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    CEP Workshop Series 2013

    Module 6: Management 2

    Fraser Todd and Michelle Fowler

    2013

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    Workshop Introduction

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    Workshop Agenda

    Mihi and Introductions

    Housekeeping & Workshop overview

    Introductory Mindfulness Exercise

    Withdrawal

    Level 1 Interventions - Diagnoses

    Psychological Interventions

    Drugs and Medication

    Action Planning

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    Exercise 1: Mindfulness Introduction

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    Review of Treatment Planning

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    Review of Treatment Planning

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    From Formulation to Treatment Planning

    Steps for Developing a Treatment Plan:

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    Rachel

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    In the next episode

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    Management Structure

    Structured Follow-up Session Planning Template:

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    Resources

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    DSMIV Criteria for Dependence

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    Factors Affecting Planning

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    Withdrawa Management: Settings

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    Factors Affecting Severity of Withdrawal

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    Alcohol Withdrawal

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    Alcohol Withdrawal

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    Alcohol Withdrawal Complications

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    Cannabis Withdrawal

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    Cannabis Withdrawal

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    Risks Associated with ATS Withdrawal

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    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

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    ]\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

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    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

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    ATS Withdrawal

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    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 -%/

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    ?%=2(=) .)%4-( 3)-(43 *)#=$&)* $6 -%S$)4DG /)'#)**$2% 2# '*D&32*$* ).)#5)-* '#2O().* '2*4 /)42S$9&-12%

    Management of Withdrawal

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    ")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

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    Exercise 2: Rachel: Withdrawal

    ?% *.-(( 5#20'*+

    j2.$%-4) - *$O) -%/ *2.)2%) 42 6))/O-&E

    \)=$); 43) &-*) 26 \-&3)( $6 D20 %))/ 42

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    Level 1 Interventions: Diagnoses

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    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

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    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%

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    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%

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    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%

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    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.*

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    Level 1 Interventions: Diagnoses

    Bipolar Disorder & Alcohol:

    P(&232( 0*)/ .2*4 &2..2%(D $% 43) /)'#)**)/ '3-*)

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    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$)=)/

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    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*-(

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    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

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    Brief Psychological Interventions

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    Brief Psychological Interventions

    Overview:

    8-#5)4 *')&$9& '#2O().* -4

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    Brief Psychological Interventions

    Amplifiers:

    J21=-12%-( $%4)#=$);$%5J$%/60(%)**A)60*$2%K.212% #)50(-12%]2'$%5 *E$((* -%/ /$*4#)** 42()#-%&)\)(-S-12% *E$((*

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    on)3-=$20#-( -&1=-12%

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    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.%$-

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    Basic CBT Model - ABC:

    A&1=-1%5 K=)%4 E)3-=$20# F2%*)`0)%&)

    Brief Psychological Interventions

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    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

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    Basic CBT Model:

    A&1=-1%5 K=)%4 E)3-=$20# F2%*)`0)%&)

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    K.212%*"3D*$&-( *)%*-12%*

    Brief Psychological Interventions

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    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

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    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

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    Brief Psychological Interventions

    Thoughts Record:

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    K=)%4 P042.-1& 8320534*F\-4) /)5#)) 26 O)($)6

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    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 .)

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    :-*3$%542% BU>U

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    Brief Psychological Interventions

    Common Cognitive Distortions:

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    Exercise 3: Rachel Maladaptive Thoughts

    ?% *.-(( 5#20'*+

    P''2$%4 *2.)2%) 42 6))/O-&E 42 43) &(-**

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    A$*&0**$2%

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    Drugs and Medication

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    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( /)')%/)%&)

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    Drugs and Medication: Naltrexone

    Side Effects:

    j-0*)-G =2.$1%5G #)/0&)/ -'')14)A$mm$%)**"%)0.2%$- F*)#$20*H

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    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*

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    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*)

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    Drugs and Medication

    Potentially Fatal Interactions:

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    Structuring Treatment

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    ?%4)5#-4) E)D *4#-4)5$)* $%42 62((2;@0'^43)#-'D *)**$2%*

    Motivational Framework for Session Structuring:

    >

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    Q *0..-#$*)

    ]3-%5) 4-(E:)((@O)$%5 4-(E

    T-B TO R

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    7'$#$4 26 .21=-12%-( $%4)#=$);$%5

    In the next episode

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    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

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    Management Structure

    Structured Follow-up Session Planning Template:

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    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

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    #)(-4)/ 42 43)$# E)D '#)*)%1%5 '#2O().*V