By Philip J Pellegrino PsyD Licensed Psychologist Moral Model Spiritual Model Disease Model Social Learning Model AAAbstinence Model Treatment Models Substance use is viewed as a problem of moral failing character defect and sin ID: 713165
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Slide1
Harm Reduction Approaches to Substance Use Problems
By Philip J. Pellegrino, Psy.D.
Licensed PsychologistSlide2
Moral ModelSpiritual Model
Disease Model
Social Learning ModelAA/Abstinence Model
Treatment ModelsSlide3
Substance use is viewed as a problem of moral failing, character defect and sin.For the individual to get better, they must make changes in their moral character.
Proponents also suggest that coercion and punishment are effective treatment tools (Brickman et al., 1992).
Moral ModelSlide4
Substance use problems are viewed as a lack of belief in a higher power.Spiritual principles and belief in a higher power are used to help the person overcome their substance use difficulties (Hester & Miller, 2003).
The Spiritual ModelSlide5
Takes a bio-medical approach.This model states that the user suffers from a disease of the brain that does not allow them to be able to control their drinking.
Alcoholics and addicts are believed to have predispositions to the disease which is initiated upon the use of the substance.
Disease ModelSlide6
The individual is not considered to be responsible for the development of a problem, but is responsible for getting help.
The solution is for the person to remain abstinent from substances.
The disease model is not a part of the original philosophy of AA/NA. AA/NA are spiritual programs.
Disease Model (Cont.)Slide7
The behavior and attitude of substance use is learned through the individual’s personal experience.
Substance use is viewed as a behavior that needs to be modified.
Substance use is reinforced by positive feelings.Family/cultural messages about substance use.
Social Learning TheorySlide8
Observational Learning—Substance use is learned by watching others.Substance use can be seen as a learned coping mechanism.
Negatively reinforced for the avoidance of negative emotions, which at times is created by use of the substance.
Social Learning (Cont.)Slide9
Views any drug use as problematic.The only way to address drug and alcohol use problems is to completely avoid substance use altogether.
Abstinence ModelSlide10
An approach that minimizes the risks and harm done by substance use.
Long-term goal can be abstinence, which is elimination of harm and risk.
Any steps towards change is an acceptable goal.
Reduction
Safer Use (i.e., clean needles, DD,
vaporizors
, hydration)
Using in Context
So What is Harm Reduction?Slide11
Student self-determination and choice is respected and fostered in this approach.The student is supported to make any positive changes.
Harm-reduction attempts to break down barriers to treatment and attempts at making a change.
What is Harm Reduction? (Cont.)Slide12
A biopsychosocial
approach.
Drug use is initially adaptive.Active users can participate in treatment. (This does not mean they are “high” in session.)
This approach is sensitive, non-judgmental, and based on respect for the individual.
What is Harm Reduction?Slide13
Harm reduction is not just an approach to drug and alcohol problems.
Exercise is Harm Reduction
Diet is Harm ReductionDBT is Harm Reduction
Condoms are Harm Reduction
Insulin is Harm Reduction
Harm Reduction is Multidisciplinary!Slide14
Drug—Pharmacology of the drug, route of administration.Set—The personality, mood, and attitude of the person.
Setting—The context where use occurs (Who, what, when, and where).
Drug, Set, and SettingSlide15
Drug use is a relationship that is more than the effects of the substance.Culture surrounding drug use has an impact.
We must illicit details of the person’s experience.
We use this to develop our interventions.
Drug, Set, and SettingSlide16
Harm Reduction Approaches
Moderation Management
Motivational Interviewing
Needle Exchange
CRAFT
Smart Recovery
Behavioral Self-Control Training
Moderation-oriented Cue Exposure
Guided Self-Change
Behavioral Couples Therapy
BASICS
SBIRT
Mindfulness-Based Relapse Prevention
Trial for Early Alcohol Tx
Medications
Methadone
Suboxone
NaltrexoneSlide17
Both a self-help group and a treatment approach.Teaches moderate drinking strategies.
Focuses on individuals who are not alcohol dependent.
Participants are asked to sample sobriety.
Specific drinking goals and strategies (
Rotgers
, Kern, &
Hoetzel
, 2002)
Moderation ManagementSlide18
Most who choose moderation will later switch to abstinence (Hodgins, Leigh, Milne, &
Gerrish, 1997).
Provides a treatment option for those who would otherwise be turned off by treatment.
Initial sobriety period.
Researchers have found a 50% reduction in drinking with similar web-based moderation programs (
Hester, et al., 2005
).
Moderation Management (Cont.)Slide19
Meet the client where they are, let them set their treatment goals.Moving the individuals towards making any positive change.
A non-judgmental, rogerian, client-centered approach.
Motivational InterviewingSlide20
MI approachReflections, open-ended questions, creating cognitive dissonance, enhancing self-efficacy.
MI has been shown to be effective with resistant individuals (Project MATCH Research Group, 1993).
Abundance of studies supporting its efficacy (Miller &
Rollnick
, 2002).
Motivational Interviewing (Cont.)Slide21
Community Reinforcement Approach and Family TherapyFocuses on treating the family member.
Goal is to get the individual into tx, reduce substance intake, and increase family member self-efficacy (
Smith and Meyers, 2004
).
CRAFTSlide22
A cognitive-behaviorally based self-help group.Provides the support similar to AA, but is focused on making specific behavioral and cognitive changes related to substance use.
Not very prevalent.
Smart RecoverySlide23
Focuses on teaching self-monitoring of drinking decisions based on functional analysis.
Teaches drink refusal skills.
Focuses on rewards and consequences as well as specific drinking goals.Relapse prevention skills.
