6. Management of CEP 2 Workshop 2013 (NXPowerLite)
-
Upload
frasertodd -
Category
Documents
-
view
216 -
download
0
Transcript of 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
1/89
CEP Workshop Series 2013
Module 6: Management 2
Fraser Todd and Michelle Fowler
2013
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
2/89
Workshop Introduction
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
3/89
Workshop Agenda
Mihi and Introductions
Housekeeping & Workshop overview
Introductory Mindfulness Exercise
Withdrawal
Level 1 Interventions - Diagnoses
Psychological Interventions
Drugs and Medication
Action Planning
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
4/89
Exercise 1: Mindfulness Introduction
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
5/89
Review of Treatment Planning
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
6/89
Review of Treatment Planning
:
"#$%&$'()*+
,-#. #)/0&12%"3-*)* -%/ *4-5)* 26 4#)-4.)%474#0&40#$%5 8#)-4.)%4
7')&$9&*+
:$43/#-;-( .-%-5).)%4 ?%4)#=)%12%* @ A$-5%2*)*
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
7/89
From Formulation to Treatment Planning
Steps for Developing a Treatment Plan:
83) I'$%$2%
,$*42#D -%/ J7K
L2#.0(-12% 74-4).)%4
M2-( ?/)%19&-12% -%/ 7)N%5
M2-( "(-%%$%5
8#)-4.)%4 "(-%%$%5
A$-5%2*$*"#2O().* -%/ 74#)%543*P)12(25$&-( 62#.0(-12%Q RSR M#$/
74)' >+
74)' B+
74)' T+
74)' R+
"#$2#$1*$%5 52-(*7')&$9& $%4)#=)%12%*>U '2$%4 4#)-4.)%4 *4#0&40#)
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
8/89
Rachel
Rachel Formulation Statement:
"#$%&'(
)*+'%,-+-./ #'0 1&-22%&3(
L#2. ;3-4 D20 3-=) 42(/ .) $4 -'')-#* 43-4 D20 .-D 3-=) *2.) 5)%)1& '#)/$*'2*$12% 42 *0O*4-%&) 0*) /$*2#/)#
4#-'.#-'-'2(
?4 -'')-#* D20# -(&232( 0*)
A$*4#)**$%5 ).212%* 6))($%5* D20 3-=) O))% )S')#$)%&$%5 62# - (2%5 1.)W
,2;)=)#
6-&$%5 X D20 3-=) O))% )S')#$)%&$%5
D20# /$*4#)** -%/ ).212%* ;$43204 ;2#*)%$%5 43) *D.'42.* 26 /)'#)**$2% ;$43204 ;2#*)%$%5 43) *D.'42.* 26
5.&%'2.63(
,2;)=)#G ? -(*2 3)-# 43-4 D20 -#) .21=-4)/ 42 .-E) *2.) &3-%5)* OD &2.$%5 3)#) -%/ 4-E$%5 43)*) *4)'*G ;3$&3
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
9/89
Rachel
Early and Middle Phase Treatment Goals:
7#86%+ 9:#+ 5%;'2
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
10/89
?%4)5#-4) E)D *4#-4)5$)* $%42 62((2;@0'^43)#-'D *)**$2%*
Motivational Framework for Session Structuring:
>
8-E) 2''2#40%$1)* 42 #)_)&4
Q *0..-#$*)
]3-%5) 4-(E:)((@O)$%5 4-(E
T-B TO R
\)$%62#&) &2..$4.)%4 4-(E7)4 P5)%/-
7'$#$4 26 .21=-12%-( $%4)#=$);$%5
In the next episode
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
11/89
Management Structure
Structured Follow-up Session Planning Template:
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
12/89
W-.60@#+ 4#'#2%=%'.
