Addictions Test Review PDF

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1. What is ADAT?  Admission and Discharge Criteria and Assessment Tools (ADAT) is a comprehensive approach to establishing an initial treatment plan which identifies the most appropriate level and intensity of care for a client entering Ontario's addictions treatment system (or whether the client is ready for discharge). 2. What are the assessment tools that can be utilized?  Psychoactive Drug History Questionnaire (DHQ)  Adverse Consequences of Substance Use (AC)  Health Screening Form (HSF)  SOCRATES (Stages of Change Readiness and Treatment Eagerness Scale)  Treatment Entry Questionnaire (TEQ)  Perceived Social Support (PSS)  Drug-Taking Confidence Questionnaire (DTCQ-8; Alcohol & Drugs)  BASIS-32  Clinical Profile Form 3. In Ontario the addiction treatment system comprises approximately 230 different programs. Why is it beneficial for all treatment programs to use the same set of standardized tools for the admission and discharge of clients?  For consistency and efficiency. 4. What is assessment considered and why?  the “critical” first step or foundation of addictions treatment  Information gathered during the assessment phase is used to develop the treatment plan 5. Define assessment.  A series of structured (standardized assessment instruments, questionnaires) and systematic procedures (counselling skills, motivational strategies) to identify client problems and strengths in order to establish and respond to “need”. 6. What is the purpose of an assessment?  Gather information  Develop a relationship and build rapport with your client 7. What are the foundations of an assessment?  Fostering Hope - A critical factor in successful treatment; encompasses many aspects such as counsellor behaviors, expectations, and beliefs  Strengths-Based Approach - Assumes all clients have positive capabilities for success; utilizes past successes and assists in developing a more comprehensive treatment plan  Whole Person Change - Recognizes that addiction problems often relate to other life areas

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“Addictions are not addictions per se, but rather are problems of life and living” Motivation - Intrinsic motivation refers to the concept of behavior being driven by internal rewards; the outcome is intrinsically (or personally) rewarding Collaboration - When the client is included in treatment planning it leads to more accurate reporting of information, higher levels of motivation, and more trust in the counsellor; working together is key Multidisciplinary - Addiction problems are often multi-faceted; utilize doctors, employment services, family counselling, mental health services, and more when reaching out for help Advocacy - One common outcome of an assessment is the need for client advocacy; client problems are often complicated by their dealings with larger systems such as courts/probation, or social services

8. Is fostering hope a critical factor in successful treatment?  Yes 9. What does a strength-based approach assume?  That all clients have positive capabilities and capacity for success 10. What should you do when using a strength-based approach?  Utilize past successes 11. What does a strength-based approach assist in developing?  A more comprehensive treatment plan 12. What does addiction problems often relate to?  Problems of life and living (whole person change) 13. Increased client participation in treatment planning has been associated with more accurate reporting of ________, ________ &________.  Accurate information, higher levels of motivation and trust in the counsellor 14. What is one common outcome of assessment?  The need for advocacy 15. What are the 2 goals of assessment?  To match clients to service: o Because the best possible match increases the likelihood of a positive treatment outcome  Motivate clients towards change

o Motivation is a dynamic process i.e. it is changeable and the counsellor can have an impact, both positive or negative in affecting the motivation of the client. 16. What are the three types of assessments?  Brief screening assessment  Structured or semi structured assessment  Specialized assessment 17. What is the benefit of a brief screening (the first level)?  Low cost and reduced training and time 18. What does a brief screening typically involve?  The use of key questions 19. What does a structured and semi-structured (standard) assessment require (the second level)?  Greater training  The use of standardized tools  Basic counselling skills 20. What are the three different types of assessments used in the Ontario addictions field?  Brief screen – Usually a form of brief questionnaire to screen clients for potential substance use issues prior to entry into a non-substance related program (i.e. anger management)  Structured, semi-structured, standard – The norm for the field; combines the use of basic counselling skills with standardized pen and paper tools/questionnaires. The focus is on key life areas to assess problem severity and degree of negative consequences  Specializes assessment – Requires specialized training (i.e. addictionologist who can diagnose and progress, involves the use of diagnostic tools and instruments) 21. What are standardized instruments?  Scientifically developed pen and paper or electronically administered tests that provide feedback to the client based on how their results compare to both normative and treatment populations 22. Structured and semi-structured (standard) assessment styles examine key life areas to answer what questions?  what is/are the main problem(s)?  how is the client functioning with respect to “key life areas”?  what “key life areas” are affected by substance abuse/MH?

