cognitive behavioral interventions for substance … · · 2015-01-16cognitive-behavioral...
TRANSCRIPT
![Page 1: Cognitive Behavioral Interventions for Substance … · · 2015-01-16Cognitive-Behavioral Interventions for Substance Abuse Motivational Engagement Cognitive-Behavioral Social Learning](https://reader034.vdocuments.site/reader034/viewer/2022051601/5ae272697f8b9a0d7d8c5751/html5/thumbnails/1.jpg)
Cognitive Behavioral Interventions
for Substance Abuse
Overview Presentation TASC Conference 2013
University of Cincinnati
Corrections Institute
![Page 2: Cognitive Behavioral Interventions for Substance … · · 2015-01-16Cognitive-Behavioral Interventions for Substance Abuse Motivational Engagement Cognitive-Behavioral Social Learning](https://reader034.vdocuments.site/reader034/viewer/2022051601/5ae272697f8b9a0d7d8c5751/html5/thumbnails/2.jpg)
Curriculum Content, Format
and Supporting Research
![Page 3: Cognitive Behavioral Interventions for Substance … · · 2015-01-16Cognitive-Behavioral Interventions for Substance Abuse Motivational Engagement Cognitive-Behavioral Social Learning](https://reader034.vdocuments.site/reader034/viewer/2022051601/5ae272697f8b9a0d7d8c5751/html5/thumbnails/3.jpg)
Curriculum Organization
• Introduction and Preparation Material
• Pretreatment Modules (optional)
• Modules 1-6
• Participant Worksheets
![Page 4: Cognitive Behavioral Interventions for Substance … · · 2015-01-16Cognitive-Behavioral Interventions for Substance Abuse Motivational Engagement Cognitive-Behavioral Social Learning](https://reader034.vdocuments.site/reader034/viewer/2022051601/5ae272697f8b9a0d7d8c5751/html5/thumbnails/4.jpg)
Mod 1
(5)
Motivation &
Engagement
Mod 2
(4)
Cognitive
Restructuring
Mod 3
(8)
Emotion
Regulation
Mod 4
(11)
Social
Skills
Mod 5
(4)
Problem
Solving
Mod 6
(7)
Relapse
Prevention
Optional: Pre-Treatment Mod (3)
![Page 5: Cognitive Behavioral Interventions for Substance … · · 2015-01-16Cognitive-Behavioral Interventions for Substance Abuse Motivational Engagement Cognitive-Behavioral Social Learning](https://reader034.vdocuments.site/reader034/viewer/2022051601/5ae272697f8b9a0d7d8c5751/html5/thumbnails/5.jpg)
Group Structure
• Ideal size: 8-10 (Max:16 = 2 facilitators)
• Group time: 1.25-1.50 hours
• Modified closed group: entry points with pre-requisites, pages 11-13
• Preparation requirement: ~30 minutes
• Homework: a key to transfer of practice
![Page 6: Cognitive Behavioral Interventions for Substance … · · 2015-01-16Cognitive-Behavioral Interventions for Substance Abuse Motivational Engagement Cognitive-Behavioral Social Learning](https://reader034.vdocuments.site/reader034/viewer/2022051601/5ae272697f8b9a0d7d8c5751/html5/thumbnails/6.jpg)
Session Format
• Session background – Facilitator notes
• Session materials
• Practice work review
• Group discussion and activities
• Practice work assignment
![Page 7: Cognitive Behavioral Interventions for Substance … · · 2015-01-16Cognitive-Behavioral Interventions for Substance Abuse Motivational Engagement Cognitive-Behavioral Social Learning](https://reader034.vdocuments.site/reader034/viewer/2022051601/5ae272697f8b9a0d7d8c5751/html5/thumbnails/7.jpg)
Who May Deliver CBI-SA?
• Individuals who have successfully completed CBI-SA training
• Preference to substance abuse professionals
• State regulations may prohibit those without certification or licensure
![Page 8: Cognitive Behavioral Interventions for Substance … · · 2015-01-16Cognitive-Behavioral Interventions for Substance Abuse Motivational Engagement Cognitive-Behavioral Social Learning](https://reader034.vdocuments.site/reader034/viewer/2022051601/5ae272697f8b9a0d7d8c5751/html5/thumbnails/8.jpg)
Who Would Benefit from CBI-SA?