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
13/89
J-40- \-E$V BU>>V !"#$%&'() +,%-./&0&1 2&'&3)4)'%5 6",.)1,')$ 78/ 4).,(&1 &'.'"/$,'3 9/&(::8')/$ ,' 9/,4&/; -)&1%-< $9)(,&1,$% &..,(:8'$< ("$%8.,&1 &'. 3)')/&1
-8$9,%&1 $)='3$>J-40- \-E$G :)(($%542%V
J-40- \-E$V BU>>V !"#$%&'() +,%-./&0&15 2&'&3)4)'% 3",.)1,')$ 78/ &..,(:8'&'. &11,). $)/?,()$>J-40- \-E$G :)(($%542%V
Resources
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
14/89
83) '#2&)** -%/ 43) -&04) *D.'42.*G '3D*$&-( -%/ '*D&32(25$&-(G 43-4 &-%-&&2.'-%D 43) &)**-12% 2# #)/0&12% 26 0*) 26 -%D *0O*4-%&) 43-4 3-* O))% 0*)/
#)50(-#(D 2=)# - '#2(2%5)/ ')#$2/ 26 1.)V
:$43/#-;-( 2&&0#* $% *0O*4-%&)@/)')%/)%4 ')2'() ;32 *42' 2# &2%*$/)#-O(D#)/0&) 43)$# /#05 0*)V
83) /$-5%2*$* 26 /)')%/)%&) $* 5)%)#-((D #)`0$#)/ 42 0%/)#*4-%/ -%/ .-%-5) /#05;$43/#-;-(V
Withdrawal
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
15/89
J-(-/-'1=) "-a)#% 26 0*) ;$43 -4 ()-*4 43#)) 26 43)
62((2;$%5 2&&0##$%5 ;$43$% - >B .2%43 ')#$2/+
>V 82()#-%&)BV :$43/#-;-(TV b*) $* 2c)% .2#) 43-% $%4)%/)/ F`0-%14DG 1.)HRV b%*0&&)**60( -a).'4* 42 &04 /2;% 2# &2%4#2( 0*)dV J0&3 1.) *')%4 $% 0*) #)(-4)/ -&1=$4DeV ?.'2#4-%4 -&1=$1)* 5$=)% 0' 2# #)/0&)/fV ]2%1%0)/ 0*) /)*'$4) E%2;()/5) 26 -**2&$-4)/ '#2O().*
DSMIV Criteria for Dependence
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
16/89
83) '0#'2*) 26 g;$43/#-;-( .-%-5).)%4Y $* 42 )%*0#) 43) *-6)4D 26 43) ')#*2%G-%/ 243)#*G -* 43)D *42' 2# #)/0&) *0O*4-%&) 0*)G -%/ ;3)#) '2**$O() 42 -//#)**
;$43/#-;-( *D.'42.* 42 -(()=$-4) -&04) /$*4#)**V
Withdrawal Management
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
17/89
P''#2'#$-4) ;$43/#-;-( .-%-5).)%4 '(-%%$%5 /)')%/* 2% -% -&&0#-4) -**)**.)%4 26
43) ')#*2%Y*+
'-a)#%* 26 *0O*4-%&) 0*)h ;3-4G 32; .0&3G 32; 2c)% -%/ (-*4 0*) ;$43/#-;-( #$*E*G #$*E* 42 *)(6 -%/ 243)#*G 3$*42#D 26 ;$43/#-;-( &2@)S$*1%5 '#2O().*h .)%4-( -%/ '3D*$&-( 3)-(43 *0''2#4 *D*4).*h 6-.$(DG ;3i%-0 -%/ 6#$)%/* .21=-12%h 52-(* -%/ #)*$($)%&) *)N%5 *-6)4D )S4)#%-( *20#&)* 26 *4#)**
Factors Affecting Planning
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
18/89
I#5-%$*) - *-6) )%=$#2%.)%4 I#5-%$*) *0''2#4* K/0&-4) 26 ;-D* 26 /)-($%5 ;$43 -=$%5* 8$'* 42 $.'#2=) *())' \)(-S-12% 4)&3%$`0)*
Management of Withdrawal
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
19/89
]2'$%5 ;$43 .22/ *;$%5*G *4#-%5) 4320534* -%/ -&3)* -%/ '-$%* K-1%5 '#2')#(D ]2%&)%4#-1%5 2%(D 2% 43) $..)/$-4) 6040#) ?/)%16D$%5 3$53 #$*E *$40-12%* IO4-$%$%5 &20%*)(($%5
Management of Withdrawal
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
20/89
]IJ"
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
21/89
:$/) #-%5) 26 *)N%5*G 6#2. 43) ')#*2%Y* 2;% 32.) 42 5)%)#-( '#-&1&)G
5)%)#-( 32*'$4-(*G '2($&) &)((* -%/ '#$*2%*V
]2..0%$4D 32.) O-*)/ ;$43/#-;-( .-%-5).)%4+ 72&$-( 2# #)*'$4) *)#=$&) O-*)/ ;$43/#-;-( .-%-5).)%4+ 72&$-( ;$43/#-;-( .-%-5).)%4 O)/*+ ?%'-1)%4 .)/$&-( ;$43/#-;-( .-%-5).)%4+
Withdrawa Management: Settings
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
22/89
?%4)%*$4D 26 0*) 8D') 26 0*) A2*)G 6#)`0)%&D -%/ /0#-12% 26 0*) J2/) 26 -/.$%$*4#-12%
I43)# *0O*4-%&) 0*) ]2@)S$*1%5 .)%4-( 3)-(43 '#2O().* ]2@)S$*1%5 '3D*$&-( 3)-(43 '#2O().* $V) 3D')#4)%*$2%G /$-O)4)* P 3$*42#D 26 3$53 #$*E 2# ;$43/#-;-( #)(-4)/ *)$m0#)* P 3$*42#D 2# -''-#)%4 ;$43/#-;-( #)(-4)/ &2.'($&-12%* *0&3 -* /)3D/#-12% \$*E* 42 43) $%/$=$/0-( 2# &2..0%$4D K%=$#2%.)%4 -%/ '*D&32*2&$-( *0''2#4*V
Factors Affecting Severity of Withdrawal