23. What are some key life areas worth exploring?  Client presentation and functioning  Current and past use and the onset of addictive behaviour  Readiness (level of motivation for change- see handout stage of change)  Prior Treatment Experiences  Family Systems and Peer Relationships  High Risk Behaviour  Coping Skills  School/Work/Vocation  Spirituality 24. What are the negatives and positives associated with using a specialized assessment?  more costly and requires specialized training  Involves a comprehensive set of measures including standardized tests and diagnostic and prognostic tools  covers all life areas 25. In what situation would we require a specialized addictions assessment?  Out of country referral for treatment  Clients with significant addiction/psychiatric issues  Ministry of Transportation re-instatement of drivers license for repeat offenders 26. Assessing for risk is a crucial part of what phase?  The assessment 27. What types of risks are there?  Risks to physical health  Risks to psychological well being  Risks to social well being 28. What are three examples of potential risk factors that impact our physical and psychological well-being?  Impaired driving  Self-harming behavior; and  Intravenous drug use 29. What are two examples of potential risk factors that impact our social wellbeing?  Domestic/partner violence; and  Involvement in high stakes illegal activities 30. The assessment referral case management model include 3 components what are they and what do they include?  The Assessment process that includes the use of: o Standardized assessment tools (pen and paper or electronically administered tests or questionnaires

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o Counselling skills (i.e. the basic listening sequence, and use of higher order skills such as confrontation) Referral o Matching the client to the most appropriate clinical resources they need. These resources include: o Addictions Services & the Self help network o Community Health Resources o Community Social Services o Community Manuals, e.g. “Blue Book” o CONNEX The Case Management Component includes the following: o Tracking the progress of the client through the service delivery system o Tracking the client’s progress towards goals/ maintenance of change o Use of a counselling strategies consistent with the “Transtheoretical Model” (Stages of Change) o The use of relapse prevention strategies

31. What is the rationale behind matching a person to the right resources?  The clinical population is heterogeneous i.e., people with different needs  They’ve experienced different consequences from the addictive/MH behavior  They present with different levels of motivation for change  They’re at different levels on use-abuse continuum  There is research support for the benefits of matching and individualized treatment plans 32. What are the 4 factors related to matching a client to the right resources?  Alcohol and drug use o type of drugs o severity of dependence o physical damage from use i.e., do they need specialized medical care  Social stability: o family and marriage o employment and housing o social level/status and leisure activities  Psychiatric variables o Psychoses o Depression o History of trauma or sexual abuse o Violence  Client factors o age (youth-specific services, services for the aged) –don’t put a 16 year old with a 50 year old o gender (women-specific services) – don’t put women of abuse with men o ethnicity (ethnic-specific services, COSTI, SAPACCY??)

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belief system/ religiosity cognitive functioning/impairment stated wishes (client states a bias towards a particular type of service) level of motivation (Stages of Change)

