Education Track, National Rx Drug Abuse Summit, April 2-4, 2013. Enabling and Intervention presentation by Karen Perry and Dominique Simon-Levin

1. Enabling
and
Interven/on
Karen
Perry
Co-­‐Founder,
Execu/ve
Director,
NOPE
Task
Force
Dominique
Simon-­‐Levine
Director,
Allies
in
Recovery

2. Learning
Objec/ves
1. Analyze
two
effec/ve
advocacy
programs
and
the
current
trends
of
Rx
drug
abuse.
2.
Describe
CRAFT
procedures
to
increase
the
chance
of
a
loved
one
entering
treatment.
3. Describe
the
methods
for
engaging
a
loved
one
to
seek
help.

3. Disclosure
Statement
• Karen
Perry
has
no
financial
rela/onships
with
proprietary
en//es
that
produce
health
care
goods
and
services.
• Dominique
Simon-­‐Levine
has
no
financial
rela/onships
with
proprietary
en//es
that
produce
health
care
goods
and
services.

4. Enabling
and
Interven/on
Karen
H.
Perry
Co-­‐Founder
Execu;ve
Director

5. Richard
Perry
Age
21

16. Richard
Perry
Age
21

18. Na/onal
Overdose
Sta/s/cs
• 28,578
uninten/onal
fatal
drug
poisonings
(2009)
• In
2009,
approximately
1.2
Million
Emergency
Room
visits
for
non
medical
use
of
pharmaceu/cals.
• Research
indicates
an
es/mated
6
people
will
be
directly
affected
by
each
sudden
loss,
which
equates
to
171,468
people
annually

19. Current
Trends
• Every
day,
2,000
teens
in
the
United
States
try
prescrip/on
drugs
to
get
high
for
the
first
/me
• 60%
of
teens
who
have
abused
prescrip/on
painkillers,
did
so
before
the
age
of
15
• 45%
of
those
who
use
prior
to
the
age
of
15,
will
later
develop
an
addic/on
which
also
increases
the
chance
for
overdose.

20. Successful
Community
Partnerships
• Assess
the
Local
Community
• Forming
Partnerships
• Plan
and
Set
Goals
• Implement

21. Community
Partnerships
• Law
Enforcement
• Medical
Examiner
• Community
Government
• Medical
Professionals
• Treatment
Providers
• Educa/onal
Ins/tu/ons
• Legislators
• Family
Members

22. Assess
Local
Community
Partnership
with
Palm
Beach
County
Sheriff
Office
• Majority
died
from
a
• Highest
spikes
occur
combina/on
of
drugs
between
ages
of
18-­‐30
an
• Prescrip/on
drugs
were
50-­‐60
found
in
majority
of
• At
least
one
third
of
deaths
vic/ms
has
suffered
a
• Majority
of
deaths
previous
non-­‐fatal
someone
was
with
in
overdose
earshot
of
vic/m
• Majority
of
vic/ms
were
Caucasian
male

23. NOPE
Task
Force™
a
501c-­‐3
non-­‐profit
Mission
To
reduce
the
frequency
and
impact
of
drug
overdose
death
through:
• Community
Educa/on
• Family
Support
•
Purposeful
Advocacy

24. Plan
and
Set
Goals
• Reduce
early
onset
of
substance
use.
• Empower
youth
to
become
peer
advocates
Increase
knowledge
of
parents
and
community
members.
• Reduce
the
number
of
drug
overdose
deaths.

25. Preven/on
&
Educa/on
Presenta/ons
• Middle
&
High
Schools
• Universi/es
• Parents
&
Communi/es
• Treatment
and
Correc/onal
ins/tu/ons
• Health
Care
Professionals

26. Student
Presenta/ons
TOPICS
OF
DISCUSSION
RELATED
NOPE
TAG
LINES
1. Addic/on
• Be
the
Hero-­‐Tell
Someone
®
2. Combining
Drugs
=
Overdose
• One
Time
Can
Kill
®
3. Make
the
Call!
Dial
911
• Make
the
Call!
Dial
911
®
4.
Passed
out=
Medical
• Some/mes
You
Never
Sleep
It
Emergency
Off
®

27. Parent
Presenta/on
4
Components:
• Impact
on
family
• Underage
drinking
• Current
trends
• Paren/ng
strategies

28. Follow
Up
• ASK
ADAM
&
AMY
• Interac/ve
Website
• Publica/ons
• Student
Cer/fica/on
and
Life
Choices
Scholarship

29. Efficacy
Empirical
support
indicates
par/cipants
show:
• Change
in
knowledge
• Change
in
aktudes
towards
drug
Lynn
University
Research
Boca
Raton,
FL

