples from how to treat a client to what to say. In this class the professor took the class to a grass roots level of experience. We got into the nitty gritty of what's going to happen during an assessment to what to say when they get angry, and addiction is a tough issue. It's not really a popular one.

As an example, I remember one role play where our professor pretended she was a client who had many years of experience but relapsed. I was stunned. There was no assessment that I knew of for this client and our teacher just gave us one off the cuff. Here it is. What is your purpose of meeting with us? What's not working this time? Is thee anything in your past that may be comming up? What about relationships, or lack of them? What about depression? And I love this line, "I don't have the time we need to get to know you. Could we meet again? Here the teacher projects as sense of almost intimate caring. When she talked I would think, "Could I come?" Now that is what I am here for.

I really want to learn how to be a supportive person who builds trust early on in the relationship and can maintain it, always giving the client something to take with them as they gain self-efficacy and the quality of life of their choosing.

Summing up the course

This was a comprehensive class with some great info about interviewing skills and motivating clients. In learning the dimensions of the ASAM PPC2, I became aware of what all goes into deciding on a treatment plan and what Level of care a person should be placed in. The time we spent on how to make the client comfortable, and role playing a screening for drug and alcohol abuse, was useful to me. I am not in the substance abuse field yet but I was interested to learn about the different screening and assessment tools that are used, and about the TIPS, and the Stages of Change. I also found the instructor’s comments about her personal experience in the field to be enlightening. It was not a boring class at all – I looked forward to each class and enjoyed writing in the blog and reading other’s comments in the blog. When I took the final exam I felt that I came away from the class with a good understanding of the material that was presented.

Making Difference

This course consists lots of useful information for effective implementation in professional arena. Stages of Change levels is important classification system for identifying client's placement and progress in treatment. Many available resources online and SA fundamental information from the Bookshelf stimulated my learning experience with additional interest and excitement. Most of the materials from the blackboard and ASAM's learning experience from this course will be very helpful to me in my professional practices.
I enjoyed to hear everyone insight, learn new strategies and techniques, play role situations and most of essential to learn from each other.

With great appreciation for being in this class, I wish everyone all the best on the road of professional adventures of helping other people. We can make a difference.

"Life can either be accepted or changed. If it is not accepted, it must be changed. If it cannot be changed, then it must be accepted". - Winston Churchill

My Learnings from HUMS 261

This Substance Abuse Assessment class was a fast, but great learning experience for me. I enjoyed all the classes that I participated in, writing in the BLOG, and everybody’s input throughout the class. I learned the different techniques about doing an actual assessment, and the different tools that can be used. I also learned that listening is the best tool you can use when working with any client. I learned how the diagnosis of substance abuse is decided in a treatment setting and how to be prepared for it.

I am not a counselor yet, but some day I will be, and this class has taught me how to make it easier. I am excited to have learned all these great techniques and tools to help me as I move towards my degree. I will practice with pretend clients using the different strategies of assessing clients. I understand that if I don’t do it consistently, I will lose the skills that I just learned. And, I do not want that to happen.

Lara is a great instructor, and I am so honored to have her help me to move on to achieve my educational goal. I wish all the instructors/professors were as courteous and supportive like Lara. Thank you Lara and I look forward to working with you again in the near future.

10/07/09

In this class I learned about ASAM dimensions and how they are used in addressing substance abuse as well as the different types of substance abuse screenings and approaches used when counseling substance abuse clients.
I have become more familiar with the terminology used in substance abuse treatment.
Before this class I didnt realize that the primary care provider is the best person to do an early intervention, it makes sense I just never thought of that. I always assumed the family would be the begining.
I will contiue to build on the skills I have learned in this class while at work and in my journey as a student.
The handouts are great and I will use them while working with individuals with substance abuse as their primary disability in vocational rehabilitation.
This was a wonderful class, I wish it was longer and we could learn more skills to early interventions and perhaps prevention.
I look forward to having others in future classes.

