main index

P00: frame around

P01: olicognography

P02: addictions




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Individual Services and Counselling Approach

Basic Olicognograph: Professional Management

Since strutures of care around indivual, and introducing family based care we provide short sequences you can use to assess. It is not for being exhaustive: suggestions for preparing logical explorations, to which you access clicking links.

Agency needs: 1) Program needs: staff valuations of the agency’s strengths/weaknesses and issues that need attention, specifically relating to goals, performance, staff relations, and information systems. 2) Training needs: staff perceptions of training in several technical and knowledge areas; 3) Pressure for change: pressures perceived to come from internal (e.g., target constituency, staff, or leadership) or external (e.g., regulatory and funding) sources.

Institutional resources: 1) Offices: the adequacy of office equipment and physical space; 2) Staffing: the overall adequacy of staff numbers and skills; 3) Training resources: staff training and education in terms of the emphasis put on them by the program and scheduling; 4) Equipment: the adequacy and use of computerized systems and equipment; 5) Internet: staff access and use of e-mail and the Internet for professional communications, networking, and the exchange of work-related information.

Staff attributes: 1) Growth: the extent to which staff members value and use opportunities for their own professional growth; 2) Efficacy: staff confidence in their own professional skills and performance; 3) Influence: staff interactions, sharing, and mutual support; 4) Adaptability: staff ability to adapt effectively to new ideas and change.

Organizational climate: 1) Mission: staff awareness of agency mission and clarity of its goals; 2) Cohesion: work group trust and cooperation; 3) Autonomy: the freedom and latitude staff members have in doing their jobs; 4) Communication: the adequacy of information networks to keep staff informed and the presence of bidirectional interactions with leadership; 5) Stress: perceived strain, stress, and role overload; 6) Change: attitudes about agency openness and efforts in keeping upwith changes that are needed.

Treatment Issues: 1) Addiction and the associated symptoms; 2) People, places, and things; 3) Structuring one’s time; 4) Craving; 5) High-risk situations; 6) Social pressures to use; 7) Compulsive sexual behavior; 8) Postacute withdrawal symptoms; 9) Use of other drugs; 10) 12-step participation.

Treatment Models: 1. medical model; 2. psychological model; 3. sociocultural model.

1) Treatment approach: 1. Model of residential chemical dependency treatment a biopsychosocial disease model of addiction that focuses on abstinence as the primary treatment goal and uses the Alcoholics/Addiction Anonymous 12-Step program as a major tool for recovery and relapse prevention; 2. Drug-free outpatient treatment using a variety of counseling and therapeutic techniques, skills training, and educational supports with little or no pharmacology to address the specific needs of individuals moving from active abuse to abstinence; 3. Methadone maintenance (or opioid substitution) treatment specifically targets chronic heroin or opioid addicts; 4. Therapeutic community residential treatment is best suited to patients with a substance dependence diagnosis who also have serious psychosocial adjustment problems and require resocialization in a highly structured setting.

2) Treatment setting: Inpatient hospitalization includes around the-clock treatment and supervision by a multidisciplinary staff that emphasizes medical management of detoxification or other medical and psychiatric crises, usually for a short period. Residential treatment in a live-in facility with 24-hour supervision is best suited for patients with overwhelming substance use problems who lack significant motivation or social supports to maintain abstinence on their own, but do not meet clinical criteria for hospitalization.

3) Intensive outpatient treatment requires a minimum of 9 hours weekly attendance, usually in increments of 3 to 8 hours a day for 5 to 7 days a week. Least intensive is outpatient treatment with scheduled attendance of less than 9 hours per week, usually including once- or twice-weekly individual, group, or family counseling as well as other services.

4) Treatment components: 1. Pharmacotherapies: - harm reduction - medications to manage withdrawal - medications to discourage substance use - agonist substitution therapy - medications to treat comorbid psychiatric; 2. Psychosocial or psychological interventions; 3. Behavioral therapies: - individual therapy - marital therapy - cognitive behavioral therapy - behavioral contracting or contingency management - relapse prevention; 4. Self-help groups.

5) The Treatment Process: repeated assessments; developing a comprehensive treatment plan; monitoring progress and clinical status; establishing a therapeutic alliance; providing education.