33. What are some addiction treatment resources?  Detoxification centres/ community withdrawal management (there is medical and non medical detox’s. ex. pinewood not medical, hospitals medical)  Assessment-referral centers - CAMH  Out-patient treatment –counseling with community  Day treatment – go everyday but live in community (3-6 months long at least)  Short-term inpatient treatment (residential – 21 days OHIP covered)  Medium to long-term inpatient treatment & recovery  homes 34. What are the factors constraining documentation?  Time and resources  Staff training  Staff motivation  Confidentiality Issues  Legal concerns  Professional standards 35. What is the purpose of documentation?  Accountability  Continuity of Care  Evaluation of clinical practice  Communication with other agencies  Program evaluation/monitoring  Research 36. What are some key things you should include in your documentation?  Client characteristics  referral sources  dates of key events  nature and frequency of contacts  contacts with other agencies on client’s behalf  referral recommendations  outcome of referrals  services used by the client following assessment 37. What should you be when documenting?  Objective not subjective 38. What are the characteristics of ideal documentation?  Yields data of known reliability and validity

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built-in quality control comprehensive easy to use easy to summarize and analyse adaptable to different settings (easily understood by different types of professionals)

39. What are the four main components of Carl Rogers’s Client Centered Counselling?  Genuineness  Unconditional positive regard  Empathy  Congruence 40. What approach did Carl use?  Non-directive style 41. What are ten tips for client centered counsellors?  Set clear boundaries. For example, when and how long you want the session to last. You may also want to rule out certain topics of conversation.  The client knows best. The client is the expert on his/her own difficulties. It’s better to let the client explain what is wrong. Don’t fall into the trap of telling them what their problem is or how they should solve it.  Act as a sounding board. One useful technique is to listen carefully to what the client is saying and then try to explain to him/her what you think he/she is telling you in your own words. This can not only help you clarify the client’s point of view, it can also help the client understand his/her feelings better and begin to look for a constructive way forward.  Don’t be judgmental. Some clients may feel that their personal problems mean that they fall short of the ‘ideal’. They may need to feel reassured that they will be accepted for the person that they are and not face rejection or disapproval.  Don’t make decisions for them. Remember advice is a dangerous gift. Also, some clients will not want to take responsibility for making their own decisions. They may need to be reminded that nobody else can or should be allowed to choose for them. Of course you can still help them explore the consequences of the options open to them.  Concentrate on what they are really saying. Sometimes this will not be clear at the outset. Often a client will not tell you what is really bothering him/her until he/she feels sure of you. Listen carefully – the problem you are initially presented with may not be the real problem at all.  Be genuine. If you simply present yourself in your official role the client is unlikely to want to reveal personal details about themselves. This may mean disclosing things about yourself – not necessarily facts, but feelings as well. Don’t be afraid to do this – bearing in mind that you are under no obligation to disclose anything you do not want to.

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Accept negative emotions. Some clients may have negative feelings about themselves, their family or even you. Try to work through their aggression without taking offence, but do not put up with personal abuse. How you speak can be more important than what you say. It is possible to convey a great deal through your tone of voice. Often it will be found helpful to slow down the pace of conversation. Short pauses where the client (and you) have time to reflect on the direction of the session can also be useful. I may not be the best person to help. Knowing yourself and your own limitations can be just as important as understanding the client’s point of view. No person centred counsellor succeeds all the time. Sometimes you will be able to help but you will never know. Remember the purpose of a counselling session is not to make you feel good about yourself.

42. What are the three theoretical foundations of Motivational Interviewing?  Supportive empathetic confrontation, client/person-centered therapy, and stages of change 43. What are the five stages of change?  Pre-contemplation – Individual has no intention to change the problem behavior in the foreseeable future (within the next 6 months)  Contemplation – Individual is seriously considering changing the problem behavior in the next 6 months, and is consciously weighing the pros and cons of the change  Preparation – Individual is intending to change the problem behavior in the next 6 months and has initiated small steps to do so (i.e. cutting down, setting a specific date to quit, etc)  Action – Individual has initiated both cognitive and behavioral steps to modify the problem such as joining a support group, seeking counselling, or avoiding friends who use  Maintenance – Individual has been successful in maintaining change in the problem behavior for at least 6 months; the problem behavior has been replaced by a new and incompatible behavior (i.e. meditation to deal with stress) 44. What are the names of five of the key processes of change?  Reinforcement management – rewarding oneself for one’s efforts and successes in changing the problem behavior  Self Liberation – Choosing to act and making a commitment to change (i.e. setting timeframes to change)  Counterconditioning – Substituting of countering the problem behavior with different strategies (i.e. stress management techniques)  Consciousness raising – increasing information about the problem behavior, e.g. looking up how cannabis affects health  Self- re-evaluation – considering how the problem behavior relates to one’s self and self-image, e.g. morals and values  Helping relationships – seeking the support of someone you trust to help initiate and maintain changes in the problem behavior, e.g. attending a self-help group

