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DUI Evaluator Training-DUI Evaluator Training-ICADD 2004ICADD 2004

Tom Wilson, LCPC

twcc@tomwilsoncounseling.com

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Session One Overview- Application Session One Overview- Application and Preparation for Licensing and Preparation for Licensing

Role of a DUI Evaluator Application Requirements

1. Evaluation or treatment experience

2. Minimum educational requirements

3. Competency – based examination. Study areas for exam

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Who is the Client?Who is the Client?

Defendant has a court order for a DUI evaluation.

Defendant is referred by his attorney for a DUI evaluation before pretrial.

Defendant is self referred three days after DUI arrest and knows he will have to get an evaluation, no attorney.

Defendant had a recent “voluntary” evaluation he didn’t like, wants second opinion.

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DUI Evaluator License Application DUI Evaluator License Application

1. Certified copy of college transcripts-Baccalaureate degree or higher in allied health field or

2. Current copy of CADC Certificate issued through IBAADC

3. Copy of LCP, LCPC or MSW Certificate4. Detailed employment history showing

minimum of 720 cumulative hours in a drug or alcohol education or treatment program for the three years prior application (Program Name. Dates, Hours, Supervisors).

5. Statement of fee you will charge6. $25.00 application fee

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DUI Evaluator License DUI Evaluator License RenewalRenewal

Application form with updated info

Statement of fees Verification of 12

hours of CEUs by

1. Workshop Certificates

2. College Transcripts $25.00 renewal fee

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Licensure Examination TopicsLicensure Examination TopicsStatutes and rules governing

evaluators and their evaluationsPhysiological effects of alcohol/drugsWithdrawal symptomsReferral processes12-step programsInterview techniquesScreening toolsProfessional conduct and ethicsGender and cultural issues

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Statutes and RulesStatutes and Rules Idaho Code 18-8005(9)

established the requirement for DUI Evaluations

Idaho Code 10-8005 (5) established the requirements for DUI Evaluators

IAC 16.06.08 gave DHW the authority to establish rules and minimum standards for DUI evaluators

Supreme Court Misdemeanor Criminal Rule 9.4 prescribed the format and content of the DUI report

Federal Regulations42 CFR Part 2Confidentiality of Alcohol and Drug Abuse Patient Records

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Physiological Effects of AlcoholPhysiological Effects of Alcohol

BAC .02

BAC .40

•Reduces tension •lowers inhibitions •impairs concentration •slows reflexes •impairs reaction time •reduces coordination •slur speech •cause drowsiness •alter emotions •vomiting •breathing difficulties •unconsciousness •coma •Death

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Chronic Effects of Alcohol Chronic Effects of Alcohol Nervous System: loss of

sensation hands/feet Muscles: Weakness and

loss of muscle tissue Lungs: Infections Liver: Liver damage

including cirrhosis, hepatitis,

Pancreas: Pancreatitis Sexual Organs - impotence

and decreased sperm count , irregular periods, reproductive problems, pregnancy and birth problems

Brain: Cell damage, memory Breasts: Risk of breast cancer Heart: High blood pressure Skin: Red nose and cheeks Stomach: Inflammation,

bleeding, and ulcers Intestines: Inflamed lining and

ulcers Esophagus- bleeding Blood: Changes in red blood

cells Hands and Feet: "Pins and

Needles" and loss of sensation

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Acute Effects of MethamphetamineAcute Effects of Methamphetamine

Increased alertness Paranoia Hallucinations Aggressive behavior Increased heart rate Insomnia Loss of appetite Excessive talking Panic

Delusions False sense of power

and confidence Loss of interest in

friends, sex or food Emotional numbing Acne, sores Tactile delusions

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Chronic Effects of MethamphetamineChronic Effects of Methamphetamine

Fatal kidney and lung disorders

Brain damage Depression Hallucinations Permanent memory,

attention, concentration problems

Violence

Paranoid delusions Malnutrition Loss of hair Loss of teeth Stroke Liver damage Severe impairment in

legal, financial social, and family role functioning

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Alcohol Withdrawal SymptomsAlcohol Withdrawal Symptoms

