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How The Two Pillars of Recovery Promote Patient Responsibil How The Two Pillars of Recovery Promote Patient Responsibil

How The Two Pillars of Recovery Promote Patient Responsibil - PowerPoint Presentation

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How The Two Pillars of Recovery Promote Patient Responsibil - PPT Presentation

Geoff Kane MD MPH HUB Teleconference April 14 2014 Themes Vulnerability Empathy Responsibility Accountability Honesty Feelings Emotions Authenticity Spirituality Outline Recidivism ID: 461871

recovery addiction patient time addiction recovery time patient nature people change behavior addictive treatment obert farentino responsibility pillars emotional

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Slide1

How The Two Pillars of Recovery Promote Patient Responsibility

Geoff Kane, MD, MPHHUB TeleconferenceApril 14, 2014Slide2

ThemesVulnerability

Empathy ResponsibilityAccountabilityHonestyFeelings / EmotionsAuthenticitySpiritualitySlide3

OutlineRecidivism

Laws of Nature – NeurobiologyTwo Pillars of RecoveryMotivationEliciting StoryDiscussionSlide4

RELAPSE RATE OVER TIME

Abstainers (%)

Time (Months)

0 1 2 3 4 5 6 7 8 9 10 11 12

2 Weeks

100

90

80

70

60

50

40

30

20

10

0

Heroin

Smoking

AlcoholSlide5

Kane, MD 2013

Abstinence results from

Skill Power

not

Will Power

Slide6

Recidivism happens

Two universal mistakesTwo Pillars of RecoverySlide7

Relapse – The Usual MistakesIndividuals take insufficient responsibility for:The details of recovery management

Honest self-disclosureSlide8

Nature: Cause and Effect You either take responsibility

or take nature’s consequences.Slide9

“Addiction is like gravity; it is governed by the laws of nature and never takes

time off.” Slide10

Laws of Nature – Neurobiology Behavior

AddictionRecovery Slide11

There is more to who we are and more to why we do the things we do than what meets our own minds.Slide12

Lower centers of the Central Nervous System can, and routinely do, act independently of higher centers.Slide13
Slide14

“New research shows that emotions have a separate system of nerve pathways, through the limbic system to the cortex, allowing emotional signals to avoid conscious control.”

-Robert Ornstein, 1991Slide15

-Robert Ornstein

“…unconscious decisions for action

go on constantly inside the head.”Slide16

-Robert Ornstein

“We’re worse off than Freud thought,

because many actions proceed

without our knowing anything about them.”Slide17
Slide18

Addictive chemical substances change the brain and change behavior.Slide19

AddictionPositive reinforcement

Negative reinforcementConditioningAltered motivational hierarchiesSlide20

“…the essence of addiction: uncontrollable, compulsive drug seeking and use, even in the face of negative health and social consequences.”

- Alan Leshner, PhDSlide21

AddictionSubjective: Powerlessness (loss of control)

Objective: Persistent use despite adverse consequencesSlide22

neurobiology of behavior

plusneurobiology of addiction

equals

neurobiology of powerlessnessSlide23

“I have a passion for alcohol.”

- 25 year old femaleSlide24

“Any addict knows, you’ll do anything to get it.”

- 23 year old maleSlide25

Pillar of RecoveryIt is the nature of addiction that you can’t trust yourself, so

Keep Your Distance!Slide26

Positive interpersonal relationships change the brain and change behavior.Slide27

27Slide28
Slide29

“Neural repatterning comes

as we enter into and sustain

new types of relationships

that allow us to reregulate

our sense impressions

slowly and over time.”

- Tian Dayton, PhDSlide30

“Interpersonal experience shapes the

mind as it continues to develop throughout the lifespan…

Interactions with the environment,

especially relationships with other people, directly shape the development

of the brain’s structure and function.”

- Daniel J. Siegel, MDSlide31

“ …the amygdala, along with related

areas…, plays a crucial role in

coordinating perceptions with memory

and behavior. These regions are

especially sensitive to social interactions.”

- Daniel J. Siegel, MDSlide32

“Our limbic system sets the mind’s

emotional tone and stores our

highly charged emotional memories.”

- Tian Dayton, PhDSlide33

RELAPSE RATE OVER TIME

Abstainers (%)

Time (Months)

0 1 2 3 4 5 6 7 8 9 10 11 12

2 Weeks

100

90

80

70

60

50

40

30

20

10

0

Heroin

Smoking

Alcohol

Kane, MD 2013Slide34

“The treatment of addiction is [still] people.” Slide35

Suggestions Made in Addiction Treatment90 meetings in 90 daysObtain and use sponsor

Do some Step workParticipate in an aftercare groupParticipate in counseling/ psychotherapySlide36

Some Recovery Skills/TipsBe honestEmbrace your painMistrust yourselfKeep your distance

Seek people, not chemicalsPay attention!Slide37

Pillar of RecoveryIt is the nature of recovery that you can’t do it alone, so

Ask for Help!Slide38

Messages for PatientsThe only way out of embarrassment and shame is

through it.Honesty is more important than image.Replace “What can I take?” with “Who can I talk to?”Slide39

The Two Pillars of Addiction RecoveryKeep your distance!

