sowk 752

1. SOWK 752
SW INTERVENTIONS IN SUBSTANCE USE
Spring 2021
Rhonda DiNovo, Clinical Assistant Professor, LMSW, MSW
MSW Program Coordinator
Graduate Certificate in Drug and Addiction Studies,
Coordinator

2. TODAY’S DISCUSSION
New Material: Treatment
Withdrawal Management
Psychosocial Treatment
Approaches
Building Resiliency
Motivational Interviewing
 Listening Skills
 Willingness/Ability Ruler
Assignment #3
Practice

3. REVIEW: TREATMENT FOR SUDS AND ADDICTION
• Evidence shows best success for treatment includes BOTH pharmacological and
psychosocial treatments that combine a number of different treatment modalities
• Pharmacological treatments include:
 medications to treat intoxication and withdrawal states
 medications to decrease the reinforcing effects of abused substances
 agonist maintenance therapies
 antagonist therapies
 abstinence-promoting and relapse prevention therapies
 medications to treat comorbid psychiatric conditions
• Psychosocial EB treatments include:
 Resilience
 Motivational Interviewing and Motivational Enhancement Therapy
(MET)
 Cognitive Behavior Therapies
 Interpersonal Therapy
 Positive Psychology
 12-step facilitation (TSF)
 brief interventions
 case management
 group, marital, and family therapies

4. WITHDRAWAL MANAGEMENT
May be referred to as “detox”
Refers to the medical and
psychological care of patients
who are experiencing withdrawal
symptoms as a result of ceasing
or reducing use of their drug of
dependence
Reduces the discomfort of
patients, shows empathy, and
can help to build trust between
patients and treatment staff
It is very common for people who
complete withdrawal
management to return to drug
use.
Important first step before a
patient commences psychosocial
treatment
Opioid dependent can be
commenced on methadone
immediately and will not need
WM

5. STANDARDS OF CARE FOR WM
• Patients in withdrawal should be accommodated away from patients who have already completed
withdrawal
• Healthcare workers should be available 24 hours a day. Workers should include:
• Doctor: on call to attend to patients with complications
• Nurses: monitoring patients in withdrawal, dispensing medications as directed by the doctor
and providing the patient with information about withdrawal
• The WM area should be quiet and calm.
• Patients should be allowed to sleep or to do moderate activities, such as walking. Patients should
have opportunities to engage in meditation or other calming practices.
• Patients in withdrawal should not be forced to do physical exercise. There is no evidence that
physical exercise is helpful for WM. Physical exercise may prolong withdrawal and make withdrawal
symptoms worse.
• Patients in withdrawal may be feeling anxious or scared. Offer accurate, realistic information about
drugs and withdrawal symptoms to help alleviate anxiety and fears.
• Do not try to engage the patient in counselling or other psychological therapy at this stage. A person
in withdrawal may be vulnerable, confused, disoriented, disruptive and difficult to manage.
• Behavioral management strategies may be employed to help address difficult behavior.

6. PSYCHOSOCIAL TREATMENT APPROACHES
• Psychosocial EB treatments include:
 Resilience
 Motivational Interviewing and
Motivational Enhancement Therapy
(MET)
 Cognitive Behavior Therapies
 Positive Psychology
 Brief interventions
 Case management
 Interpersonal Therapy
 Group, marital, and family therapies
 12-step facilitation (TSF)

7. BUILDING RESILIENCY
• Garmezy, 1973: Published 1st research on
resilience
• Defined: ability to bounce back, to
withstand hardship and repair oneself
• Concepts of Risk and Protective Factors
• More than a response to difficult
situations. Includes the realization of:
• Strengths
• Cognitive capabilities
• Self-regulating behaviors
• Building of social networks
https://youtu.be/-DfStNZtUjE

8. BUILDING RESILIENCY
Process:
1- Homeostasis
2- Adversity, stressors, life events
3- Disruption
4- Reintegration
• Dysfunctional reintegration
• Reintegration with loss
• Reintegration back to homeostasis
Resilient Reintegration

9. WAYS TO BUILD RESILIENCE
Realistic Self Appraisal and
Understanding
Placing Emphasis on Relationships and
connecting with others
Ability to Evoke Nurturance
Accept Change as a part of Living
Self-Righting Tendencies Make Goals and
Take Decisive Actions
Address Stigma and Nurture a Positive
View of Self
Instill Hope

10. DEFINITION OF
MOTIVATIONAL INTERVIEWING
• A collaborative
conversation style for the
primary purpose of exploring
and resolving ambivalence
so as to strengthen a
person’s own motivation
and commitment to change

11. SOME BASIC FACTS ABOUT MOTIVATIONAL
INTERVIEWING
Dr. Bill Miller & Stephen Rollnick, 1991
MI evolved from the addictions field
MI is evidence-based- Proven effective in a wide variety of
client populations, in both clinical and non-clinical settings
MI is brief
MI is NOT therapy, rather a conversation style and a way of
being present with the client