Sweating or Rapid Pulse

Increased Hand Tremor Insomnia Nausea or Vomiting Physical Agitation Anxiety Transient Visual, Tactile

or Auditory Hallucinations or

Illusions Grand Mal Seizures

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Methamphetamine Methamphetamine HydrocodoneHydrocodone

fatigue long, disturbed

periods of sleep irritability intense hunger moderate to severe

depression psychotic reactions anxiety

intense cravings for the drug irritability nausea or vomiting muscle aches runny nose or eyes dilated pupils sweating diarrhea yawning fevers chills inability to sleep depression

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Referral ProcessesReferral Processes Education or Treatment?

Match severity of client’s problem to level of education or treatment

Special needs of clients?

Three referrals

Private Providers and State approved Substance Abuse Treatment Programs

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12 Step Programs12 Step Programs

The “tools of recovery,” common to all of the 12-Step Programs, include:Meetings (usually 60 - 90 minutes)

Sponsorship Twelve steps Twelve traditions Service work

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Interviewing TechniquesInterviewing Techniques

Physical environment Reading level Client’s language Distractions Confidentiality Informed consent Acceptance and respect

vs. agreement Empathy vs. Sympathy Verbal vs. Nonverbal

communication

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Approved Screening Tools Approved Screening Tools

Addiction Severity Index (ASI)

Michigan Alcohol (ASI) Screening Test (MAST)

Substance Abuse Subtle Screening Inventory (SASSI)

DSM-4 Criteria for Substance Abuse Disorders

Mortimer-Filkens Questionnaire with Interview

Compu-13 Compu-15 Substance Abuse

Disorders Diagnosis Schedule(SUDDS)

Driver Risk Inventory II

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Professional Conduct and EthicsProfessional Conduct and Ethics

Non-discrimination Competence Client welfare Confidentiality Dual relationships Receiving remuneration for referral of

clients for professional services Using one's relationship with clients to

promote personal gain or the profit of an agency

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Gender and Culture IssuesGender and Culture Issues

Gender Issues Women have

higher BACs Higher risk for

Cirrhosis Higher risk for co-

morbid disorders Higher risk for

O.B. complications Higher risk for

FAS Risk for Domestic

Violence

Cultural Issues Cultural drinking

norms Attitude towards

treatment Cultural sensitivity

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Session Two OverviewSession Two Overview

“Treatment = Punishment”Approved Screening ToolsTranstheoretical Model of Change and

Stages of ChangeLevel of Care: Treatment or EducationMotivational interviewingMaking recommendationsConfidentiality, ethics

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Approved Screening Tools Approved Screening Tools

Addiction Severity Index (ASI)

Michigan Alcohol Screening Test (MAST)

Substance Abuse Subtle Screening Inventory (SASSI)

DSM-4 Criteria for Substance Abuse Disorders

Mortimer-Filkens Questionnaire with Interview

Compu-13 Compu-15 Substance Abuse

Disorders Diagnosis Schedule(SUDDS)

Driver Risk Inventory II

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Transtheoretical Model of Change: Transtheoretical Model of Change: Five Distinct Stages of Change Five Distinct Stages of Change1. Precontemplation: not seeing a problem2. Contemplation: seeing a problem and

considering whether to act3. Preparation: making concrete plans to act

soon4. Action: doing something to change5. Maintenance: working to maintain

change

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Moving through the StagesMoving through the Stages

Stages of Change1. Precontemplation 2. Contemplation3. Preparation 4. Action5. Maintenance6. Relapse

Processes of Change1. Consciousness Raising 2. Environmental Re-

evaluation3. Dramatic relief4. Self Re-Evaluation 5. Self-efficacy6. Helping relationships7. Contingency management 8. Counter conditioning9. Stimulus control10. Social liberation

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Assessing Stage of ChangeAssessing Stage of Change

Readiness Ruler

Clinical Interview

TCU DRUG Screen

SOCRATES- Stage of Change Readiness for Treatment Scale

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Treatment vs. EducationTreatment vs. Education

ASAM Treatment DX: Substance Abuse or

Dependence Level 1-OP Level 2-IOP Level 3 IP Level 4 IP PPCR-2 used to classify

intensity of tx required Precontemplation to

Maintenance

ASAM Early Intervention May not meet DX for Abuse At risk ASAM .5 level No individual tx plan defined Precontemplation to

Contemplation / Preparation

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Motivational Interviewing (MI)Motivational Interviewing (MI)

Miller and Rollnick (1991) - Counseling style used to enhance client’s use of the processes of change.