• Clients who score MODERATE or HIGH need in the substance use domain
• Admission does not require a substance use disorder diagnosis
• Those with substance abuse or dependence diagnosis are appropriate
![Page 9: Cognitive Behavioral Interventions for Substance … · · 2015-01-16Cognitive-Behavioral Interventions for Substance Abuse Motivational Engagement Cognitive-Behavioral Social Learning](https://reader034.vdocuments.site/reader034/viewer/2022051601/5ae272697f8b9a0d7d8c5751/html5/thumbnails/9.jpg)
How is the term “Substance Abuse” used in the
Curriculum?
• Substance abuse leads to impairment in some aspect of functioning
• Individual may or may not be dependent on substances
• Current substance use (unless in a controlled environment)
![Page 10: Cognitive Behavioral Interventions for Substance … · · 2015-01-16Cognitive-Behavioral Interventions for Substance Abuse Motivational Engagement Cognitive-Behavioral Social Learning](https://reader034.vdocuments.site/reader034/viewer/2022051601/5ae272697f8b9a0d7d8c5751/html5/thumbnails/10.jpg)
Is Abstinence Required?
• Abstinence is not required – programs will use their own policies
• Safety could warrant banning participants currently under the influence
• Drug testing is often used to monitor, but positive results are evidence of the need for treatment
![Page 11: Cognitive Behavioral Interventions for Substance … · · 2015-01-16Cognitive-Behavioral Interventions for Substance Abuse Motivational Engagement Cognitive-Behavioral Social Learning](https://reader034.vdocuments.site/reader034/viewer/2022051601/5ae272697f8b9a0d7d8c5751/html5/thumbnails/11.jpg)
![Page 12: Cognitive Behavioral Interventions for Substance … · · 2015-01-16Cognitive-Behavioral Interventions for Substance Abuse Motivational Engagement Cognitive-Behavioral Social Learning](https://reader034.vdocuments.site/reader034/viewer/2022051601/5ae272697f8b9a0d7d8c5751/html5/thumbnails/12.jpg)
Drugs Work in Two Ways
Mimicking
the Neurochemical
Processes
Increasing Action
of Endogenous
Transmitters
![Page 13: Cognitive Behavioral Interventions for Substance … · · 2015-01-16Cognitive-Behavioral Interventions for Substance Abuse Motivational Engagement Cognitive-Behavioral Social Learning](https://reader034.vdocuments.site/reader034/viewer/2022051601/5ae272697f8b9a0d7d8c5751/html5/thumbnails/13.jpg)
How it Works
• Dopamine affects pleasure center of brain
• Stimulates the release of dopamine at a rapid rate
• Experience of pleasure
• Over time results in dopamine depletion
![Page 14: Cognitive Behavioral Interventions for Substance … · · 2015-01-16Cognitive-Behavioral Interventions for Substance Abuse Motivational Engagement Cognitive-Behavioral Social Learning](https://reader034.vdocuments.site/reader034/viewer/2022051601/5ae272697f8b9a0d7d8c5751/html5/thumbnails/14.jpg)
Reward Pathway Survival
![Page 15: Cognitive Behavioral Interventions for Substance … · · 2015-01-16Cognitive-Behavioral Interventions for Substance Abuse Motivational Engagement Cognitive-Behavioral Social Learning](https://reader034.vdocuments.site/reader034/viewer/2022051601/5ae272697f8b9a0d7d8c5751/html5/thumbnails/15.jpg)
Craving
• The brain becomes active when a person with addiction sees or hears stimuli that trigger craving
• Individuals who suffer from addiction can learn how to manage cravings
![Page 16: Cognitive Behavioral Interventions for Substance … · · 2015-01-16Cognitive-Behavioral Interventions for Substance Abuse Motivational Engagement Cognitive-Behavioral Social Learning](https://reader034.vdocuments.site/reader034/viewer/2022051601/5ae272697f8b9a0d7d8c5751/html5/thumbnails/16.jpg)