Goals for individual issues : 1) Teach the addict to recognize and avoid the environmental triggers that lead to drug use; 2) Teach the addict to engage in alternative behaviors when he or she experiences craving; 3) Help the patient to achieve and sustain abstinence from all drugs. 4) Urge the patient to participate in healthy activities. 5) Encourage participation in self-help groups.

Treatment rules. The laxicity of conditions are to be adapted to the patient, the group (considering as far as possible the positive progress of any) and the essential feasability of structure or frame in charge. Basically there is a formal or informal sort of contract or project (better to be effectively explicit, but modulated by any sincere opportunity of good will to progress from the patient. Working at the same time on enhancing, developing sense of responsibility and self-esteem of the patient or the social unit (family, group, community). Rules their should be, should be fair, fair and respectful for being sustainable. Mercy or pity are attitudes traits property of the empathy of caregiver, should not be forced and non sincere, "empathically" manipulating (unless the patient do not catch that it is for what he/she is positivelly well disposed to gain). Pityness or mercyness cannot be the only part of the contract. Sustainability, if the patient has no overwhelming psychiatric comorbidity,it is to expect the patient to reach some enough good level of social incorporation, not only the one he/she or you felt.

Compliance being how the patient, or the group accept and respect the therapeutic scheme as the means toward his/her cure or the intermediate better sustainable state she/he can reach. Nevertheless compliance has to be mixed with an ability to examine social situations and behave. Often, stigmatization of addicts by society and neighbours, past practices and new condition, still not necessary a socially enviable one, hard a matter of fact so compliance is not just obedience. Patient needs to analyse discuss, criticize and apply what he/she mind the best for him/her pathway.

For general counseiling to patient: 1) relapse is normal; 2) you (patient) have earned distrust - expect it; 3) help your family or friends learn about recovery; 4) invite your family to join group meetings and make opportunities for them to meet with positive new friends; 5) be open yourself for family members meeting; 6) try to make at least one family member the partner of your recovery; 7) do as much as you can without relying on family but ask if you have an essential need and they have a solution easy for them; 8) application of tests and screening & relevance (have the borders or limits in mind and indvidual significance).

For more specific, non exhaustive observations: 1) women are more likely than men to have comorbid depressive and anxiety disorders; 2) pregnant and postpartum women and their dependent children have numerous special needs including prenatal and obstetrical care; pediatric care; knowledge of child development; parenting skills; economic security; and safe, affordable housing; 3) treatment of substance misuse in adolescents with psychosis may be complicated by a number of factors including deviant behaviors and negative affective symptoms, pointing to the importance of integrated treatments to help reduce substance misuse and associated problems. 4) adolescents need treatment that is developmentally appropriate and peer-oriented; 5) educational needs in adolescents are particularly important as well as involvement of family members in treatment planning and therapy for dysfunctional aspects; 5) elderly persons may have unrecognized and undertreated substance dependence on alcohol or prescribed benzodiazepines and sedative hypnotics that can contribute to unexplained falls and injuries, confusion, and inadvertent overdose; 6) age decreases the body’s ability to metabolize many medications; 7) Parents can transmit their anxiety to their child, and just as children can pick up on parental anxiety, they can also respond to a parent's ability to stay calm in stressful situations; therefore, when treating children, it is important to address parental anxiety and to improve their understanding of their child's ailment.

Addictions in families should examine: 1) family cycle; 2) level of family differenciation; 3) family myths; 4) liability within family; 5) family blindness to the problems; 6) transgeneration transgressions; 7) ab or deculturaltions; 8) deny of mortal game played with addiction; 9) lack of generational barriers (up to incest); 10) overrepresentation of family trauma; 11) overrepresentation of organic and psychologic problems presented by parents; 12) associated pathologies between brothers and sisters.

Family-based conceptualizations of substance abuse observe: 1) the family disease approach, the best known model, views alcoholism and other drug abuse as illnesses of the family; 2) the family systems approach, the second widely used model, applies the principles of general systems theory to families, paying particular attention to the ways in which family interactions become organized around alcohol or drug use and maintain a dynamic balance between substance use and family functioning; 3) a third set of models, a cluster of behavioral approaches, assumes that family interactions reinforce alcohol and drug-using behavior; 4) Behavioral Cognitive Therapies (BCT) methods typically used with substance abusing patients and their partners.

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