Behavioral Self-Control TrainingSlide24
A meta-analysis has shown this approach to be superior to other moderation approaches and abstinence approaches (
Walters, 2000
).
Behavioral Self-Control TrainingSlide25
Based on classical conditioning.Involves exposure to alcohol cues without access to alcohol.
The hope is to decrease those cues with drinking.
Found to have similar impact as BSCT
(Dawe, Reese, Mattick, Sitharthan and Heather, 2002; Heather et al., 2000).
Moderation-Oriented Cue ExposureSlide26
Combines MI and CBT approaches.Is a short, brief intervention that focuses on getting individuals to make their own changes.
Emphasizes the self-determination approach to harm reduction.
One
session found to be as effective as four
(
Andreasson, Hansagi, and
Osterlund, 2002).
Guided Self ChangeSlide27
Couples therapy based on behavioral strategies.Contracting not to drink with SO.
Another CBT based approach.
Found to be more effective than individualized treatments (Marlatt and Winkiewitz, 2002
).
Behavioral Couples TherapySlide28
A brief two session intervention for college students.
First session-assessment
2nd session-feedback and MI
Found to reduce frequency and amount of drinking.
Also a reduction in harmful drinking behaviors (i.e., driving, shots, binge drinking) (
Dimeff
, L.A., et al, 1999).
BASICSSlide29
Conducted by physicians to get patients to enter treatment or reduce use of alcohol and other drugs.
Uses the CRAFFT assessment tool.
Gives feedback using basic MI skills (Clark et al., 2010).
SBIRTSlide30
This is tricky due to the illegality of drugs.
We are a Federal Program, therefore we fall under Federal rules.
Goal is employability. Positive drug tests lead to employability issues.Alcohol is also a major concern.
We can follow the rules, let the guidelines be known, while our interventions can reflect a harm-reduction approach.
Harm Reduction in Job CorpsSlide31
Most of these interventions we reviewed are for alcohol use.
Students referred to alcohol infractions may respond well to SBIRT and BASICS.
Alcohol is something that students may choose to engage when they turn 21.Addressing how drinking affects employability with harm reduction is highly pragmatic.
AlcoholSlide32
Some may not be ready to make complete changes.Those who are sober may not be committed to long-term sobriety.
Harm-reduction approaches emphasize internal motivation and not abstinence based on avoidance of punishment (What we see in Job Corps).
Or avoidance of getting caught!
How Do Students See Drug Use?Slide33
When our only message is to stop, how does this affect those students who are not ready to make changes?
Do they give us lip service?
Does this close them off to us?HEALs is about making good decisions and reducing unhealthy behaviors to minimize their harm on the body.
Not only 1 way to change.
Gives TEAP more options when working with students.
Applying to Job CorpsSlide34
NaltrexoneAcamprosite
Methadone
Suboxone
MedicationsSlide35
Andreasson, S., Hansagi, H., &
Osterlund
, B. (2002). Short-term treatment for alcohol related problems
: Four session guided self-change versus one session of advice. A
randomized
, control trial.
Alcohol, An International Biomedical Journal, 28
, 57-62.
Brickman, P., Babinowitz, V.C., Karuza J., Jr., Coates, D., Cohn, E. & Kidder, L. (1992).
Models
of helping and coping.
American Psychologist, 37
, 368-384.
Clark, D.B., Gordon, A.J., Ettaro, L.R., Owens, J.M., & Moss, H.B. (2010). Screening and brief
intervention
for underage drinkers.
Mayo Clinic Proceedings, 85
, 380-391.
Dawe, S.,
Reese,
V., Mattick
,
R., Sitharthan, T., &
Heather
, N. (2002). Efficacy of
moderation-oriented
cue exposure for problem drinkers: A randomized control trial.
Journal
of Consulting and Clinical Psychology, 70
, 1045-1050.
Denning, P. (2000).
Practicing harm reduction psychotherapy
. New York: Guilford Press.
Dimeff, L.A., Baer, J.S., Kivlahan, D.R., Marlatt, A.G. (1999).
Brief alcohol screening and
intervention
for college students: A harm reduction approach.
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.
ReferencesSlide36
Heather, N., Brodie, J., Wale, S., Wilkonson, G., Luce, A., Webb. E. et al. (2000). A
randomized
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Studies
on Alcohol, 61
, 551-570.
Hester, R.K. & Miller, W.R. (2003). Handbook of alcoholism treatment approaches: Effective
alternatives
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Hester, R.K., Squires, D.D., & Delaney, H.D. (2005). The drinkers check-up: 12 month
outcomes
of a controlled clinical trial of stand alone software program for problem
drinkers
.
Journal of Substance Abuse Treatment, 28
, 159-169.
Hodgins, D.,
Leigh
, G., Milne
,
R., &
Gerrish,
R. (1997). Drinking goals election in behavioral
self-management
treatment of chronic alcoholics.
Addictive Behaviors, 22
, 247-255.
Marlatt, A.G. & Witkiewitz, K. (2002). Harm reduction approaches to alcohol use: Health
promotion
, prevention, and treatment.
Addictive Behaviors, 27
, 867-886.
Miller
, W.R. & Rollnick, S. (2002).
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ReferencesSlide37
Project MATCH Research Group. (1993). Project MATCH: Rationale and method
for
a multisite clinical trial matching patients to alcoholism treatment. Alcoholism
: Clinical and Experimental Research, 6
, 1130-1145.
Rotgers, F., Kern, M.F., & Hoeltzel, R. (2002).
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, J.E. & Meyers, R.J. (2004).
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abusers
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Walters, G.D. (2000). Behavioral self-control training for problem drinkers: A
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Witkiewitz
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