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
23/89
KS-&)#O-12% 26 &2@)S$*1%5 .)%4-( 3)-(43 2# '3D*$&-( '#2O().*
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
24/89
P
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
25/89
g:$43/#-;-( *D%/#2.)Y f @>U /-D* F/)')%/$%5 2% *0O*4-%&)H:2#*4 /-D* O)4;))% B@R
"3/86:+:2-8#+(
P5$4-12% G $##$4-O$($4D J22/$%)**G .22/ *;$%5* 2# 6))($%5 (2; P%S$)4D -%/ ;2##$)* \)*4()**%)** -%/ $%-O$($4D 42 *())' A$p&0(4D &2%&)%4#-1%5 -%/ 9/5)1%)** 8$#)/%)** -%/ (2; $% )%)#5D ]#-=$%5 F3-%5$%5 204H -%/ *4#2%5 0#5)* 42 0*) 74#-%5) /#)-.* -%/^2# %$534.-#)*
Withdrawal Symptoms
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
26/89
"6/3-8#+ 5/=?.:=3
7;)-1%5G 522*)O0.'*G 6))($%5 324 2# &2(/ ]2(/ 2# _0 ($E) *D.'42.*
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
27/89
A33%33=%'.(
P *')&$9& -(&232( 0*) 3$*42#D -(*2 $%&(0/)*+
4D') -%/ *4#)%543 Fq -(&232( ')# =2(0.)H &0##)%4(D 0*$%5 1.) 26 (-*4 /#$%E -=)#-5) %0.O)# 26 *4-%/-#/ /#$%E* F78AY*H - /-D 2=)# 1.) -%D /#$%E$%5 *22% -c)# ;-E$%5 %))/$%5 42 &2%4#2( *3-E)* OD 0*$%5 -(&232( '-*4 3$*42#D 26 *)$m0#)* '-*4 3$*42#D 26 3-((0&$%-12%* &2@)S$*1%5 '3D*$&-( 3)-(43 '#2O().*
Alcohol Withdrawal
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
28/89
")2'() ;32 -#) '3D*$&-((D /)')%/)%4 0'2% -(&232( -#) ($E)(D 42)S')#$)%&) ;$43/#-;-( *D.'42.* e@BR320#* -c)# 43) (-*4 /#$%E $*
&2%*0.)/
P:7 $* 0*0-((D 0%&2.'($&-4)/ #)*2(=$%5 $% d/-D* P:7 32;)=)# $* /)4)#.$%)/ OD &($)%4* /#$%E$%5 '-a)#%G 6#)`0)%&DG
/0#-12% -%/ 0-%14D
Alcohol Withdrawal Syndrome
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
29/89
Alcohol Withdrawal
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
30/89
Alcohol Withdrawal
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
31/89
Alcohol Withdrawal Complications
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
32/89
2&&0# $% Bdq 26 ')2'() ;$43 *)=)#) -(&232( /)')%/)%&) 5)%)#-((D .2#) &2..2% $% 43) 9#*4 Rr 320#* O04 &-% 2&&0# 0' 42 /-D
9=)
0*0-((D =$*0-( -%/ 4-&1() -%/ -#) 2&&-*$2%-((D -0/$42#D &-% 2&&0# ;3$() 43) ')#*2% $* *1(( 2#$)%4-4)/ ;$43204 /)($#$0.
Hallucinations
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
33/89
2&&0# $% >dq 26 ')2'() ;$43 *)=)#) -(&232( /)')%/)%&) #$*E $%)-*)* 42 fUq $6 ')#*2% 3-* 3-/ - '#)=$20* ;$43/#-;-(
*)$m0#)
5)%)#-((D 2&&0# ;$43$% 43) 9#*4 Rr 3#* g5#-%/ .-(Y 4D') 26 *)$m0#) 0*0-((D 2%) 2# 6); $% %0.O)#
Seizures
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
34/89
A)($#$0. 4#).)%* $* 43) .2*4 *)=)#) 62#. 26 -(&232( ;$43/#-;-( *D%/#2.)-%/ $* - .)/$&-( ).)#5)%&DV
?% ')2'() ;32 -#) *)=)#)(D /)')%/)%4 /)($#$0. 4#).)%* 4D'$&-((D 2&&0#*-c)# 4;2 42 9=) /-D* 26 0%4#)-4)/ *)=)#) ;$43/#-;-( *D%/#2.)V
Delerium Tremens (DTs)
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
35/89
L)-40#)* $%&(0/)+
L(0&40-12%* $% O(22/ '#)**0#) 2# '0(*) A$*40#O-%&) $% _0$/ O-(-%&)^)()&4#2(D4)*^3D')#43)#.$- M#2** 4#).2#
"-#-%2$/ $/)-12% ]2%60*$2% -%/ /$*2#$)%4-12% KS4#).) -5$4-12% 2# #)*4()**%)**
Delirium Tremens (DTs)
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
36/89
L2#. 26 O#-$% $%s0#D #)*0(1%5 6#2. (-&E 26 43$-.$%) Fn>H /)9&$)%&D $%&3#2%$& -(&232( /)')%/)%4 '-1)%4*
]-% ()-/ 42 ')#.-%)%4 O#-$% /-.-5) -%/ .).2#D (2** $6 %24 4#)-4)/)-#(D
Wernickes Encephalopathy
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
37/89
]2%60*$2% jD*4-5.0*G ;$43 2# ;$43204 O(0##)/ =$*$2% P4-S$- ")#$'3)#-( %)0#2'-43D F&-% O) '#)*)%4 $% 0' 42 rUq 26 ')2'() ;$43
:)#%$&E)Y* )%&)'3-(2'-43DH