30. Awareness
• Na/onal
Candle
Light
Vigil
• Interac/ve
Website
• Social
media
• Prescrip/on
Drug
Take
Back
• Advocates
for
legisla/ve
change

31. Advocate
for
Legisla/on
• Be
informed
of
local
issues
and
poten/al
bills
• Create
tool
kit
for
community
partners
• Inform
partners
of
upcoming
bills

32. Family
Support
• Treatment
Support
• ASK
ADAM
• Support
Groups
• Interac/ve
Website
• Publica/ons

33. NOPE
Task
Force’s
Accomplishments
• 11
Chapters
across
Florida
• Florida
Prescrip/on
Drug
• Over
120,000
students
Monitoring
Program
passed
receiving
our
evidence
and
ac/ve
based
message
annually
• Good
Samaritan
911
Law
• Over
50
loca/ons
hos/ng
passed
Candle
Light
Vigils
Annually

34. Partners
• Office
of
Na/onal
Drug
Control
Policy
• Mar/n
County
Sheriff’s
Office
• Florida
Office
of
the
Anorney
General
• Okeechobee
County
Sheriff’s
Office
• The
Florida
Sheriff’s
Associa/on
• Palm
Beach
County
Sheriff’s
Office
• The
Florida
Police
Chiefs
Associa/on
• Palm
Beach
County
State
Anorney
• Florida
Coali/on
Alliance
• Pinellas
County
Sheriff’s
Office
• Safe
and
Drug
Free
Schools
• St.
Lucie
County
Sheriff’s
Office
• Caron
Center
• Sarasota
County
Sheriff’s
Office
• Hanley
Center
• Seminole
County
Sheriff’s
and
• Lynn
University
municipal
law
enforcement
agencies
• Flagler
County
Sheriff’s
Office
• Volusia
County
Sheriff’s
Office
• Hillsborough
County
Sheriff’s
Office
• Indian
River
County
Sheriff’s
Office

35. NOPE
Task
Force
866-­‐612-­‐NOPE
www.nopetaskforce.org
Karen
Perry
KPerry@NOPETaskForce.org

36. Enabling
and
Interven;on
When
Love
Isn’t
Enough…
CRAFT
(Community
Reinforcement
and
Family
Training)
Dominique
Simon-­‐Levine,
PhD
April
2
–
4,
2013
Omni
Orlando
Resort
at
ChampionsGate

37. Learning
Objec;ves
1.
Understand
specific
CRAFT
procedures
(eg.
reinforcement
strategies,
allowing
natural
consequences)
to
increase
the
chance
that
the
Loved
One
will
enter
treatment.
2.
Understand
the
methods
for
engaging
a
Loved
One
to
seek
help.
3.
Review
the
science
behind
CRAFT.

38. Disclosure
Statement
Dominique
Simon-­‐Levine
has
no
financial
rela/onships
with
proprietary
en//es
that
produce
health
care
goods
and
services.

39. CRAFT
is
driven
by
the
principles
of
classical
behavioralism.
Dolphins
do
it,
dogs
do
it,
people
do
it…

41. Control vs Influence: !
Control
Influence
• Demand,
dominate,
• Request,
provide
resources,
you
manipulate
are
a
mirror
“what
do
you
want
to
do?”
• “No”
leads
to
guil/ng,
• “No”
leads
to
disappointment
and
anger,
shaming,
provides
informa/on
resentment
• Power
over
• Power
with,
it’s
a
partnership
“Use
and
you’re
out
of
“Please
do
not
come
home
if
you’ve
here.”
been
using.
You’re
welcome
back
when
you
straighten
up.”

42. The
Essen/al
Skill
Set:
CRAFT
1.
Safety,
de-­‐escala/on
2.
Posi/ve
communica/on
3.
What
to
do
when
your
LO
is
not
using,
right
now
4.
What
to
do
when
your
LO
is
using,
right
now
5.
How
to
handle
the
hard
emo/ons
6.
How
to
get
your
LO
into
treatment

43. CRAFT
happens
in
the
moment
…
the
world
divides
in
two.
•
How
you
respond
when
you
see
use
•
How
you
respond
when
you
don’t
see
use

44. When
you
see
use,
disable
the
enabling
…
1)
Remove
the
rewards.
2)
Remove
yourself
in
a
quiet
neutral
way.
3)
Allow
natural
consequences,
if
safe
to
do
so.
.