![Page 17: Cognitive Behavioral Interventions for Substance … · · 2015-01-16Cognitive-Behavioral Interventions for Substance Abuse Motivational Engagement Cognitive-Behavioral Social Learning](https://reader034.vdocuments.site/reader034/viewer/2022051601/5ae272697f8b9a0d7d8c5751/html5/thumbnails/17.jpg)
Craving
Cocaine Rush, High and Craving Peaks
3 Minutes 11 Minutes 12th Minute
Rush High
![Page 18: Cognitive Behavioral Interventions for Substance … · · 2015-01-16Cognitive-Behavioral Interventions for Substance Abuse Motivational Engagement Cognitive-Behavioral Social Learning](https://reader034.vdocuments.site/reader034/viewer/2022051601/5ae272697f8b9a0d7d8c5751/html5/thumbnails/18.jpg)
Cognitive-Behavioral Interventions
for Substance Abuse
Motivational Engagement
Cognitive-Behavioral
Social Learning – Emotion
Regulation, Social Skills,
Problem Solving
Relapse Prevention
We Poured
Elements of
Effective
Intervention into
the Curriculum
![Page 19: Cognitive Behavioral Interventions for Substance … · · 2015-01-16Cognitive-Behavioral Interventions for Substance Abuse Motivational Engagement Cognitive-Behavioral Social Learning](https://reader034.vdocuments.site/reader034/viewer/2022051601/5ae272697f8b9a0d7d8c5751/html5/thumbnails/19.jpg)
Stages of Change Precontemplation
C
R
I
S
I
S
Contemplation
Determination
Action
Maintenance Relapse
![Page 20: Cognitive Behavioral Interventions for Substance … · · 2015-01-16Cognitive-Behavioral Interventions for Substance Abuse Motivational Engagement Cognitive-Behavioral Social Learning](https://reader034.vdocuments.site/reader034/viewer/2022051601/5ae272697f8b9a0d7d8c5751/html5/thumbnails/20.jpg)
Stages of Change
![Page 21: Cognitive Behavioral Interventions for Substance … · · 2015-01-16Cognitive-Behavioral Interventions for Substance Abuse Motivational Engagement Cognitive-Behavioral Social Learning](https://reader034.vdocuments.site/reader034/viewer/2022051601/5ae272697f8b9a0d7d8c5751/html5/thumbnails/21.jpg)
Project MATCH
CBT MET
12 Step Facilitation
http://pubs.niaaa.nih.gov/publications/match.htm
![Page 22: Cognitive Behavioral Interventions for Substance … · · 2015-01-16Cognitive-Behavioral Interventions for Substance Abuse Motivational Engagement Cognitive-Behavioral Social Learning](https://reader034.vdocuments.site/reader034/viewer/2022051601/5ae272697f8b9a0d7d8c5751/html5/thumbnails/22.jpg)
Research on
12 Step Programs
2 Controlled Studies
Mandatory AA with
Offenders
No Beneficial
Outcomes
![Page 23: Cognitive Behavioral Interventions for Substance … · · 2015-01-16Cognitive-Behavioral Interventions for Substance Abuse Motivational Engagement Cognitive-Behavioral Social Learning](https://reader034.vdocuments.site/reader034/viewer/2022051601/5ae272697f8b9a0d7d8c5751/html5/thumbnails/23.jpg)
Self-Help and Support Network
• Self-Help compliments and extends treatment effects
• Examples include 12 Step, SMART Recovery, Women for Sobriety
• Support is key – type of support can vary (church, family/friends, community groups)
![Page 24: Cognitive Behavioral Interventions for Substance … · · 2015-01-16Cognitive-Behavioral Interventions for Substance Abuse Motivational Engagement Cognitive-Behavioral Social Learning](https://reader034.vdocuments.site/reader034/viewer/2022051601/5ae272697f8b9a0d7d8c5751/html5/thumbnails/24.jpg)
MI + CBT compared to CBT alone for Cocaine TX
• Attended more sessions
• Reported greater desire for abstinence
• Reported expectation of success
• Expected greater difficulty in maintaining abstinence
• No differences on cocaine use
McKee, et al., (2007)
![Page 25: Cognitive Behavioral Interventions for Substance … · · 2015-01-16Cognitive-Behavioral Interventions for Substance Abuse Motivational Engagement Cognitive-Behavioral Social Learning](https://reader034.vdocuments.site/reader034/viewer/2022051601/5ae272697f8b9a0d7d8c5751/html5/thumbnails/25.jpg)