Symptoms of Wernickes Encephalopathy
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
38/89
83$-.$%) *320(/ O) '#)*$O)/ -%/ 2t)#)/ -* -% 2#-( .)/$&-12% 42 ')2'() -4
3$53 #$*E 26 /)=)(2'$%5 :)#%$&E)Y* )%&)'3-(2'-43D+
43) .-(%20#$*3)/ 2# -4 #$*E 26 .-(%20#$*3.)%4 432*) ;$43 /)&2.')%*-4)/ ($=)# /$*)-*) $% -&04) -(&232( ;$43/#-;-( O)62#) -%/ /0#$%5 '(-%%)/ -(&232( ;$43/#-;-(
Preventative Measures for WE
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
39/89
83) ]($%$&-( ?%*1404) :$43/#-;-( P**)**.)%4 62# P(&232( \)=$*)/ ]?:P@
P\
>U $4). *&-() 0*)/ $% -**)**$%5 *)=)#$4D 26 ;$43/#-;-( ,)('* 42 50$/) 4#)-4.)%4 ?.' 42 3)(' $%/$&-4) ;3)% ;$43/#-;-( $* &2%1%0$%5 /)*'$4) 4#)-4.)%4 83) *&-() $* 0*0-((D /2%) >@R 1.)* ')# /-DV
Monitoring the Withdrawal State
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
40/89
83$-.$%) >UU.5 /-$(D 0' 42 43#)) 1.)* - /-D 62# ')2'() ;$43/#-;$%56#2. -(&232(
A$-m)'-. #)/0&$%5 #)5$.) /)')%/$%5 2% *)=)#$4D 26 ;$43/#-;-(V L2#.$(/ 42 .2/)#-4) ;$43/#-;-( #)5$.) $* 0*0-((D 2=)# d@f /-D*
Medication Management
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
41/89
A55B554BC1(
P *')&$9& &-%%-O$* 0*) 3$*42#D $%&(0/)*+
`0-%14D 26 0*)G -.20%4 &2%*0.)/G 4D') 26 &-%%-O$* -%/ '24)%&D /0#-12%G '-a)#% -%/ 6#)`0)%&D 26 0*) .2/) 26 -/.$%$*4#-12% F*.2E)/ 2# )-4)%G .$S)/ ;$43 42O-&&2H 1.) -%/ -.20%4 26 (-*4 0*) '-*4 3$*42#D 26 -55#)**$2% -%/ =$2()%&)
Cannabis Withdrawal
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
42/89
"#2=$/) - .)%0 26 $%4)#=)%12% 2'12%*V 83$* .-D $%&(0/)+
83) &32$&) 26 *0//)% &)**-12%G ;$43 2# ;$43204 *D.'42.-1& .)/$&-12% P *0''2#4)/ 5#-/0-( #)/0&12% 0*$%5 '*D&32@*2&$-( $%4)#=)%12%*V ]2.'#)3)%*$=) -**)**.)%4G 4#)-4.)%4 '(-%%$%5 -%/ *0''2#1=) &20%*)(($%5
$% 43) &2..0%$4D -#) 43) .-$% *4#-4)5$)*
Measurement of Cannabis Withdrawal
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
43/89
P '-*4 3$*42#D 26 =$2()%&) -%/ -55#)**$2% .-D $%/$&-4) - #$*E 26 -55#)**$=)O)3-=$20# ;3$&3 &20(/ '(-&) 243)# ')2'() -4 #$*E
b%/)#(D$%5 .)%4-( 3)-(43 $**0)* .-D O) 0%.-*E)/ /0#$%5 ;$43/#-;-(
70$&$/-($4D -%/ *)(6 $%s0#D .-D O) - #$*E 6-&42# 62# ')2'() ;$43 - &2@)S$*1%5.22/ 2# '*D&321& /$*2#/)#
Risks Associated with Cannabis Withdrawal
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
44/89
Cannabis Withdrawal
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
45/89
Cannabis Withdrawal
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
46/89
")2'() ;$43 *)=)#) ;$43/#-;-( *D.'42.* -%/ 2# &2@)S$*1%5 '#2O().* .-D#)`0$#) -''#2'#$-4) .)/$&-12%
]2..2% 42 0*) (2; /2*) u0)1-'$%) 2# $6 .2#) *)=)#) #)/0&$%5 /$-m)'-.#)5$.)V
Medication Management
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
47/89
P *')&$9& P87 0*) 3$*42#D $%&(0/)*+
%-.)* -%/ 4D')* 26 P87 0*)/ #204) 26 0*) -%/ /2&0.)%4-12% 26 $%s)&1%5 *$4)* -=)#-5) 6#)`0)%&D -%/ 0-%14D 26 0*)G $% .$(($5#-.*G 2=)# 1.) 1.) 26 (-*4 0*) &2%4)S4 26 0*) ')#$2/* 26 -O*1%)%&) &0##)%4 2# #)&)%4 '*D&32*$* *D.'42.* $%$1-( #)-*2%* 62# *4-#1%5 42 0*) P87
ATS Withdrawal Assessment
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
48/89
P87 ;$43/#-;-( $* %24 '3D*$&-((D /-%5)#20* -%/ .2*4 ')2'() ;$(( &2.'()4);$43/#-;-( ;$43 .$(/ 42 .2/)#-4) *D.'42.*
- '-*4 3$*42#D 26 =$2()%&) -%/ -55#)**$2% .-D $%/$&-4) - #$*E 26 -55#)**$=)O)3-=$20# ;3$&3 &20(/ '(-&) 243)# ')2'() -4 #$*E
0%/)#(D$%5 .)%4-( 3)-(43 $**0)* .-D ).)#5) /0#$%5 ;$43/#-;-( *)#242%$% 42S$&$4D .-D 2&&0# /0) 42 )()=-4)/ *)#242%$% ()=)(*G )*')&$-((D $6
43) ')#*2% $* -(*2 '#)*$O)/ -% 77\?