"TIP 35"

Tip 35 (Enhancing Motivation for Change in Substance Use Disorder Treatment), shows how clinicians can influence the change process in their clients by developing a therapeutic relationship, one that respects and builds on the client's autonomy and, at the same time, makes the treatment counselor a participant in the change process. This TIP also describes different motivational inteventions that can be used at all stages of change, from precontemplation and preparation to action and maintenance.

Another very useful TIP, which even requires us "counselors" to be a part of our clients changes.

now or never

After reading the information introduce to me by this class I have to say I was overwhelmed, but in an informed manner. In the beginning I thought that the only way to stop someone from using or abusing drugs and/or alcohol was to simply stick them in a treatment facility, but now I know that there are certain steps that need to occur even before addressing someone who has a drug and/or alcohol problem. In many cases intervention is necessary, but how to go about introducing that intervention is critical, and not all intervention is welcomed with open arms. We don't want to force intervention unless the situation is life threatening, because if a substance abuser is not ready then the treatment is not going to have the effect intended. As mentioned in the article, behaviorally oriented treatment is one option where the patient takes primary responsibility for their change in behaviors. I would image that this gives the substance abuser a since of empowerment, and many clinicians think that this a more favorable prognosis for recovery.

Many treatment programs provide information to families, communities, and substance abusers. I would guess their primary goal would be to help families, communities, and substance abusers understand their situations. In many cases family members who have relatives or friends who become substance abusers do not know or understand that they are not alone when dealing with a family member or friend who has become a substance abuser. I know that in my community drugs and alcohol are as a part of everyday life, as waking up in the morning. In every corner of the city there is a liquor store and drugs are easily available. As mentioned in the article,"... about 5 million users of illicit drugs and 18 million people with alcohol use problems need treatment, but only one fourth of them receive it." these are staggering numbers; inwhich, many of the programs to help combat these problems are under budget.

I don't understand why something that seems to work does not have the support or funding it needs to help save our youth. Are we willing to let something drastic occur before we make the right decisions? Are we really going to allow cost to be the deciding factor for us to take control of our future? Another portion of the article that really catches my attention is that 1 in 20 high school seniors use marijuana daily, maybe this is what happened to the kid in Chicago who was beaten to death by a group of his peers. We have to ask ourselves, when does it matter? Do we wait until it hits home? And trust me it will happen if we don' t do something now. How is it that we can contribute millions of dollars to campaigns and wars, but when it comes to our youth, citizens, and country we feel that we are wasting money. I think that we are enabling our nation to become substance abusers, by allowing ourselves to think that there is a drug for every little ache and pain. I think that many companies are just out to get money at the expense of any and everyone, and we can't trust the government or city officials to speak up for us, because they too are in the pockets of these big industries whose sole purpose is to direct advertisements toward our youth.

Motivation + Improvements = Positive Chages

Treatment Improvement Protocol (TIP 35) is a practical guidance for substance abuse treatment. It based on experience and knowledge of clinical research. Major goal of TIP is to make applicable relevant updated information and recommendations toward practical implementation. Availability and access of Internet allow to provide latest updates for practices and make that information easy available.The TIP 35 focuses on Enhancing Motivation for change in Substance Abuse Treatment and presents main concept of motivation in new perspective as dynamic and changeable. The TIP 35 is helpful guidance for clinicians to emphasize and influence change process by supporting and respecting client's autonomy and still as a professionals being a part of change process. The TIP provides different motivational interventions, which applicable through all stages of change. Promoting motivation for change interventions, the TIP supports its wide use in clinical practices and treatment programs in United States.