12. MI: CONSTRUCTED ON AN ETHICAL THEORETICAL FRAMEWORK
MI practice aligns with four foundational practice theories:
• Person/Relationship-Centered Approach: non-directive, empathic
approach that empowers and motivates
• Self Determination Theory: examination of psychological needs and
continuum of motivation
• Mindfulness: A state of active, open awareness and attention on the
present moment
• Trans-theoretical Model of Change: understanding fluctuations in and
incremental stages of changes

13. TRANS THEORETICAL MODEL OF CHANGE:
ACCEPTING THAT CHANGE FLUCTUATES AND OCCURS INCREMENTALLY
Pre-
contemplati
on
Contemplati
on
Preparation
Action
Maintenanc
e
Set Back
(Return to
behavior)
No intention of
changing behavior
Aware a problem
exists, but no
commitment to
action
Intent upon
taking action
Actively modifying
behavior
Sustained change –
new behavior
replaces old
Fall back into old
patterns of behavior
Stable,
safer
lifestyle

14. THE STYLE OF MI
• MI is not just techniques
• A way of being present with
a person
• Approach the relationship
with exploration and
wonder
• A way of guiding through
communication

15. THE SPIRIT OF MI
Habits of the Heart
We are a privileged witness to
change
Four key elements
• Partnership
• Acceptance
• Compassion
• Evocation

16. THE MI PROCESS FOR CHANGE
Two phases:
• Engaging
• Focusing
1. Building motivation
• Evoking
• Planning
2. Strengthening
commitment to change
The four processes flow, overlap, and
recur.

17. BREAK TIME

18. MI PROCESS STEP #1: ENGAGEMENT
Establishment of mutual trust
and respect
Agreement on treatment
goals
Collaboration on mutually
negotiated tasks to reach the
goals

19. MI PROCESS STEP #2: FOCUSING
• Clarifying, developing and
maintaining a specific
direction in the conversation
about change
• Goals may/may not involve
behavior change. Change can
also occur in attitude,
thoughts, acceptance of not
change

20. MI PROCESS STEP #3: EVOKING
• Once engagement and a working
relationship is established, and a clear
focus is determined, we can move on
to evoking.
• The task of the helper is to recognize
change talk, know how to evoke and
respond to it.
• Helper elicits client’s motivation for
change and strengthens change talk.
• Clients talk themselves into change

21. STEP #1: PREPARATORY CHANGE TALK
• Acronym: DARN
• None of these, alone or together, indicate
that change in going to happen
D- Desire Statements
• I want to make my life better.
A-Ability Statements
• I can do it.
R-Reason Statements
• Here are the reasons I have to
quit.
N-Need Statements
• I need to do this.

22. STEP #2: MOBILIZING CHANGE TALK
• Acronym: CAT
• Committing language signals likelihood of
action
C-Commitment
• I will, I promise, I intend to, I
guarantee
A-Activation
• Language that describes when
and how the change will occur
T-Taking Steps
• Speech that indicates steps have
been taken in the direction of
change

23. MI PROCESS STEP #4: PLANNING
• Formulating a plan for action
• Developing commitment to
change
• Implementing the plan
• Supporting the change

24. TOOL #1 FOR MI: LISTENING
OARS:
• Open-ended questions
• Affirming
• Reflective Statements
• Summarizing

25. OPEN ENDED QUESTIONS
Requires more than yes or no answer:
• What would you like to talk about?
• What do you want to gain from our time
together?
• How did that happen?
• Can you describe what you did?
• Can you tell me more about it?
• How do you see yourself if you stay the same?
• What are your goals? What do they look like?
• What steps do you think you could take toward
change?

26. AFFIRMING
A 3 Step Process:
Acknowledging the client’s
difficulties
Validating the client’s
experience and feelings
Emphasizing past
experiences that demonstrate
strength and success

27. REFLECTIVE STATEMENTS
• Steps:
• Listen carefully
• Form a hypothesis
• Try out your guess
• Types:
• Simple
• Complex
• Amplified
• Double-Sided

28. SUMMARIZING
• Demonstrates you’ve been
listening carefully
• Shows you understand the
big picture
• Highlights important points
• Wraps up and serves as a
transition to move on

29. TOOL #2 FOR MI: WILLINGNESS/ABILITY RULER
• On a scale of 1-10, with 1 being not at all, and 10 being
the most, how willing/able are you to ___________?
• Follow up question: And why are you at a ____ and not (a
lower number)?
• If client answers 0, this signals no ambivalence, and
suggests pre-contemplation.
• What would it take for you to go from (current number) to
say, (a higher number)?
• What might a significant other give? Why is this person’s
number so high?

30. ASSIGNMENT #3

31. PRACTICE: OARS LISTENING SKILLS
Pair with a partner. Listen while they
describe a problem/change they are
considering.
Practice each of the listening skills.
Ask an open-ended question.
Affirm my experience.
Reflect on my statements.
Summarize the dialogue.
Use the willingness/ability ruler to
assess where you might be able to
help them.

32. CONTACT ME:
Email: dinovo@mailbox.sc.edu
Text: (803)586-3830
Office: Hamilton, Room 221
Office Hours: By Appointment

33. THANKS!