Risks Associated with ATS Withdrawal
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
49/89
L2((2;$%5 43) g-*3Y ;$43/#-;-( O)5$%* J2*4 *D.'42.* ')-E O)4;))% /-D* 4;2 -%/ 4)% 72.) *D.'42.* &-% ')#*$*4 62# *)=)#-( .2%43*G )*')&$-((D *())' -%/
.22/ '#2O().*V
ATS Withdrawal
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
50/89
]\P7, ",P7K APZ7 >@R
L-150) -%/ )S3-0*12% ,0%5)# K.212%-( (-O$-($4D F$##$4-O()G -5$4-4)/G /)'#)**)/H I=)#;3)(.$%5 /)*$#) 42 *())' 2# *())'$%5 /$p&0(1)* ]#-=$%5*
ATS Withdrawal
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
51/89
Ab\?jM jKv8 :KKk
74#2%5 -=$%5* 2# 0#5)* 42 0*) A$*#0'4)/ *())'$%5 '-a)#%* J22/ *;$%5* ,)-/-&3)*G -&3)* -%/ '-$%* ?%)-*)/ -'')14) ?##$4-O$($4DG '-#-%2$-G -%S$)4D
ATS Withdrawal
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
52/89
ATS Withdrawal
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
53/89
P//#)** 3)-(43 $**0)* 43-4 &20(/ O) &-0*$%5 '-$% J2%$42# .22/ *4-4)* -%/ *0$&$/-( $/)-12% &(2*)(D "#2=$/) /$)4-#D -/=$&) -O204 43) %))/ 62# *0*4-$%)/ 3)-(43D )-1%5 -%/
.0(1=$4-.$% 0*) 62((2;$%5 ($E)(D '22# %04#$12% ;3$() 0*$%5 P87
?%=2(=) .)%4-( 3)-(43 *)#=$&)* $6 -%S$)4DG /)'#)**$2% 2# '*D&32*$* ).)#5)-* '#2O().* '2*4 /)42S$9&-12%
Management of Withdrawal
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
54/89
")2'() ;$43 *)=)#) ;$43/#-;-( *D.'42.* -%/ 2# &2@)S$*1%5 '#2O().*.-D #)`0$#) -''#2'#$-4) .)/$&-12%
]2..2% 42 0*) u0)1-'$%) 2# $6 .2#) *)=)#) #)/0&$%5 /$-m)'-. #)5$.)V
Medication Management
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
55/89
Exercise 2: Rachel: Withdrawal
?% *.-(( 5#20'*+
j2.$%-4) - *$O) -%/ *2.)2%) 42 6))/O-&E
\)=$); 43) &-*) 26 \-&3)( $6 D20 %))/ 42
>V :3-4 *D.'42.* 26 ;$43/#-;-( /2 D20 43$%E \-&3)( ;$(( )S')#$)%&)wBV I=)# ;3-4 1.) ')#$2/wTV A)*$O) $% /)4-$( 43) *')&$9& *4)'* D20 ;$(( 4-E) 42 .-%-5) 3)# ;$43/#-;-( *D.'42.*
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
56/89
Level 1 Interventions: Diagnoses
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
57/89
Level 1 Interventions: Diagnoses
Overview:
8#)-4.)%4 x -''(D$%5 5)%)#$& $%4)#=)%12%* 42 /$-5%2*)*b*)60( $% *4)'')/ &-#) -''#2-&3h &2..2% O-*$* 26 4#)-4.)%4 $%4)5#-12%L2# 432*) ;$43 *)=)#) .)%4-( $((%)**+
o>^T#/ /2 ;)(( -c)# >B .2%43* 26 4#)-4.)%4o>^T#/ /2 '22#(D $%$1-((D O04 -#) /2$%5 ;)(( -c)# >U D)-#* 26 4#)-4.)%4o>^T#/ -#) /2$%5 '22#(D -c)# >U D)-#* 26 4#)-4.)%4
83)#)62#) - *4)'')/ -''#2-&3 $* #)-*2%-O() $%$1-((D
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
58/89
Level 1 Interventions: Diagnoses
Major Depression & Alcohol:
7D.'42.* 26 .-s2# /)'#)**$2% FJAKH '#)*)%4 $% 43) .-s2#$4D 26 3)-=D /#$%E)#* ?% .2*4G /)'#)**$2% #)*2(=)* ;$43$% B@R ;))E* 26 -O*1%)%&)P%D ')#*$*1%5 /)'#)**$=) *D.'42.* $%)-*) 43) #-4) 26 #)(-'*) Q =$&) =)#*-77\?Y* $%)-*) 43) #$*E 26 #)(-'*) /0) 42 $%)-*)/ $.'0(*$=$4D F43)#)62#) /#$%E$%5;3)% )S')#$)%&$%5 -=$%5*H )*')&$-((D $% .-()* ;$43 )S4)#%-($*$%5 O)3-=$20#V
j-(4#)S2%) #)/0&)* 77\?@$%/0&)/ $.'0(*$=$4D77\?Y* y j-(4#)S2%) x O)a)# 204&2.)* 62# O243 -(&232( -%/ /)'#)**$2%
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
59/89
Level 1 Interventions: Diagnoses