Cognitive-Behavioral Treatment (CBT)
Trigger Use
THOUGHTS
FEELINGS
BEHAVIORS
![Page 26: Cognitive Behavioral Interventions for Substance … · · 2015-01-16Cognitive-Behavioral Interventions for Substance Abuse Motivational Engagement Cognitive-Behavioral Social Learning](https://reader034.vdocuments.site/reader034/viewer/2022051601/5ae272697f8b9a0d7d8c5751/html5/thumbnails/26.jpg)
Cognitive-Behavioral Treatment (CBT)
Trigger Refuse
THOUGHTS
FEELINGS
BEHAVIORS
![Page 27: Cognitive Behavioral Interventions for Substance … · · 2015-01-16Cognitive-Behavioral Interventions for Substance Abuse Motivational Engagement Cognitive-Behavioral Social Learning](https://reader034.vdocuments.site/reader034/viewer/2022051601/5ae272697f8b9a0d7d8c5751/html5/thumbnails/27.jpg)
Reinforcement
![Page 28: Cognitive Behavioral Interventions for Substance … · · 2015-01-16Cognitive-Behavioral Interventions for Substance Abuse Motivational Engagement Cognitive-Behavioral Social Learning](https://reader034.vdocuments.site/reader034/viewer/2022051601/5ae272697f8b9a0d7d8c5751/html5/thumbnails/28.jpg)
Pavlov Video
![Page 29: Cognitive Behavioral Interventions for Substance … · · 2015-01-16Cognitive-Behavioral Interventions for Substance Abuse Motivational Engagement Cognitive-Behavioral Social Learning](https://reader034.vdocuments.site/reader034/viewer/2022051601/5ae272697f8b9a0d7d8c5751/html5/thumbnails/29.jpg)
SA is Reinforcing Positive Reinforcement
Social
Situation + Substance
Use Pleasure
Negative Reinforcement
Stressful
Situation + Substance
Use
Reduced
Unpleasant
Feeling
![Page 30: Cognitive Behavioral Interventions for Substance … · · 2015-01-16Cognitive-Behavioral Interventions for Substance Abuse Motivational Engagement Cognitive-Behavioral Social Learning](https://reader034.vdocuments.site/reader034/viewer/2022051601/5ae272697f8b9a0d7d8c5751/html5/thumbnails/30.jpg)
Charlie Brown and Lucy
![Page 31: Cognitive Behavioral Interventions for Substance … · · 2015-01-16Cognitive-Behavioral Interventions for Substance Abuse Motivational Engagement Cognitive-Behavioral Social Learning](https://reader034.vdocuments.site/reader034/viewer/2022051601/5ae272697f8b9a0d7d8c5751/html5/thumbnails/31.jpg)
Motivational Incentives
http://www.bettertxoutcomes.org/motivationalincentives/PAMI.html
![Page 32: Cognitive Behavioral Interventions for Substance … · · 2015-01-16Cognitive-Behavioral Interventions for Substance Abuse Motivational Engagement Cognitive-Behavioral Social Learning](https://reader034.vdocuments.site/reader034/viewer/2022051601/5ae272697f8b9a0d7d8c5751/html5/thumbnails/32.jpg)
Marijuana Abstinence Post-Treatment
![Page 33: Cognitive Behavioral Interventions for Substance … · · 2015-01-16Cognitive-Behavioral Interventions for Substance Abuse Motivational Engagement Cognitive-Behavioral Social Learning](https://reader034.vdocuments.site/reader034/viewer/2022051601/5ae272697f8b9a0d7d8c5751/html5/thumbnails/33.jpg)
Use of Lower Cost Items
• Petry (2000) has shown lower but still significant benefits from low cost incentives
• Use of fishbowl, refund of fees, etc.
• Socio-economic status did not change efficacy of incentives
![Page 34: Cognitive Behavioral Interventions for Substance … · · 2015-01-16Cognitive-Behavioral Interventions for Substance Abuse Motivational Engagement Cognitive-Behavioral Social Learning](https://reader034.vdocuments.site/reader034/viewer/2022051601/5ae272697f8b9a0d7d8c5751/html5/thumbnails/34.jpg)
Contact Information
• University of Cincinnati-UCCI
• Kelly Pitocco – [email protected]
• 513.502.8999