Module 4: Counselling

Question 1

Why should counselling be done with OAT?

Answer 1

• It’s the standard of care (CRISM, 2018) for concurrent disorders
• OUD + Structured counselling / psychotherapy has small to moderate effect in reducing substance use
  
  • It increases retention rates, promote harm reduction, stress management

Question 2

Name some of the models of counselling that are evidence-based “best practice”?

Answer 2

CBT
ACT
MI
DBT
MBRP (mindfulness based relapse prevention)
CM (Contingency management)

Question 3

What is the basic premise of the Stages of Change model?

Answer 3

People do not move linearly towards behaviour change.

Instead, they circulate through 5 stages:
- Precontemplation - recognition of need, but not actively considering
- Contemplation - considering change
- Preparation/action - making changes
- Maintenance - practising new skills to sustain change
- Relapse - relapse to previous behaviour
- Leaving treatment

Question 4

What is the “spirit” of MI?

Answer 4

PACE
Partnership - avoid confrontation, work collaboratively
Acceptance - believe in the absolute worth of a person, express empathy
Compassion - give priority to client needs
Evocation - draw on client’s skills, strengths and motivation for change

Question 5

Core skills of MI

Answer 5

OARS
Open-ended questions
Affirm - highlight strengths, positives
Reflect - active listening
Summarize - reinforce change talk, progress, committment

Question 6

Phases of OAT

Answer 6

Clients may not progress or may not progress linearly through
1. Stabilisation - withdrawal, OAT initiation +/- continued opioid use
2. Action/maintenance - address SDH/lifestyle
3. Tapering/discontinuation

Question 7

Elements of relapse prevention

Answer 7

• Expect it, normalize it. Most likely to occur in action/maintenance phase
• Encourage to see as opportunity to address future situations and do so
• Non-judgmental
• If privileges are adjusted (loss of carries) frame as safety first

Question 8

Elements to discuss in counselling w.r.t. OUD in action/maintenance phase

Answer 8

• SDH (housing, employment, etc)
• social circle and factors promoting / preventing change
• relapse prevention
• harm reduction
• safety
• commitment to change
• privileges

Question 9

Elements to consider in the tapering/discontinuation phase

Answer 9

• motivation / readiness to taper
• high relapse rate after tapering
• symptoms of withdrawal and timeline (long for bup/nlx or methadone)
• importance of support groups / relapse prevention / continued counselling

Question 10

Examples of harm reduction behaviours

Answer 10

• naloxone kit
• not using alone
• knowing the substance used
• small “test doses” for new supply
• no mixing substances
• supervised consumption site
• safe injection (sterile supplies, no reuse/sharing, hand hygiene)

Question 11

Common stigma associated with OAT

Answer 11

• OAT substitutes one drug for another (“you’re not really clean yet”)
• OAT clinics increase drug use and crime
• stereotypes of OAT / OUD clients (“OAT is for ‘junkies’”)

Question 12

elements of counselling in the stabilization phase

Answer 12

• engaging clients and developing a therapeutic alliance
• orienting clients to the treatment program
• urine testing
• introducing harm reduction strategies
• planning treatment
• addressing stigma issues.