Major Depression & Alcohol:
1&%#.=%'. 7%8:==%'0#D:'3
:3)#) /)'#)**$2% -'')-#* 42 O) '#$.-#DG 4#)-4 O243 /)'#)**$2% -%/ -(&232( )-#(D:3)#) $4 $* 0%&()-# $6 /)'#)**$2% $* '#$.-#DG /)42S -%/ .2%$42# 62# B@R ;))E* ?% .-()* ;$43 )S4)#%-($*$%5 '#2O().*G &2.O$%) -%1/)'#)**-%4 y j-(4#)S2%)71(( &2%*$/)# 77\? y j-(4#)S2%) $% 243)#* ;$43 '#$.-#D^')#*$*1%5 /)'#)**$2% y -(&P$. 62# &2.'()4) #).$**$2% 26 /)'#)**$=) *D.'42.*]2%*$/)# -% 2Os)&1=) #-1%5 *&-() .)-*0#) )V5V nA? 42 &2.'().)%4 &($%$&-($.'#)**$2%
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
60/89
Level 1 Interventions: Diagnoses
Major Depression & Cannabis:
83) &2@2&&0##)%&) 26 /)'#)**$2% -%/ &-%%-O$* $* .-$%(D /0) 42 &2..2%0%/)#(D$%5 6-&42#* F/$*#0'1=) O)3-=$20# $% &3$(/322/H #-43)# 43-% -%D /$#)&4 )t)&4
77\?Y* .-D $%4)#-&4 ;$43 &-%%-O$* *0&3 43-4 &-%%-O$* $* ()** )%s2D.)%4832*) ;$43 &-%%-O$* /)')%/)%&) )%5-5) ()** ;)(( $% 4#)-4.)%4 26 /)'#)**$2%83)#) $* %2 )=$/)%&) 43-4 &-%%-O$* 0*) $.'-&4* 2% 43) 4#)-4.)%4 62# /)'#)**$2%V83)#) $* %2 #-12%-() 62# ;$43/#-;$%5 &-%%-O$* O)62#) 4#)-1%5 /)'#)**$2%
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
61/89
Level 1 Interventions: Diagnoses
Major Depression & Cannabis:
1&%#.=%'. 7%8:==%'0#D:'3
:$43 #)*')&4 42 43) #)(-12%*3$' O)4;))% &-%%-O$* -%/ /)'#)**$2% $% -%D '-#1&0(-#')#*2%G ($*4)% 42 43) ')#*2% -%/ ;2#E ;$43 43)$# #)'2#4* 26 43) $%4)#-&12%
?6 -% 77\? $* 42 O) '#)*$O)/ ;2#E 3-#/ 42 )%5-5)V 72.) ;$(( #)/0&) &-%%-O$*G 243)#*;$(( *42' 43) 77\?A2 %24 /)(-D 4#)-4.)%4 62# /)'#)**$2% 0%1( &-%%-O$* 0*) 3-* *42'')/V ?6 43)#) $* &2.2#O$/ -(&232( 0*)G j-(4#)S2%) .-D O) 0*)/ O04 .-D ()-/ 42 $%)-*)/&-%%-O$* 0*)V
]2%*$/)# 43) $%4)#-&12% O)4;))% &-%%-O$* -%/ 243)# '#2O().* 2c)% &2.2#O$/ ;$43/)'#)**$2%G *0&3 -* -%S$)4D *D.'42.*
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
62/89
Level 1 Interventions: Diagnoses
Bipolar Disorder & Alcohol:
P(&232( 0*)/ .2*4 &2..2%(D $% 43) /)'#)**)/ '3-*)
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
63/89
Level 1 Interventions: Diagnoses
Bipolar Disorder & Cannabis:
]-%%-O$* 0*)/ .-$%(D /0#$%5 ')#$2/* 26 )()=-12%b*)/ 62# 3)/2%$& 2# '()-*0#-O() -*')&4*]-%%-O$* -**2&$-4)/ ;$43 )()=-4)/ .22/ -%/ '*D&321& *D.'42.*83) $.'-&4 26 &-%%-O$* 2% O$'2(-# *D.'42.* .-D O) `0$4) =-#$-O()6#2. ')#*2% 42 ')#*2%
1&%#.=%'. 7%8:==%'0#D:'3
P* 62# -(&232(G 4#)-4 O$'2(-# /$*2#/)# -**)#1=)(DPO*1%)%&) 6#2. &-%%-O$* .-D O) `0$4) )-*$(D -&3$)=)/
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
64/89
Level 1 Interventions: Diagnoses
PTSD & Alcohol:
P(&232( 0*) /#$=)% OD 3D')#-#20*-(l$&$20* &D&() 26 $%4#0*$=) .).2#$)*G 3D')#-#20*-( -%/ #0.$%-12%
1&%#.=%'. 7%8:==%'0#D:'3b*) .$%/60(%)** -%/ $.-5$%-( /)*)%*$1*-12% )-#(D]2%*$/)# #$*')#$/2%)G O)4-@O(2&E)#* 2# '#-m2*$% 62# 3D')#-#20*-(A$*0('3$#-. F-%4-O0*)H .-D #)/0&) -%S$)4D -%/ 3D')#-#20*-(
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
65/89
Level 1 Interventions: Diagnoses
PTSD & Cannabis:
,$53 #-4)* 26 &-%%-O$* 0*) $% ')2'() ;$43 "87AG /#$=)% OD $%4#0*$=) .).2#$)*w]-%%-O$* -'')-#* 42 #)/0&) $%4#0*$=) .).2#$)*\)/0&12% $% &-%%-O$* 0*) .-D O) -**2&$-4)/ ;$43 $%)-*)/ "87A *D.'42.*1&%#.=%'. 7%8:==%'0#D:'3