45. When
you
don’t
see
use….*!+REWARD+!*
4
Characteris/cs
 pleasurable
to
your
LO
 free
or
affordable
 can
be
given
immediately
 something
you
are
willing
to
give
4
Types
Stuff:
like
a
video
game
or
/x
to
a
ball
game
or
a
favorite
food.
Verbal
comments:
“It
really
saves
me
/me
when
you
take
out
the
trash.
Non
verbal
behaviors:
eye
contact
or
a
pat
on
the
back.
Ac;vi;es:
a
back
rub,
a
walk
to
the
corner
for
ice
cream.

46. How
do
I
get
my
Loved
One
into
treatment?
• You
create
that
bridge
between
the
two
of
you.
• You
empathize
and
show
respect.
• You
stop
the
nega/ve
talk,
add
in
posi/ve
talk,
and
listen
to
what
your
LO
is
saying.
• You
make
requests.
You
don’t
dominate.
• You
take
care
of
yourself,
which
helps
you
stay
calm
and
pa/ent.
• You
understand
that
gekng
sober
and
clean
is
a
process.

47.  You
have
treatment
in
your
back
pocket.
 Treatment
defined
broadly:
public,
private,
self-­‐help,
faith-­‐based..
Windows
of
Opportunity
1)
A
wish
or
a
dip…Change
Talk,
there’s
mo/va/on
in
this.
2)
The
planned
conversa/on.
A
serious
moment
around
the
table.
3)
When
LO
talks
of
gekng
help.
 Script
it
out.
Avoid
jargon
and
words
like
alcoholic,
drug
addict,
treatment…
 Rehearse
it.
 Prepare
for
refusal.

48. Sandy’s
Tea
Party
I
hate
that
I
don’t
want
to
have
sex
with
you.
Only
recently
has
there
been
any
closeness
at
all.
I
don’t
want
any
more
weekends
like
the
last
one.
We
aren’t
enjoying
each
other.
I
think
we’re
both
isolated
and
lonely.
I
want
us
connected
again.
I
want
you.
That
isn’t
possible
with
your
drinking.
Come
see
me.
I
have
a
list
of
places
that
help
professionals
who
have
problems
with
drinking.
Will
you
take
a
look
at
it
with
me?

49. Controlled
Trial
130
family
members
assigned
to
1
of
3
interven/ons
" Al-­‐Anon
Facilita/on
therapy
" Johnson
Ins/tute
Interven/on
" CRAFT
" Loved
Ones
are
all
alcoholic

51. Family
Member
Depression
(Becks)

52. Sisson & Miller,
CRAFT
STUDIES
Kirby, et al., Meyers, Meyers, Waldron, Dutcher, et Manual, et
Azrin Meyers, et 1999 Miller, et al., Miller, et al., et. al., 2007 al., 1999 al., 2011
1986 al., 1999 1999 2002 adolescent Group vs
Self-
Directed
14 CSOs 130 CSOs 32 CSOs 62 CSOs 90 CSOs 42 CSOs 99 CSOs 40 CSOs
75% Anglo 80% 49% 48% 59% 60% Anglo
23% AA Hispanic Hispanic Hispanic Hispanic
Alcohol Alcohol 55% 37% Coca MJ MJ Alcohol Drugs/
Cocaine 35% MJ Cocaine Alcohol 90% Alcohol
22% 16% Stim Stimulants Cocaine
opiates 8% opiate 7%
Randomized Randomized Randomized Non- Randomized Non- Non- Craft in
(CRAFT vs (CRAFT/JI (CRAFT vs Randomized Randomized Randomized Group vs
12 Step) /12-step 12-step) Self-
Directed
86% vs 64% 74% vs 74% 65.5% vs 71% 55%-65% 70%
0% vs23% 17% CSOs 29% CSOs CSOs vs 40%
CSOs vs13% CSOs Better CSOs Better Better Better
Better CSOs Better Better
Better

53. Other
Outcomes
from
Clinical
Trials
" CRAFT-­‐engaged
Loved
Ones
most
owen
anend
6
sessions
of
outpa/ent
treatment
as
compared
to
NM
state
modal
of
1.
" Loved
Ones
reduce
their
use
by
50%
while
family
member
is
in
CRAFT

54. CRAFT
Resources
Dr.
Robert
Meyers,
William
Miller,
Jane
Ellen
Smith,
University
of
New
Mexico,
Center
on
Alcoholism,
Substance
Abuse,
and
Addic/ons
HBO
film
on
CRAFT
hnp://www.hbo.com/addic/on/thefilm/supplemental/
628_addict_into_treatment.html
Dominique
Simon-­‐Levine
dominiquesimon@comcast.net
Simonlevine.com