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Module 3 - Behavioral Interventions: Integrating Tobacco Use Interventions into Chemical Dependence Services PowerPoint PPT Presentation


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Module 3 - Behavioral Interventions: Integrating Tobacco Use Interventions into Chemical Dependence Services. Welcome. Add Trainer Names. This training was developed by the Professional Development Program, under a contract with the NYS Department of Health, Tobacco Control Program.

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Module 3 - Behavioral Interventions: Integrating Tobacco Use Interventions into Chemical Dependence Services

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Module 3 - Behavioral Interventions:Integrating Tobacco Use Interventions into Chemical Dependence Services


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Welcome

  • Add Trainer Names


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This training was developed by the Professional Development Program, under a contract with the NYS Department of Health, Tobacco Control Program.

PDP developed five classroom-based curricula and seven online modules, which are available at www.tobaccorecovery.org


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Housekeeping

  • Hours of Training

  • Breaks and Restrooms

  • Tobacco Use Policy

  • Cell Phones

  • Active Participation

  • Complete Training Evaluation


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Introductions


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Training Modules

Module 1 - The Foundation

Module 2 - Assessment, Diagnosis, Pharmacotherapy

Module 3 - Behavioral Interventions

Module 4 - Treatment Planning

Module 5 - Co-occurring Disorders

E-Learning - All Modules (www.tobaccorecovery.org)


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Module 3 Agenda

  • Counseling Techniques

    • Motivational Interviewing

    • Cognitive Behavioral Therapy

    • Relapse Prevention

  • Case Studies

  • Facilitating a Tobacco Awareness Group


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    Module 3 Objectives

    PM 9


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    Unit 1Motivational Interviewing


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    Discussion

    Understanding and Applying the

    Stages of Change

    PM 12


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    Readiness to Change

    IMPORTANCE

    READINESS

    Skills/Knowledge

    CONFIDENCE

    PM 13


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    Discussion

    Treating Tobacco Use and Dependence:

    Clinical Practice Guideline

    2008 Update

    PM 14


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    When MIis Most Effective

    40%

    40%

    20%


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    Motivational Interviewing

    MI is considered an evidence-based practice for the treatment of substance use disorders, including tobacco dependence

    “A patient-centered, directive method for enhancing intrinsic (internal) motivation to change by exploring and resolving ambivalence” (Miller and Rollnick, 2002)


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    Discussion

    What is the “spirit” of Motivational Interviewing?

    PM 16 - 17


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    Discussion

    What are the four guiding principles of Motivational Interviewing?

    PM 18


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    What ambivalence usually looks like…


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    Discussion

    What is resistance?

    What does resistance look like?

    What makes resistance worse?


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    Discussion

    O - open questions

    A - affirmation

    R - reflective listening

    S - summarizing

    PM 21


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    Activity

    Identifying open and closed questions

    PM 22


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    Discussion

    What are the different kinds of reflective responses?

    PM 23 - 25


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    Activity

    Reflective Listening

    PM 26


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    Discussion

    What is “problem talk”?

    What is “change talk”?

    PM 27


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    The more change talk that patients demonstrate, the more likely it is that they will move towards making a change.

    Status

    Quo

    Change

    PM 27


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    Using DARN-C for Identifying Change Talk

    D - Desire to Change

    A - Ability to Change

    R - Reasons to Change

    N - Need to Change

    C - Commitment

    PM 28


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    Activity

    Identifying change talk

    Ten strategies for eliciting change talk

    PM 29 - 31


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    Discussion

    What are the Five Rs?

    PM 32 - 34


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    Roadblocks

    PM 35


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    Discussion and Activity

    Providing Information vs. Giving Advice

    Using Elicit-Provide-Elicit

    PM 36 - 38


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    Unit 2Cognitive-Behavioral Therapy (CBT) andRelapse Prevention

    PM 41


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    Psychosocial Therapies

    • Psychosocial therapies are effective, but only received by 5% of tobacco users

    • Dose-response relationship

    • Combining with medication increases outcomes

    PM 42


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    Evidence-based Methods

    • CBT/RPT have been shown to be effective

    • CBT/RPT integrates with MI skills and SOC

    • Best used for patients in later stages of change

    PM 43


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    When to shift from MI to CBT?

    When

    CBT

    Is Most Effective

    PM 43


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    Principles of CBT

    • Thoughts/beliefs drive feelings and behaviors

    • Patients learn to identify and examine thinking patterns that lead to troublesome emotional states and behavior

    • Clinicians teach practical problem-solving skills

    • Patients gain new knowledge, develop new coping skills, and change old behaviors

    PM 44


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    Principles of CBT, cont’d

    CBT Helps a Patient to Examine and Change:

    • What they believe and feel about their tobacco use

    • Their relationship with tobacco and AOD

    • Their rituals of use

    PM 44


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    Components of CBT

    • Functional Analysis – identify patient thoughts, feelings, beliefs, and circumstances

    • Skills Training – learn coping skills, change behaviors, and use “homework” to practice change

    PM 45 - 46


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    Relapse Prevention

    • Relapse is a part of the disease of addiction. It is not failure or “a character defect” of the patient.

    • What are the major factors that contribute to relapse, and specifically for tobacco relapse?

    PM 47


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    PM 47


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    Relapse Prevention, cont’d

    • Minimal Components of Relapse Prevention

    • Components of Prescriptive Relapse Prevention (bio, psycho, social, and cultural)

    • Addressing behavioral patterns

    PM 48 - 54


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    Unit 3 Case Studies

    PM 57


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    Discussion

    What stage of change is each patient in regarding his/her tobacco use?

    Is the patient in the same or a different stage of change for their alcohol/other drug use?

    What treatment approaches might work best regarding the patient’s tobacco use?

    PM 58


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    PM 58 - 63


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    Unit 4Facilitating Tobacco Awareness Groups

    PM 67


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    Review

    Group Facilitation Skills – using EPE, open and closed questions, non–judgmental approach, and supporting self-efficacy

    Shifting to Recovery Language

    PM 68


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    Tobacco Treatment Groups

    Patient-Centered Psychoeducation

    Tobacco Awareness Group

    vs.

    Tobacco Recovery Group

    PM 70 - 71


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    Tobacco Awareness Groups (TAG)

    • Outcomes for TAGs

    • Topics for TAGs

    • Importance of using MI skills

    PM 70 - 71


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    TAG Activity 1

    Trainer demonstration

    Leading a tobacco awareness group

    Debrief

    PM 72 - 84


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    TAG Activities 2 and 3

    Participants practice facilitating a tobacco awareness group

    Debrief

    PM 85 - 97 and 98 - 105


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    Resources

    The Tobacco Recovery Resource Exchange http://www.tobaccorecovery.org

    E-Learning and Online Resources

    OASAS http://www.oasas.state.ny.us/tobacco/index.cfm

    Email: [email protected]


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    Workshop Evaluations and Post Test


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