P* ;$43 -(&232(G 0*) $.-5$%-( /)*)%*$1*-12% )-#(D]2%*$/)# -% 77\? 62# $%4#0*$=) .).2#$)*
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
66/89
Brief Psychological Interventions
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
67/89
Brief Psychological Interventions
Overview:
8-#5)4 *')&$9& '#2O().* -4
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
68/89
Brief Psychological Interventions
Amplifiers:
J21=-12%-( $%4)#=$);$%5J$%/60(%)**A)60*$2%K.212% #)50(-12%]2'$%5 *E$((* -%/ /$*4#)** 42()#-%&)\)(-S-12% *E$((*
o"#25#)**$=) .0*&() #)(-S-12%oA))' O#)-43$%5oM0$/)/ ?.-5)#D
on)3-=$20#-( -&1=-12%
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
69/89
Brief Psychological Interventions
Psychological Transdiagnostic Factors:
7)(6@)*4)). -%/ *)(6@)p&-&DPa)%12% &2%4#2( ?.'0(*$=$4Dj)5-1=) 0#5)%&Dj)5-1=) ).212%-($4D]25%$1=) -%/ -a)%12%-( O$-*K.212% #)50(-12%\0.$%-12%")#6)&12%$*.P=2$/-%4 &2'$%5 *4D()
?%*2.%$-
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
70/89
Basic CBT Model - ABC:
A&1=-1%5 K=)%4 E)3-=$20# F2%*)`0)%&)
Brief Psychological Interventions
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
71/89
Basic CBT Model:
A&1=-1%5 K=)%4 E)3-=$20# F2%*)`0)%&)
8320534*
L))($%5*P&12%*K.212%*"3D*$&-( *)%*-12%*
Brief Psychological Interventions
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
72/89
Basic CBT Model:
A&1=-1%5 K=)%4 E)3-=$20# F2%*)`0)%&)
8320534*
L))($%5*P&12%*
P042.-1& 8320534* ?%4)#.)/$-4) n)($)6* ]2#) 7&3).-
2&1&.&9:?) @-8"3-%$ A B)1,)7$5
K.212%*"3D*$&-( *)%*-12%*
Brief Psychological Interventions
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
73/89
Brief Psychological Interventions
Identifying Activating Events/Antecedents:
:3-4 ;)#) D20 6))($%5 O)62#) D20 /$/ 43-4w F-t)&4^).212%H
:3-4 3-'')%* '3D*$&-((D O)62#) 43$* 3-'')%*w F'3D*$&-(H
,2; /2 D20 %2#.-((D -&4 O)62#) 43$* 3-'')%*w FO)3-=$20#H
:3-4 4320534* 52 43#2053 D20# .$%/ O)62#) 43$* 3-'')%*w F]25%$1=)H
:3)#) -%/ ;3)% /2)* $4 0*0-((D 3-'')%w F&2%4)S40-(H
A2)* 43$* 3-'')% ;$43 )=)#D2%) 2# s0*4 ;$43 &)#4-$% ')2'()w F#)(-12%-(H
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
74/89
Brief Psychological Interventions
Identifying Maladaptive Thoughts:
M0$/)/ /$*&2=)#D F72-1& 0)*12%$%5H ?/)%19&-12% 26 -042.-1& 4320534* 43-4 2&&0# $% - *)**$2%n#$)6 )S'(-%-12%*^.$%$ ()**2%*\)-/$%5* -%/ 243)# #)*20#&)*8320534 #)&2#/*P042.-1& 4320534 &3)&E($*4*]2.'04)#@-**$*4)/ ]n8
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
75/89
Brief Psychological Interventions
Thoughts Record:
16:*26. 7%8:&0
K=)%4 P042.-1& 8320534*F\-4) /)5#)) 26 O)($)6
U@>UUqH
K.212%F\-4) ?%4)%*$4D
U@>UUqH
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
76/89
Brief Psychological Interventions
Automatic Thoughts Checklist:
A*.:=#D8 16:*26.3 F6%8G+-3.
! ? *320(/ O) /2$%5 O)a)# $% ($6)! ,)^73) /2)*%Y4 0%/)#*4-%/ .)! ?Y=) ()4 3$^3)# /2;%! ? s0*4 &-%4 )%s2D 43$%5* -%D.2#)! :3D -. ? *2 ;)-E! ? -(;-D* E))' .)**$%5 43$%5* 0'! JD ($6) $* 52$%5 %2;3)#)! ? &-%Y4 3-%/() $4! ?Y. 6-$($%5! ?4* 422 .0&3 62# .)! ? /2%Y4 3-=) .0&3 26 - 6040#)! 83$%5* -#) 204 26 &2%4#2(! ? 6))( ($E) 5$=$%5 0'! 72.)43$%5 O-/ $* *0#) 42 3-'')%!