(avoid the negatives)Ask for help! (chase the positives)Slide40

MotivationA state – not a traitYou

are a brain treatmentSlide41

Professionals Influence Client MotivationExpectations influence outcomes

Differences in drop-out ratesDifferences in outcome ratesSimple actions decrease drop outEmpathic professionals have better outcomes

-Obert and FarentinoSlide42

Determinants of Client “Change”Client factors 40%Relationship factors 30%Expectancy & Hope 15%

Model/technique 15%- Michael Clark, MSWSlide43

Counseling TipsBe Empathic, Nonconfrontational

Offer ChoicesEmphasize Patient’s ResponsibilityConvey Confidence In Patient’s Ability To ChangeSlide44

“…people will forget what

you said, people will forget

what you did, but people

will never forget how you

made them feel.”

- Maya AngelouSlide45
Slide46

Motivational InterviewingElicits Behavior ChangeRespects AutonomyTolerates Patient Ambivalence

Explores Consequences- Obert and FarentinoSlide47

Four Principles of Motivational InterviewingExpress empathyDevelop discrepancyAvoid argumentation

Support self-efficacySlide48

What Motivational Interviewing is not:Giving informationGiving advice

Using logic to persuadeWarningConfrontingAgreeingTheresa Moyers, PhDSlide49

StyleAcceptingNon-judgmentalEmpowering

SupportiveUnderstandingPatient- elicitedCollaborativeAmbivalence normalFacilitative-Obert and FarentinoSlide50

Building MotivationOpen-ended questioningAffirmingReflective listening

Summarizing- Obert and FarentinoSlide51

Reflective Listening: Key-ConceptsListen to what patient says and to what patient means

Check out assumptionsCreate an environment of empathy (non judgmental)Patient and change agent do not have to agreeBe aware of intonation (statement, not question)

- Obert and FarentinoSlide52
Slide53

Providers help ensure recovery success when they promote continuity of:Healthcare

CaringAccountabilitySlide54
Slide55

Influences on Cognitive and Emotional Responses to Pain Pain

IntensityCharacterLocationDurationPrecipitantsTreatments/ pharmacology

Relevant factors

Current context

Meaning

Past experiences/

expectations

Fatigue

Depression/anxiety

Distraction

“Stress”

Coping techniques

Addiction- Adapted from Compton et al. 2009Slide56

Contributors to Increased Opioid DependenceAvailabilityDecreased price/Increased purityRemoval of the injection barrier

Speed of physical dependenceSlide57

“Truth”

Unreliability of memory

Vagaries of psychopathology

What is historically untrue may

be emotionally true

Conflicts of interest create

distortions Slide58

When the

only

treatment

that has ever provided a patient relief

happens to be a controlled substance;

much more often than not, the patient’s

complaint is motivated by addiction.

Consider telling the patient that

the more they push for that treatment,

the more concerned you must be

about addiction.

“Turning the Tables”

- Adapted from Ted Parran, MD 1997Slide59

If you are convinced the

only

treatment that can help you

is an addictive medication:

worry and ask for help

because

that’s a sign of addiction.Slide60

If You Have an Addictive Illness: Avoid These Medications

BenzodiazepinesOpioidsBarbiturates (esp. Butalbital)StimulantsMeprobamate (including carisoprodol or Soma)AlcoholSlide61

And Be Cautious Taking Any of These:

AntihistaminesMuscle relaxantsSedating medications (psychiatric and other) Slide62

Your Responsibilities With PrescribersLook for alternatives before accepting an addictive medication

Tell them you have an addictive disorder even if the problem was a long time agoIt’s best to tell them this before you are sickRemember you have “no brakes” when it comes to addictive substances

Ask the prescriber to set a time limit

Have someone else control the supply of medicationSlide63
Slide64

Biomedical Ethics:Basic PrinciplesRespect for Autonomy

NonmaleficenceBeneficenceJusticeSlide65
Slide66

SpiritualityInvolves Relationships With:SelfOther Human BeingsNature

Creator, God, Higher PowerSlide67

Patients help ensure recovery success when they embrace:Abstinence

Mental and emotional changesSpiritual changesDaily spiritual practiceSlide68

A Model for RecoveryEmotional ArousalSense of HopeSense of Mastery

Love and Humor- Modified from Jerome Frank, MDSlide69

Additional Informationaddictiontreatmentbareessentials.com

The Two Pillars of RecoveryKeep Your Distance!Ask for Help!Adverse Childhood Experiences

“Can I have just one?”

Sedative-hypnotics