COSIG CONFERENCE BROCHURE.pdf - Drexel University College ...

COSIG Co-Occurring Disorders Conference, Hershey PA, May 15-17, 2006
What are the essential features of the Community
Reinforcement Approach (CRA)…
• Provide reinforcement for abstinence (vouchers).
• The ABCs of behavior: functional analysis
• Antecedents (Triggers)
• Behaviors
• Consequences (Positive reinforcers; Negative reinforcers;
Positive punishers; Negative punishers)
• Change reinforcement contingencies: alter
lifestyle.
• Family relationships
• Recreational activities
• Social networks
• Vocational Functioning
What are the basic principles of Motivational
Enhancement Therapy?
•Client-centered counseling approach.
•Designed to help clients resolve ambivalence about
treatment and ceasing drug use.
•Employs strategies to evoke rapid patient directed change.
•Patient directed change includes therapeutic tasks
designed to accelerate patients through pre-contemplation,
contemplation, and change phases.
Is Motivational Enhancement Therapy effective?
• Motivational interviewing and relapse prevention
effective treatments for alcohol use and other substance
use (Najativis & Weiss, 1977, PROJECT MATCH, 1977).
• Reduces smoking in schizophrenic patients (Zeidonis,
1997).
• Increases post-incarceration treatment contact in drug
abusing veterans (Davis et al., 2003).
The results of behavior therapy trials have been
mixed in dually diagnosed populations…
Positive results
• Daley et al (1998) increased
treatment adherence among
depressed cocaine users.
• Martino et al. (2000) increased
treatment attendance.
• Swanson et al (1998)
increased attendance at 1 st
outpatient appointment.
Negative results
• Miller et al(2003) targeted
improvement in compliance
among inpatient & outpatient
drug using clinical populations.
• Donavan et al. (2001) targeted
reduction in drug use among
IV users.
• Booth et al. (1998) targeted
reduction in opioid use among
IV users.
• Baker et al (2002) attempted to
increase participation in
substance abuse inpatient
programs.
We designed, piloted and evaluated a treatment
that…
• Considers impact of cognitive impairments in attention and
memory.
• Focuses on the interacting consequences of mental health and
substance abuse.
• Utilizes a structured “decisional balance sheet” approach to
integrate substance use, adherence and mental health symptoms.
• Remediates social skill and problem-solving strategy deficits.
• Engages patient through behaviorally-oriented structured
interventions, e.g., social skill training, successive approximations.
• Integrates housing, outpatient and social services with a
community reentry module.
In summary, the purposes of the clinical trial were
to …
• Design a multi-dimensional intervention which includes
elements necessary for treatment of mental illness and
substance use disorder.
• Include elements of motivational interviewing, relapse
prevention and skill training in the intervention.
• Evaluate the effectiveness of these procedures in a
primarily minority clinical population and in a typical
clinical environment.
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