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We now know from research that motivation is nnoott the sole responsibility of the person seeking recovery but rather a responsibility shared with the helping professionals. Motivational
interviewing (MI) is a counseling style based on the following assumptions:20
• Ambivalence about substance use (and change) is normal and constitutes an
important motivational obstacle in recovery.
• Ambivalence can be resolved by working with
• The alliance between you and your client is a collaborative partnership to which you each bring important expertise.
• An empathic, supportive, yet directive,
counseling style provides conditions under which change can occur. (Direct argument and aggressive confrontation may tend to
increase client defensiveness and reduce the likelihood of behavioral change.)
45
} For a free archived webinar on Motivational Interviewing (MI), go to
} http://www.integration.samhsa.gov/clinical-practice/motivational-interviewing
} Then click on the word “recording”
} You will have to register (even though it is an
} EEffffeeccttiivvee ttrreeaattmmeenntt aatttteennddss ttoo mmuullttiippllee nneeeeddss ooff tthhee iinnddiivviidduuaall,, nnoott jjuusstt hhiiss oorr hheerr ddrruugg
aabbuussee.. To be effective, treatment must
address the individual’s drug abuse and any associated medical, psychological, social,
family, vocational, legal problems, safe housing, etc.) It is also important that
treatment be appropriate to the individual’s age, gender, ethnicity, and culture.21
47
▶ You may play a role in the process of
ensuring the best alignment between the
parent and the type of treatment program to which he or she is referred. Sharing
everything you know about the parent with the assessment counselor can help to ensure the best match possible. Also, getting to
know your local treatment providers and asking about their specific approaches and plans for meeting the multiple and diverse needs of the parents you refer is critical (and
} One of the more common needs of families involved in the child welfare system is for trauma informed care. People who have experienced traumatic events in childhood are at increased risk for a host of other
problems, impacting all domains of
functioning. Impaired emotional, social,
cognitive, and physiological functioning can result from adverse childhood events.22
49
} Trauma is so prevalent in the lives of parents with SUD that is can almost be assumed that it should be universally addressed in SUD treatment.
} In one of the first studies on addicted women and trauma, 74% of the addicted women reported
sexual abuse, 52% reported physical abuse, and 72% reported emotional abuse.23
} Between 44% and 56% of women seeking treatment for a substance use disorder had a lifetime history of Post-traumatic Stress Disorder (PTSD).
} Tonier Cane, Team Lead for the National Center for Trauma Informed Care (NCTIC)
} http://www.youtube.com/watch?
v=kqmAF_RCeUo&feature=related
} You will need to advance the YouTube
tracking bar to 17.50 to see the presentation (otherwise you will have to listen to other
presentations first)
Module 6 -‐ Dra6 51
Other multiple areas on which effective treatment should focus include being:
• Both individualized and family focused
• Gender specific
• Culturally relevant
Each of these categories could comprise a full training module. Some resources are available at the end of this module for further review.
▶ It is important parents’ unique needs are
identified and addressed on the service plan and treatment plan as this is the road map for addressing these needs. In most cases the
addiction process involved multiple problems and therefore needs multiple solutions. You will need to collaborate regularly with the
treatment partner to help address needs that cannot be met by the treatment provider
alone.
53
} As depicted on the next slide from NIDA, because drug abuse and addiction have so many dimensions and disrupt so many
aspects of an individual’s life, treatment is not simple. Effective treatment programs
typically incorporate many components, each directed to a particular aspect of the illness and its consequences.24
55
Source: NIDA Principles of EffecIve AddicIon Treatment25
} AAllssoo bbeeccaauussee aann iinnddiivviidduuaall''ss nneeeeddss cchhaannggee oovveerr ttiimmee,, tthhee ttrreeaattmmeenntt aanndd sseerrvviicceess ppllaann m
muusstt bbee aasssseesssseedd ccoonnttiinnuuaallllyy aanndd mmooddiiffiieedd aass nneecceessssaarryy ttoo eennssuurree tthhaatt iitt mmeeeettss tthheessee
cchhaannggiinngg nneeeeddss.. A patient may require varying combinations of services and
treatment components during the course of treatment and recovery.26
} In addition to counseling or psychotherapy, a patient may require medication, medical
services, family therapy, parenting
instruction, vocational rehabilitation, and/or social and legal services. For many patients, a continuing care approach provides the best results, with the treatment intensity varying according to a person’s changing needs.27
57
} RReemmaaiinniinngg iinn ttrreeaattmmeenntt ffoorr aann aaddeeqquuaattee ppeerriioodd ooff ttiimmee iiss ccrriittiiccaall.. The appropriate duration for an individual depends on the type and degree of the patient’s problems and needs. Research indicates that most
addicted individuals need aatt lleeaasstt 33 mmoonntthhss in treatment to significantly reduce or stop their drug use and that the best outcomes occur with longer durations of treatment.28
Treatment length:
} Depends on patient problems/needs;
} Less than 90 days is of limited or no effectiveness for residential/outpatient setting;
} A minimum of 12 months is required for methadone maintenance; and
} Longer treatment is often indicated.29
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▶ The Adoption and Safe Families Act (ASFA)
requires a permanency plan within 12 months after a child enters foster care and requires
states to initiate proceedings to terminate parental rights if a child has been in foster care for 15 of the most recent 22 months.
While 12 or 15 months is a long time in the life of a child, it is a relatively short time in the recovery process of a parent with years, or even decades, of alcohol and/or drug
abuse.30
} In cases where the ASFA time clock is ticking, it is critical that the 15-month time period be well spent. When substance abuse is an
issue, the parent’s need to be assessed and appropriate alcohol and drug services
accessed without delay. These parents did
not get into their addiction overnight and it is not reasonable to expect that they can
emerge from it that quickly either.31
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} Recovery from drug addiction is a long-term process and frequently requires multiple
episodes of treatment. As with other chronic illnesses, relapses to drug abuse can occur and should signal a need for treatment to be reinstated or adjusted. Because individuals often leave treatment prematurely, programs should include strategies to engage and keep patients in treatment.32
} Because drug abuse and addiction—both of which are mental disorders—often co-occur with other mental illnesses, patients
presenting with one condition should be assessed for the other(s). And when these
problems co-occur, treatment should address both (or all), including the use of medications as appropriate.33
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}