Process Full Continuum of Care Adequate Duration Sufficient Intensity Stage of Recovery- based Design Policies & Procedures Team Interactions Evaluation
Practice Culturally-appropriate evidenced based treatment practices Practitioners trained and coached in manual-guided delivery Services dominated by those that have been rigorously tested
Sources of Information
Randomized Controlled Trials Project MATCH COMBINE Study UK Alcohol Treatment Trials Mesa Grande Project (361 clinical trials analyzed) Four Big Alcohol Studies
A Big Resource National Registry of Evidenced- based Programs and Practices:
1.Behavioral Couples Therapy (BCT) – Not well tested in an offender population 2.Brief Interventions (5 or fewer sessions) – Not appropriate for an addicted DUI offender Other Evidence Based Practices
Not Evidence Based 1.Generic Counseling 2.AOD Education 3.Confrontational Interventions 4.Psychodynamic Therapy 5.Solution-focused Therapy 6.Mindfulness-based Stress Reduction 7.Acupuncture
Goals of Cognitive Behavioral Therapy (CBT) Approaches 1.Analyzes thoughts, feelings, and actions (behavior) 2.Thoughts drive emotions 3.Emotions drive behavior 4.Identify thinking patterns and stop thinking “errors” from leading to emotional reactions that produce problem behaviors.
Be Skeptical Nearly every evidenced based intervention is manual-based. However not every intervention that is manual-based is evidenced based.
1.To increase and maintain the person’s motivation to change his or her life 2.Motivate those who don’t want to change 3.Help increase the motivation of the people who aren’t sure 4.Help the motivated maintain their readiness to change Motivational Approaches
1.Motivational Interviewing: Preparing People for Change – William Miller & Stephen Rollnick (2002) 2.Addiction and Change: How Addictions Develop and Addicted People Recover – Carlo C. DiClemente (2003)
Pre-Contemplation Contemplation Preparation Action Maintenance Assessing Readiness to Change
1. To provide relief from withdrawal symptoms 2. To prevent drugs from working (antagonist) 3. To reduce craving 4. To provide replacement (agonist) 5. To provide aversive reactions Medication-Assisted Treatment
Naltrexone – Interrupts actions of alcohol and opiates; reduces cravings (Vivitrol) Acamprosate – reduction of alcohol cravings Disulfiram/Antabuse – produces adverse reaction with alcohol use Medication-Assisted Treatment
Methadone – Opiate addiction – reduces craving, mediates withdrawal symptoms, helps restore normal functioning (agonist) Buprenorphine (Subuxone) – similar to methadone, may be prescribed by an MD with special training (partial agonist) Driving while using a legally prescribed medication, including methadone taken according to doctor’s orders, can still trigger a DUI charge in all 50 states Medication-Assisted Treatment
Combining Medications and Behavioral Interventions for Alcoholism Finding: Naltrexone in combination with medication management sessions delivered by health professionals was at least as effective as psychosocial interventions Side note: Pathology of multiple DUI offenders will likely require psychosocial interventions in addition to medications
Those Missed 92.9% with bipolar disorder 68.4% with depression 100.0% with OCD
1.Blended Screening and Assessment Approaches? 2.Education on Co-Occurring Disorders? 3.Medication Monitoring and Management Sessions? 4.Heavy Utilization of Positive Reinforcement and Flexible Application of Graduated Sanctions? 5.Mental Health Specialists? 6.Agreements with Community Mental Health Services Agencies? Does Program include:
Twelve Step Groups
What About Alcoholics Anonymous? What about coerced AA participation?
What About Alcoholics Anonymous? “Attendance” versus “Involvement” (active participation)
What About Alcoholics Anonymous? Seek Alternatives to Mandating AA
Using Support Groups in Therapy “The 12 Step Facilitation Therapy Manual” Offer choice (types, spiritual & secular) Be selective regarding approved groups Try to match demographics, lifestyles, and level of substance involvement
1.Identify and adopt evidence-based practices 2.Incorporate medication-assisted treatment 3.Utilize alcoholics anonymous and provide secular alternatives for those with religious-based objections 4.Treat the hard, core alcohol-dependent impaired driver 5.Modify (lessen) treatment requirements if treating non-addicted participants in DWI Court. 6.Stay abreast of latest DUI Court treatment-related research findings Next Steps