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Emotional arousal and dramatic relief – the open and honest expression of one’s true emotions related to the problem behavior and associated circumstances, e.g. expressing a powerful emotion such as anger Environmental re-evaluation – re-assessing the effects of the problem behavior on one’s environment, e.g. family, work, etc. Social liberation – enacting or involving oneself in a social cause/endeavor to support changes in the problem behavior and extending help to others

45. Resistant clients are at what stage of change?  Pre-contemplative” or “contemplative” stage of change. 46. The counsellor’s role is to respond in a stage appropriate manner this is characterized by:  Reflective listening  Respect for client choice  Empathy 47. What skills does the BLS consist of?  Encouragers, paraphrases, summaries, open and closed questions and reflection of feeling. 48. Which skills that comprised the basic listening sequence (BLS) did Dr. Henry employ to help build rapport and a trusting with her client?  Debrief 49. The most commonly held assumption of individuals who are drinking/using substances problematically and fail to/resist change is that they are “in denial”; that is, they lack awareness of the impact of their behavior on themselves and others  This belief is in most cases false. 50. What is the difference between the stages and processes of change?  The process of change signifies how an individual moves from one stage to the next; by affecting the processes of change counsellors can increase the likelihood of the client progressing to the next stage of change 51. What are the four types of Resistance (Hint: The Four R’s)?  Reluctant Pre-contemplators – May lack information about the effects of problem behaviors or are comfortable with the problem behaviors and need empathetic feedback on how the behavior may be affecting them  Rebellious Pre-contemplators – Have strong investment in making their own decisions and need a menu of options for incremental change  Resigned Pre-contemplators – Have lost hope in their ability to change; need affirmation and increase in self-efficiency  Rationalizing Pre-contemplators – Project responsibility for problem behavior onto others; need decisional balance assessment to accept personal responsibility for change

52. What are the Primary Principles of Motivational Interviewing (Hint: Four Pillars)?  Express empathy – Empathic responsiveness to client’s feelings, life experiences, behaviors  Develop discrepancies – Reflective listening to identify client discrepancies (cognitive dissonance)  Rolling with resistance – When a client argues or refutes information; roll with it, don’t argue against the client  Support self-efficacy and affirmations – By providing personal choice and control in changing behavior; empower and build on strengths 53. In regards to Motivational Interviewing, what key techniques should you use early and often?  Open-ended questions – What, who, how, tell me, etc. Allows clients to express own views and avoids yes/no answers  Affirming and supporting – Convey your understanding of the client’s position and experience. Compliment them, listen actively for strengths, values, and positive qualities. Reflect them back to the client in an affirming manner.  Reflective listening – Paraphrasing and reflection of feeling. Mirrors what the client had stated in a non-judgemental manner, and deepens the conversation  Summarizing – Include summaries throughout the session, meeting ends with a collaborative summary. Reinforce client’s motivation to change, highlight realizations, identify transitions, progress, or themes 54. What techniques can be used to manage resistance?  Shifting focus  Reframing, and agreeing with a twist (slightly altering the meaning of your client’s response to encourage a different perspective)  Simple reflections  Amplified reflections (using a word they used)  Double sided reflections (on one hand/on the other) 55. What are three characteristics of a Cognitive Behavioral Model of addiction?  There are a number of motivating and reinforcing properties associated with taking alcohol and drugs (i...