Recovery- Oriented System of Care ,Motivational Approach , in Substance Use Disorders

1. Dr. Ahmed Albehairy , M.D
Psychiatry Consultant
AFCPC, TAIF, HADA, KSA
MOH, EGYPT
Recovery- Oriented System of Care ,
Motivational Approach , in Substance Use
Disorders

2. Presentation Outline
 Treatment of addiction .
 Recovery in addiction.
 Recovery care: sets and tool.
 Motivational approach in recovery.
Referrences:
Marshall Smith Chair, Bri7sh Columbia Recovery Council,2016
Gail D'Onofrio, MD, Richard Saitz, MD, MPH, Paul Seale, MD, elearning , ASAM.

3. RECOVERY VS.
TREATMENT

4. Treatment
 As it relates to Substance Use
Disorders, treatment generally refers to
a direct medical intervention in the
disease process - the acute response -
and can include:
• Residential care .
• Outpatient care .
• Pharmacotherapy .
• Other direct medical interventions.

5. Recovery
 A process of sustained change action that addresses the
biological, psychological, social and spiritual disturbances
inherent in addiction.
 Aims to improve the quality of life by seeking balance and
healing in all aspects of health and wellness.
 Addressing an individual’s consistent pursuit of
- abstinence,
- dealing with cravings,
- deals with the chronic relapsing nature of the disease.
- impairment in behavioral control,
- recognizing problems in one’s behaviors and
interpersonal relationships,
- and dealing more effectively with emotional responses.

6. Recovery
 Addiction treatment is not recovery.
 Depending on the substance used, there are
non-pharmacological, evidence-based effective
therapeutic modalities for helping addicts.
 It is important to match the treatment to the
needs of the patient.
 Treatment plans must be continually assessed
and organic to meet the changing needs of the
individual.
 Post-discharge supports must be in place to
ensure continued care.

7. Recovery
 An individual’s recovery actions lead to
- reversal of negative.
- self defeating internal processes and
behaviors, allowing healing of relationships
with self and others.
- The concepts of acceptance and surrender
may be useful in this process.
!!!!!!!! Recovery is not only for addicts

8. A First Step to
Recovery
Understand the importance
and limitations of detox as a
first step to recovery.
Medical detoxification by itself
does little to change long-
term drug use.

9. 2nd, Continuing Care
Following Inpatient Treatment
Discharge –
The Role of the
Physician in Follow-up

10. Continuing Care
 Pre- and post-discharge checklist for
physicians:
• Participate in a pre-discharge conference call with the
treatment centre.
• Ensure you receive a copy of the patient’s continuing care
plan.
• Partner with the patient by making regular appointments for
follow-up.
• Provide empathic, supportive care during the
extended process of periodic reevaluations, adjustment of
treatment, and relapse prevention.
• Discuss successes and setbacks with the patient by asking

11. Motivational Approach
Motivational Interviewing:
An Effective Technique in
Recovery Support.
Contributing writer Gloria Dickerson interviews SAMHSA's Steven Samra on
motivational interviewing and applying those techniques in recovery support.2014

12. Stages of Motivational
Interviewing
 Engage.
 evoke .
 plan.

13. Engage
Clinicians begin by engaging
the patient—by asking
permission and gathering the
patient's perspective about a
behavior that warrants
change.

14. Evoke
 Identify the patient's motivation to change.
 Highlighting discrepancies between wanting and
not wanting to change, and/or acknowledging .
 Addressing any resistance to change.
 In cotext, provide feedback and medical advice,
helping the patient form connections between
use and medical problems or other potential
risks.
 The most important thing is to elicit reasons for
change.

15. Plan
The patient identifies steps to
take toward change, and the
clinician summarizes what has
been said and reviews future
steps.

16. Motivational Interviewing Skills
The 4 core MI skills are summarized in the
mnemonic OARS
 Asking Open-ended questions.
 using Affirmations.
 forming Reflective statements, also known
as reflective listening.
 providing Summaries, also a form of
reflective listening.

17. Motivational Interviewing Skills
Reflective listening does not involve:
 giving advice ????
 asking questions
 providing solutions
 moralizing
 lecturing
 Sarcasm .
 Confrontation.

18. Motivational Interviewing Skills
An easy way to do reflective listening is to start
with any of the following:
 “So…” ‫اذا‬
 “Sounds like…” ‫يكون‬ ‫ممكن‬ ‫الموضوع‬‫زي‬
 “What I hear you saying is…” ‫انك‬ ‫فهمته‬ ‫اللي‬‫عايز‬
‫تقول‬
and then repeat or paraphrase what the patient
said.

19. Motivational Interviewing Skills
 communicate respect for and
acceptance of the patient and his/her
feelings.
 establish a nonjudgmental and
collaborative relationship with the
patient.
 avoid arguments.

20. Motivational Interviewing Skills,
Evoke
An important tool of MI is
to develop discrepancy
between the client’s current
behavior and his or
her goals or values .

21. Motivational Interviewing Skills, Evoke
A mnemonic that can help clinicians identify possible
“change talk” is DARN-CATs.
 D: Desire statements about changing (I wish, I would like to…)
 A: Ability statements about one’s capability to change (I think I
could, I am able to…)
 R: Reason statements that present specific arguments for
change (I know I would feel better if, I would worry less if…)
 N: Need statements regarding feeling an obligation to change
(I should, I ought to, I have to…)
 C: Commitment statements: “I want to,” “I could,” or “I need to.”
 A: Activation statements reflecting patient’s commitment to
actions they will take to change (low-level intention—I hope to,
plan to, will try to; higher-level commitment—I will, am going to,
promise to, I’m ready to, prepared to…
 T: Taking Steps: Actions they have taken: I went to a support
group, I got rid of my stash…

22. Motivational Interviewing Skills
Resistance behaviors can
manifest as:
 Excuses.
 Blaming others.
 Denials.
 Pessimism.
 initiating arguments.

23. Motivational Interviewing Skills
if resistance emerges, there are
strategies for dealing with it.
 Reflection.
 Clarification.
 Shifting focus.
 Emphasize personal choices.
??????? Useful,but not sure in every
situation.

24. AfTER Evoke …
PLAN TO
CHANGE

26. CHANGE
The 3 Rulers of Change
 Readiness.
 Importance.
 Confidence.

27. Negotiating a Plan for Change
Change comes in many sizes and shapes—it might
be as simple as:
 Thinking about how to stop using drug /alcohol.
 Committing for a follow-up visit.
 Committing to working with an addiction counselor.
 Decreasing the frequency or amount of drug
/alcohol use.
 Stopping use for a few months.

28. Conclusion
 Recovery is the utmost result of intervention with
addicts.
 Recovery needs a set and a tool to be
accomplished.
 Recovery’s set includes detox and continuing care.
 Recovery’s tool includes change process.
 Motivational interviewing offers the simple and
tasteful approach for continuous change and
continuous recovery.???the patient is not