Addictions TreatmentPlanning 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”.