Principles of Motivational Interviewing Express Empathy-seek to gain understanding Develop Discrepancy-pros and cons of change Avoid Argumentation-avoid labeling Roll with Resistance-reflecting skills Support self-efficacy-confidence and importance

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Examples of MI Counselor Behaviors Examples of MI Counselor Behaviors

“That must have been difficult.” (sympathetic not appreciative)

“You’ve accomplished a difficult task.”

“It was your decision to come here today.”

“Thank you for coming today.”

“Would it be all right if I suggested something?”

Support

Affirm effort

Emphasize Control

Affirm appreciation

Advise with Permission

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Examples of MI Counselor BehaviorsExamples of MI Counselor Behaviors

Client: “I don’t really have a problem with alcohol.”

Counselor: Drinking really hasn’t caused problems for you.

Your 18 drinks a week places you in the 96th percentile for men.

Tell me about your DUI. Did you take the field

tests?

Reflection

Giving Information

Open question

Closed question

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Case StudiesCase Studies

Review Case study and reach consensus on :

Severity of problem DSM Diagnosis Stages of Change Motivation for change Recommendations for education or treatment Reasons for recommendations Recommended programs

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Session Three OverviewSession Three Overview

Goals of Early Intervention

Picking Topics

Designing Learning Activities

Interventions Interventions for First Time for First Time OffendersOffenders

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Goals of Early InterventionGoals of Early Intervention

Consciousness Raising

Dramatic Relief Environmental

Reevaluation Self reevaluation

Scope of DUI problem

Client’s quantity, frequency and pattern of use

DUI laws, Fines, penalties, jail

Effects of alcohol.drugs on driving

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Goals of Early InterventionGoals of Early Intervention

Consciousness Raising

Dramatic Relief(Emotional arousal) Environmental

Reevaluation Self reevaluation

Emotional responses to Victim’s Panel or other testimonials

Feelings at time of arrest

Feelings since arrest about drinking behavior

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Goals of Early InterventionGoals of Early Intervention

Consciousness Raising

Dramatic Relief(Emotional arousal) Environmental

Reevaluation Self reevaluation

Costs of DUI to community /society

Effects on friends and family

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Goals of Early InterventionGoals of Early Intervention

Consciousness Raising

Dramatic Relief(Emotional arousal) Environmental

Reevaluation Self reevaluation

DUI vs. Personal Values

Financial costs of DUI

Personal costs of DUI

Future life goals and drinking /driving behavior

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Adult Learners…Adult Learners…

expect a learning climate that is interactive and mutually respectful.

diagnose their own needs and progress using interactive exercises, not lecture.

have a broad base of knowledge and experience they contribute to the learning situation.

learn by interacting and doing. “do not argue with their own data”-Bob Pike,

author of Creative Training Techniques.

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Training Methods for Small Training Methods for Small Groups (up to 15)Groups (up to 15) Traditional lectures Participatory

lectures/structured discussions

Open discussions Brainstorming T-group exercises Self-tests

Case studies Incident process Warm-ups/

Icebreakers Energizers Role plays

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Where to Get More InformationWhere to Get More InformationTom Wilson Counseling Center514 So. Orchard, Suite 101Boise, ID 83705Ph 208-368-9909 Fax 208-388-1687Website: www.tomwilsoncounseling.com

(/signup) Email: twcc@tomwilsoncounseling.comBooks: “Motivational Interviewing”,

William Miller and Steve Rollnick “Changing for Good” Prochaska and

Diclemente