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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


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.

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


Housekeeping

  • Hours of Training

  • Breaks and Restrooms

  • Tobacco Use Policy

  • Cell Phones

  • Active Participation

  • Complete Training Evaluation


Introductions


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)


Module 3 Agenda

  • Counseling Techniques

    • Motivational Interviewing

    • Cognitive Behavioral Therapy

    • Relapse Prevention

  • Case Studies

  • Facilitating a Tobacco Awareness Group


  • Module 3 Objectives

    PM 9


    Unit 1Motivational Interviewing


    Discussion

    Understanding and Applying the

    Stages of Change

    PM 12


    Readiness to Change

    IMPORTANCE

    READINESS

    Skills/Knowledge

    CONFIDENCE

    PM 13


    Discussion

    Treating Tobacco Use and Dependence:

    Clinical Practice Guideline

    2008 Update

    PM 14


    When MIis Most Effective

    40%

    40%

    20%


    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)


    Discussion

    What is the “spirit” of Motivational Interviewing?

    PM 16 - 17


    Discussion

    What are the four guiding principles of Motivational Interviewing?

    PM 18


    What ambivalence usually looks like…


    Discussion

    What is resistance?

    What does resistance look like?

    What makes resistance worse?


    Discussion

    O - open questions

    A - affirmation

    R - reflective listening

    S - summarizing

    PM 21


    Activity

    Identifying open and closed questions

    PM 22


    Discussion

    What are the different kinds of reflective responses?

    PM 23 - 25


    Activity

    Reflective Listening

    PM 26


    Discussion

    What is “problem talk”?

    What is “change talk”?

    PM 27


    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


    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


    Activity

    Identifying change talk

    Ten strategies for eliciting change talk

    PM 29 - 31


    Discussion

    What are the Five Rs?

    PM 32 - 34


    Roadblocks

    PM 35


    Discussion and Activity

    Providing Information vs. Giving Advice

    Using Elicit-Provide-Elicit

    PM 36 - 38


    Unit 2Cognitive-Behavioral Therapy (CBT) andRelapse Prevention

    PM 41


    Psychosocial Therapies

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

    • Dose-response relationship

    • Combining with medication increases outcomes

    PM 42


    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


    When to shift from MI to CBT?

    When

    CBT

    Is Most Effective

    PM 43


    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


    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


    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


    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


    PM 47


    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


    Unit 3 Case Studies

    PM 57


    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


    PM 58 - 63


    Unit 4Facilitating Tobacco Awareness Groups

    PM 67


    Review

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

    Shifting to Recovery Language

    PM 68


    Tobacco Treatment Groups

    Patient-Centered Psychoeducation

    Tobacco Awareness Group

    vs.

    Tobacco Recovery Group

    PM 70 - 71


    Tobacco Awareness Groups (TAG)

    • Outcomes for TAGs

    • Topics for TAGs

    • Importance of using MI skills

    PM 70 - 71


    TAG Activity 1

    Trainer demonstration

    Leading a tobacco awareness group

    Debrief

    PM 72 - 84


    TAG Activities 2 and 3

    Participants practice facilitating a tobacco awareness group

    Debrief

    PM 85 - 97 and 98 - 105


    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]


    Workshop Evaluations and Post Test


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