Addictions Treatment Planning for Effectiveness CSD 5970

Issues to Consider Safety –Withdrawal Potential –Suicidality –Medical Issues (Immediate) –Domestic Violence –Risk Behaviors

Issues to Consider Basic Needs –Food –Clothing –Shelter –Transportation –Medical Care

Issues to Consider Engagement –Motivation (external & internal) –Contingencies –Stage of Change –Stage of Engagement –Treatment history (successes and “failures”)

Issues to Consider Diagnoses Identified Problems Client’s Perception of Problems & Goals Environment Support System Strengths & Resilience

Treatment Planning Licensure Guidelines –Initial plan approved by a physician –Written & Individualized –Gender & culturally appropriate –Within 24 hours, Level IV –Within 7 days, Level III & Level II –Within 14 days, Level I

Treatment Planning Problem list Goals (a statement to guide resolution or reduction of the problem) Objectives (observable & measurable) Methods (Services) –intensity, duration, frequency, referrals for client, family & significant other

Toolbox Community resources –Shelters –Food pantries –Government aid programs –Domestic violence programs –Psychiatric services –Medical clinics –Family service providers, etc

Toolbox Education & Information –Drug information –Disease process –Family issues –Resources –Treatment options

Toolbox Skill Building –Problem solving skills –Anger management –Relaxation –Recreation & hobbies –Relapse prevention

Toolbox Support –12-step recovery groups (AA,NA,CA) –Online AA –Women for Sobriety –Rational Recovery –Church (Structured addiction groups)

Toolbox Insight & Clinical resources –Structured groups (step groups, skill-building groups) –Process groups –Specialized groups based on gender, sexual orientation, age, or education

Toolbox Insight & clinical resources –12-step facilitation –Cognitive-behavioral counseling –Motivational interviewing –Gestalt therapy –Narrative therapy –Strength-based counseling –Therapeutic recreation

Toolbox Misc. Tools –Journaling –Drug & alcohol testing –Contingencies (recovery birth dates, celebrations)

Guidelines “What do you want”? treatment plans. Guides our efforts until the next revision. Incorporate additional information into psycho-social history & revised plans Creative & affirming Strength-based The client owns their treatment plan!

Exercise Robert –48 year old African-American male, warehouse worker –Divorced, lives alone in a house he owns –Referred by EAP after on the job accident –Multiple treatment episodes including 3 residential treatment admissions. –Drinks 8-24 beers daily, no drug history –Alcohol dependence –2 DUIs, 3 illegal transportation, 1 battery charge –“I really want to want to stop, but I don’t”. “I have to keep my job and work or I will lose my house”.

Exercise Evelyn –25 year old Caucasian female, unemployed & homeless –Referred by homeless shelter –Intermittently works as sex worker or “mules” for a dealer. –Heroin & Cocaine “sometimes uses needles”. –No treatment history –Heroin dependence –“I have to get off the streets or I am going to die. I have to find another way to live but I am trapped”.

Exercise Nate –19 year old Native-American male –Student, lives in dormatory –Referred by college after 2 mandatory alcohol ed classes. Faces expulsion hearings in 60 days. –Alcohol, Marijuana, Ecstasy –Alcohol & Marijuana abuse –“Do what you have to do, collect your money from my insurance, and leave me to my own devices – I will be fine/ Just get the damned Dean off my back”.

Exercise Sylvia –14 year old Caucasian female student –Referred by father who stayed during the session. –Alcohol and occasionally Inhalants –Alcohol abuse –No previous treatment history – history of acting out in school and poor academic performance. –“Father, give her whatever she needs, I will pay for it”. Sylvia, “I will do whatever you say, I didn’t mean to cause all of these problems”.

Exercise Jerry –50 year old African-American male –Self-referred – Self-employed musician –Divorces, lives with girlfriend –Extensive drug history including hallucinogens, marijuana, alcohol, cocaine. Multiple treatment episodes and periods of abstinence the longest about 2 years. –Heroin dependence –“I am tired, I can’t live that life anymore. I want to quit”.

Exercise Helen 26 year old Chinese-American female Single, lives alone in rented home Referred by physician Employed as electrical engineer Cocaine & rarely alcohol Cocaine dependence “I can’t let my employer find out. My career would be over. I am expecting a 30 million dollar research grant in a few months”.