Transcript Document

Recovery is described as a deeply personal, unique process of changing one’s
attitudes, values, feelings, goals, skills, and/or roles. It is a way of living a
satisfying, hopeful, and contributing life even with limitations caused by illness.
Recovery involves the development of new meaning and purpose in one’s life as
one grows beyond the catastrophic effects of mental illness.
A mental health services system that is guided by the
recovery vision incorporates the critical services of a
community support system organized around the
rehabilitation model’s description of the impact of
severe mental illness—all under the umbrella of the
recovery vision. In a recovery-oriented mental health
system, each essential service is analyzed with
respect to its capacity to ameliorate people’s
impairment, dysfunction, disability, and disadvantage
Effects Wald Z df F
f-index
Percentage of days abstinent from alcohol or other drugs (0–100)
Random intercept 4.87**
Time
Condition
CBOP (vs. MET/CBT7)
ACC (vs. w/o ACC)
ACC × CBOP
Time × overall condition
Time × CBOP
Time × ACC
Time × CBOP × ACC
(4, 729)
(3, 318)
(1, 317)
(1, 317)
(1, 317)
(12, 729)
(4, 729)
(4, 729)
(4, 729)
1.45**
0.14
1.58 0.09
0.12 0.01
1.06 0.04
3.57 0.08
2.03*
0.10
4.08**
0.08
0.88 0.04
1.14 0.03
Concluded that MET/CBT7 most ‘cost effective’
Godley et al
2010
Treatment effectiveness
Intervention effect mediated by ‘ACRA’
ACRA - resistance
Resistance can be influenced or decreased by a therapist’s behavior and style. It is
difficult to provide step-by-step guidance on how a therapist approaches resistance
because success in this endeavor is dependent on the total therapeutic approach. The
approach should encompass behaviors that convey the most desirable of therapeutic
qualities, including listening with empathy; having genuine concern;
being open-minded, affirming, reflecting; praising and having expectations; and being
accepting and rolling with the resistance. Compliance enhancement strategies begin
with the first contact between the therapist and teenager and continue throughout the
therapy episode.
Effect of post-intervention outreach on
%/timing readmission rates
Functional analysis
• Identify triggers
• ‘Chaining’
• Positive and negative consequences
Effect of post-intervention outreach on
readmission rates
More treatment;
more abstinence, less
abuse/dependence
p<0.05
Effect of continuing care (post res. median 4-12 wks) O.R.
Dep. variable
predictors
High gen
comm. care
Abst. 1-3
mos.
Abstained 912 mos.
More
community
care
ACC
3.35
AOD
ACC
1.0
1.0
General community
care
2.16
Abstinent 1-3
months
11.2
CYT ‘brief treatment’ evaluation
Alliance
• Patient rated therapeutic
alliance (b=.14, .1 3 and 6
mos) and therapist (B=0.1, 3
months p<0.001) predicted
rates cannabis use post
intervention
Brief treatment
MI
• McCambridge (2004) comments that ‘MI seeks
to promote reflection on drug use and its
personal consequences in the context of the
values and goals of the individual.’ And
• concludes ‘the tantalizing prospect resulting
from this study is that a brief conversation with
young people, which is comprehensive in its
consideration of drug use, can simultaneously set
in motion reductions in risk behaviours across
different drugs of use.
• ‘The therapist also serves as a therapeutic
case manager, coordinating and facilitating
meetings and/or services for the youth and
family based upon a needs assessment.’
(Slesnick et al 2009)
Brief (16 sessions) Tx runaway alcohol
abusing youth
% days using drugs or alcohol
Brief (16 sessions) Tx runaway alcohol
abusing youth
% days using drugs or alcohol
Only 1 of 19 comparisons proved significant
Cannabis use last 90 days - N = 109