As daily life continuously relies on changes in human services, technological, economical, social, political and other areas, it is important follow and implement improvements and new approaches especially in fields of substance abuse and mental health, where TIP 35 is playing significant role. Overall progress in therapeutical relationships comes with improvements and is inevitable when changes take place.

motivation

Tip 35 - Motivation

It took a lot of reading to get any inspiration to write a blog on tip 35 even though the topic peaked my interest. Finally I came to a part that inspired me and was a match for my own philosophy. It stated that today’s treatment included a broad range of action. In other words it is holistic. A new age term but so appropriate. We are now considering a person’s health, employment, reduction in criminal activity, and more than anything we are considering if it is improving a person’s life. Is there more joy, hope, intimacy, and self-worth through productive action. I like to ask myself if I am doing anything that I would like to write home about.
Here the attention is not so much on the drug but on life. I was recently talking to a friend who has liver failure and is living in a convalescent home. I said it sucks getting old doesn’t it. And she said, “I’m not concerned about getting old. I’m concerned about living. When I feel depression coming on I know that it will disappear if I get into action. Even doing the dishes works. Indeed there are AA meetings that I have gone to that made me want to head to the bar. Even in AA meetings they say to talk about how it was, what we did to change, and how it is now. And then they suggest that most of the conversation is on how it is now. That would be the living part.
I was also interested in the statement, “motivation was viewed as a static trait or disposition…Furthermore, motivation was often viewed as the client’s responsibility, not the clinician’s. This caught me off guard because I had no idea why it would be the clinician’s responsibility. And here they went into the counselor’s style as being the most often ignored but the most important. This gave me hope that I may succeed in this field as the style entails the ability to develop a trust with a helping alliance. They also named nonpossessive warmth, friendliness, genuineness, respect, affirmation, and empathy. This certainly sounds like the kind of person I would aspire to be.

I Love TIP 35

All of the TIPS I have reviewed have contained good information, but TIP 35: Enhancing Motivation for Change in Substance Abuse Treatment is my favorite so far. I have not read much of it, but I noticed that it is a very thorough, step-by-step guide to engaging clients and encouraging change at all the different stages. I read the part about dealing with precontemplators and I was impressed with how it not only explains what needs to be done but gives lots of examples of actual things you could say to someone who doesn’t think they have a problem. It even explains how the client often thinks that other people do not see the situation correctly, and how the counselor can seek to find the client’s viewpoint in a non-judgemental way.

In my presentation that I was going to give in class today, I was going to talk about an involuntary client, and I was going to quote from TIP 35 about how client motivation is influenced by the counselor’s style. The way the counselor relates to the client has a powerful effect on how they react to treatment and whether they achieve the intended results. I noted that “establishing a helping alliance and good interpersonal skills” were found to be “more important than professional training or experience.” It is interesting because I know someone who just did an alcohol assessment (involuntarily) and I casually interviewed him about it on the phone (because I’m taking the class) and while it can certainly be said that he is in denial about his problem, he was not persuaded in the least to become more contemplative by the way his assessor spoke to him. Apparently she did not make any effort to establish a rapport and came across in a very demanding and demeaning manner. TIP 35 says:

“A direct comparison of counselor styles suggested that a confrontational and directive approach may precipitate more immediate client resistance and, ultimately, poorer outcomes than a client-centered, supportive, and empathic style that uses reflective listening and gentle persuasion (Miller et al., 1993).”

I also read about this Johnston Intervention. It is a scenario in which friends and family rehearse what they are going to say to the client about how the substance abuse is affecting them and then, with some element of surprise all of these people confront the client in the counselor’s presence. Apparently is has been revised into a fairly successful way to get uninterested clients to come around to the idea that they need some help.

Some of the writing was repetitive and like I said, I haven't even read much of this yet, but I am happy to be introduced to this material. Thank you

10/05/09

TIP 35 is about the concept of motivation which is very interesting to me.

The motivation is directed toward the best interest of the client.
The idea that the clients best interest is at heart hopefully with spark motivation in the client who will be compliant with the reccommendations of the treatment plan.
Tip 35 explains how the counselor and staff can have a part of the plan and influence the client to change by building a rapport with the client. This will help the client trust the counselor and let them be a partner in their recovery process.
This TIP also describes different motivational techniques that can be used in all stages of change.

This TIP would be great for motivating involuntary clients who may not want to change and it states that motivation for change is the key to addressing substance abuse.

I believe this is an excellent TIP. The client needs to be "motivated" and want to change thier behavior in order for any treatment to work.

The different views on treatment are great because if something doesnt work, look at it from a different prespective and maybe the new techniques will work.