Assignment 7 of 9

I think that the LOC cheat sheet is an excellent tool for providing guidance to health and social service providers. Not only does it inform the providers on how to plan and/or care for potential clients, it can also help facilities build the teams needed to provide the correct level of care for potential clients. Listed below are three of the many treatment centers located in Southeast Alaska:

1. Gateway Center for Human Services
Substance Abuse Services Division
3050 5th Avenue
Ketchikan, AK.99091
Primary focus: Mix of mental health and substance abuse services
services provided: Rehab for drugs and/or alcohol, Detoxification
Types of car: outpatient, Non-hospital residential(24hour)
special groups/programs: Adolescents, persons with co-occurring mental and substance abuse disorders, women, men, DUI/DWI offenders, criminal justice clients.
Forms of payment accepted: self payment, medicaid, medicare, private insurance, military insurance (e.g., VA, TRICARE)
Payment Assistance: sliding fee scale (fee is based on income and other factors), payment assistance.

2. Juneau Recovery Hospital
Bartlett Regional Hospital
3250 Hospital Drive
Juneau, AK. 99801
Primary Focus: Drug and rehabilitation Services
Services Provided: Rehab for drug and/or alcohol, Detoxification
Type of care: outpatient, partial hospitalization/Day treatment, Hospital inpatient
Forms of Payment Accepted: self payment, medicaid, private health insurance, military insurance (e.g., VA, TRICARE)
Payment Assistance: sliding fee scale (fee is based on income and other factors)
Special Language Services: ASL or other assistance for hearing impaired

3. Southeast AK. Regional Hlth Consortium
Ravens Way
222 Tongass Drive
Sitka, AK. 99835
Primary Focus: Drug and alcohol rehabilitation services
Services Provided: Rehab for drug and/or alcohol
Types of care: Non-hospital residential (24hour)
Special Programs/groups: Adolescents, persons with co-occurring mental and substance abuse disorders
Forms of Payments Accepted: Medicaid, Medicare, Private health insurance
Payment Assistance: Payment assistance

Assignment 6 of 9

I think that the reading from the ASAM Assessment Dimensions; although overwhelming, provides the health and human services field with up-to-date information which can help providers make well informed decisions with their patients and/or clients. The reading provides evidence reports, protocols, preventive medicine, and consensus reports; which, are all necessary in diagnosing, providing medicine or therapy, and informing the patients and/or clients. I know that most of the clients I've worked with in the past, say that they feel better after knowing that their provider has done his or her home work on the issues facing their health and/or needs, and by providing them with evidence and other ways to approach their medical or substance abuse needs they are able to obtain knowledge that will help them to make the necessary changes in their lives. In the end. I think that this assignment really arms me with the tools needed to research or find information in which I can provide clients with in the future; while also enhancing my competency, because we should always strive to learn more.

Assignment 5 of 9

After reading the stages of change,and chapter 4 of TIP35 I could not help but shake my head in agreement with the methods and procedures used to help substance abusers get on the road to recovery. From contemplation to relapse, this is a cycle that may play it self over and over again before a user is completely ready and able to stop abusing or using substances. I agree with reading, that providing more information is not always the better route to go with a substance abuser who is in the stage of precontemplation. I think that a person should be guided into the stages slowly, given the correct information as mentioned in the reading, and given as much time as needed to make the first steps to becoming independent of drugs and/or alcohol. I think giving them too much information may overwhelm them, and sometimes even cause the substance abuser to think that remaining on the substance is easier than taking in too much information. The substance abusers must realize for themselves the problems and grief caused by their abuse of drugs and/or alcohol, and want to make the necessary steps to help themselves. As mentioned in the readings, our goals in assisting abusers are to establish reporrt and trust, explore events that precipitated treatment entry, and commend clients for coming. I think that if these guidelines are practiced better in some establishments, there would be more successful recoveries. I think that most of the time stereo types and prejudice gets in the way of progress, which only leads to more devastation. I know from my experiences dealing with substance abusers most of them are always trying to see if your there to help them, or there to receive a pay check.

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.