83)#) .0*4 O) *2.)43$%5 ;#2%5 ;$43 .)
:#$534 zV,VG 70/-EG AVJV 80#E$%542%G AV 83-*)G JV
,$53@Z$)(/ ]25%$1=) n)3-=$2# 83)#-'D 62# n#$)6 7)**$2%*+ P% ?((0*4#-4)/ M0$/)
P.)#$&-% "*D&3$-4#$& "0O($*3$%5
:-*3$%542% BU>U
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
77/89
Brief Psychological Interventions
Common Cognitive Distortions:
>V P(( 2# %243$%5 43$%E$%5BV I=)#5)%)#-($m-12%TV J)%4-( 9(4)#$%5RV A$*`0-($6D$%5 43) '2*$1=)dV z0.'$%5 42 &2%&(0*$2%*eV J-5%$9&-12% 2# .$%$.$*-12%fV K.212%-( #)-*2%$%5rV 7320(/ *4-4).)%4*{V UV")#*2%-($*-12%
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
78/89
Exercise 3: Rachel Maladaptive Thoughts
?% *.-(( 5#20'*+
P''2$%4 *2.)2%) 42 6))/O-&E 42 43) &(-**
:3-4 -042.-1& 4320534*G $%4)#.)/$-4) 4320534*G
&2#) *&3).- -%/ &25%$1=) /$*42#12%* 42 D20 43$%E \-&3)( $* ($E)(D 42 3-=)w
A$*&0**$2%
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
79/89
Drugs and Medication
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
80/89
Drugs and Medication: Naltrexone
:
I'$2$/ #)&)'42# -%4-52%$*4n(2&E* #)$%62#&$%5 )t)&4* 26 -(&232(G #)/0&)* -=$%5 /D*%4#2(b%/)# 01($*)/h 2%) 26 43) .2*4 '24)%4 $%4)#=)%12%* 62# -(&232( /)')%/)%&)
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
81/89
Drugs and Medication: Naltrexone
Side Effects:
j-0*)-G =2.$1%5G #)/0&)/ -'')14)A$mm$%)**"%)0.2%$- F*)#$20*H
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
82/89
Drugs and Medication: Naltrexone
Dosing:
"-1)%4 *320(/ O) 2'$-4) 6#)) 62# f@>U /-D*dU.5 4-O()474-#4 dU.5 /-$(DG .-D $%)-*):2#E* ;$43$% - 6); /-D*G .-S$.0. )t)&4 -c)# - 6); ;))E*
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
83/89
Drugs and Medication: Naltrexone
Other Information:
"24)%1-( )t)&4* 2% 62)40* $% -%$.-( *40/$)* F-=2$/ -4 ()-*4 $% 9#*4 4#$.)*4)#HL20%/ $% O#)-*4 .$():-#% '#)=$20* ?l /#05 0*)#* 2% %-(4#)S2%) 62# 2'$2$/ /)')%/)%&) 26 #$*E 26(2** 26 42()#-%&) 42 2'$2$/* -%/ '24)%1-( 2=)#/2*)
J-D O) 0*)/ ;$43 77\?Y* FyyyHG P%4-O0*)
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
84/89
Drugs and Medication
Potentially Fatal Interactions:
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
85/89
Structuring Treatment
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
86/89
?%4)5#-4) E)D *4#-4)5$)* $%42 62((2;@0'^43)#-'D *)**$2%*
Motivational Framework for Session Structuring:
>
8-E) 2''2#40%$1)* 42 #)_)&4
Q *0..-#$*)
]3-%5) 4-(E:)((@O)$%5 4-(E
T-B TO R
\)$%62#&) &2..$4.)%4 4-(E7)4 P5)%/-
7'$#$4 26 .21=-12%-( $%4)#=$);$%5
In the next episode
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
87/89
Exercise 4: Rachel: Maladaptive Thoughts
?% *.-(( 5#20'*+
P''2$%4 *2.)2%) 42 6))/O-&E 42 43) &(-**
b*$%5 43) 4).'(-4) O)(2; "5 RR 26 3-%/O22EG )%4)# 43) *')&$9& $%4)#=)%12%*
D20 ;20(/ '(-% 62# \-&3)( -** 43) 9#*4 r *)**$2%* 26 4#)-4.)%4
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
88/89
Management Structure
Structured Follow-up Session Planning Template:
-
8/13/2019 6. Management of CEP 2 Workshop 2013 (NXPowerLite)
89/89
Action Plans
n)62#) 43) %)S4 ;2#E*32'G '$&E - &($)%4 D20 -#) /0) 42 *))V A0#$%5 D20# %)S4 *)**$2% ;$43 43).G $/)%16D -%D -042.-1& 4320534*G
$%4)#.)/$-4) O)($)6*G &2#) *&3).- -%/ &25%$1=) /$*42#12%* 43)D 3-=)
#)(-4)/ 42 43)$# E)D '#)*)%1%5 '#2O().*V