Assessment of Chemical Dependency Final

Question 1

Assumptions of CBT

Answer 1

• Behavior is learned.
• Same processes that create bad behavior can change them.
• Behavior is contextual.
• Can learn to change thoughts/feelings (covert behaviors).

Question 2

More assumptions of CBT

Answer 2

• Engaging in new behaviors is critical.
• Each client is unique.
• Thorough behavioral assessment is key.

Question 3

Critical Tasks in CBT

Answer 3

• Assess individuals behavior and environment.
• Motivation
• Teach coping/reinforcement skills.

Question 4

Coping Skills

Answer 4

• Craving management
• Interpersonal functioning.
• Communication skills.
• Enhancing social supports.

Question 5

Advantages of CBT

Answer 5

• Short-term.
• Goal oriented
• Flexible
• Empirically supported

Question 6

Community Reinforcement Approach (CRA)

Answer 6

• Behavioral treatment for substance abuse.
• Social and recreational reinforcers to aid recovery.
• Reinforce(positive) sober behavior.
• Avoid confrontation.

Question 7

Basic Tasks of CRA

Answer 7

• Eliminate positive reinforcement for substance abuse.
• Enhance positive reinforcement for non-use behavior.

Question 8

CRA Clinical Components

Answer 8

• Assessment
• Sobriety Sampling
• Medication
• Treatment Plan
• Behavioral Skills Training

Question 9

Functional Analysis

Answer 9

Identifying patterns of use and triggers.

Question 10

Cost Benefit Analysis

Answer 10

• Identify areas to address and validates client experience.
• Can help lower defenses.

Question 11

High Risk/High Safety

Answer 11

• Used when motivated to abstain.
• People, places, things.

Question 12

Sobriety Sampling

Answer 12

• Let’s client experience sobriety for a set period (90 days) to reflect on it later.
• Builds trust, attainable, motivator, etc.

Question 13

Medications

Answer 13

• Disulfiram/Antabuse (inhibitor): Treats alcohol by making hangover effects immediate after drinking.
• Suboxone/Naltrexone (antagonist): blocks positive effects of alcohol.
• Reduce worry Increase opportunities for positive reinforcement

Question 14

Behavior Skills Training

Answer 14

• Communication Skills (brief, specific)
• Problem Solving Skills (define problem, generate alternatives)
• Drinking Refusal Skills (social support, assertive, restructure negative thoughts)

Question 15

Social and Recreational Counseling

Answer 15

• Develop a healthy social life through areas of interest and community access.
• Reinforcer sampling Reinforcer access

Question 16

CRA Marital Therapy

Answer 16

Time limited Focus on present-day problems

Address expectations, communication, problem solving.

Question 17

Common Mistakes with CRA

Answer 17

• Losing sight of client’s reinforcers.
• Inadequate monitoring.

Question 18

Problems with old approaches.

Answer 18

• 12-step saturated.
• Focus on inpatient treatment.

Question 19

Best Practices

Answer 19

• Psychiatrically sophisticated
• Individualized
• Medication-supported
• Outpatient
• CBT/CRA/DBT
• Evidence Based

Question 20

MI Spirit

Answer 20

• Honors Autonomy. (Client choice, roll with resistance, build discrepancy)
• Collaborative. (Supports self-efficacy and express empathy)
• Evocative. (Strategic, clear goal)

Question 21

Motivational Interviewing (MI)

Answer 21

• A collaborative conversation style to strengthen a person’s motivation and commitment to change.
• Person-centered
• Addresses ambivalence
• Goal-oriented

Question 22

Motivation facts

Answer 22

• It’s a state not a trait.
• Negatively affected by confrontation.
• Needs interpersonal interaction.
• Can occur when cost/benefit balance shifts in favor of change.

Question 23

Self Determination Theory

Answer 23

• Competence and autonomy are needed to change.
• Autonomous reasons are better than controlled reasons.

Question 24

Overlap of MI and SDT

Answer 24

• Autonomy oriented
• Resolves ambivalence
• Avoid coercion/unsolicited advice/imposing beliefs
• Clarify goals for change/non-change

Question 25

Sustain Talk

Answer 25

Reinforce status quo. "There no way I can do this..."

Question 26

Change Talk

Answer 26

DARN **D**esire. **A**bility. **R**eason. **N**eed. Therapist reinforces this. "I can change, I want to change..."

Question 27

MI Skill Focus Areas

Answer 27

* Engaging (building relationship, understanding problem) * Focusing (set agenda, switch and repeat, feedback/tone/empathy) * Evoking (strategic, use OARS) * Planning (More CBT than MI, collaborate on goals, SMART)

Question 28

OARS

Answer 28

* **O**pen ended questions * **A**ffirmations * **R**eflections * **S**ummary statements

Question 29

Harm Reduction

Answer 29

* Reducing the harm associated with drug use without reducing drug use. * *Yellow Light* alternative to abstinence. * Humanistic, rooted in acceptance. * More acceptable outside the US/outpatient treatment programs.

Question 30

Morbidity vs Mortality

Answer 30

* Morbidity = living with sickness * Mortality = leading to death

Question 31

Harm Reduction Public Policy examples

Answer 31

Needle exchanges, safe injection facilities, Naloxone, etc

Question 32

Suboxone

Answer 32

* Buprenorphine * Partial agnonist to mu opioid receptor which protects against withdrawal. * Antagonist for kappa and delta opioid receptors. (reduces drug reward)

Question 33

Vivitrol

Answer 33

* Naltrexone * Opioid antagonist that blocks opioid receptors.

Question 34

Neuron System

Answer 34

Question 35

HIPAA

Answer 35

* Health Insurance Portability and Accountability Act 1996 * PHI: protected health information * Need conset to disclose PHI

Question 36

DBT Prioritization

Answer 36

* Suicidality * Behavior that interferes with treatment * Quality of life * Increasing other skills * Trauma related symptoms * Increasing self respect * Other

Question 37

Setting Frame of Treatment

Answer 37

* Establish routine early * Attend to high risk behaviors