Treatment Interventions

Treatment Interventions

Grand Canyon University: PCN-501

Treatment Interventions

Introduction

Doweiko (2015) defines intervention “as being an organized effort by a person or persons who are part of the addicted person’s environment, to break through the walls of denial and rationalization that surround the addictive behavior, which is often supervised by a trained professional, with the goal of obtaining an agreement from the addicted person to immediately seek admission to a designated treatment center” (p.420). The main idea of an intervention is to help individuals with a substance use disorder “face the reality of his or her addiction and the harm that it has caused the individual, family, and friends” (Doweiko, 2015, p.420). Interventions can may be both formal and informal. Formal interventions “involve family members and friends meeting with the identified individuals, confronting them with evidence of how their SUD is hurting both themselves and others, and attempting to obtain a commitment from the identified individuals to immediately enter treatment” (Doweiko, 2015, p.428). Informal interventions can include health providers warning an individual that his/her continued substance use will result in major health issues and possibly death. Another example would be a supervisor providing proof that an individual’s substance use is negatively affecting his/her work ethics and informing him/her that they will be terminated if unable to receive treatment services and refrain from any substance use (Doweiko, 2015, p.428). This summary will discuss two specific treatment interventions and how they differ. The differentiation of the application of each treatment intervention, in a professional setting, will also be explored.

Intervention One

Project ASSERT “is an acronym for improving Alcohol and Substance abuse Services and Educating providers to Refer patients to Treatment” (Bernstein, Bernstein, & Levenson, 1997, p.182). It is “a screening, brief intervention, and referral treatment (SBIRT) model designed for use in health clinics or emergency departments (EDs)” (NREPP, 2011). The treatment settings for Project ASSERT are both inpatient and outpatient (NREPP, 2011). Project ASSERT targets “out-of-treatment adults (ages 26-55) who are visiting a walk-in health clinic for routine medical care and have a positives screening result for cocaine and/or opiate use, adolescents (ages 13-17) and young adults (ages 18-25) who are visiting a pediatric ED for acute care and have a positive screening result for marijuana use, and adults (ages 26-55) who are visiting an ED for acute care and have a positive screening result for high-risk and/or dependent alcohol use” (NREPP, 2011).

Project ASSERT strives to motivate patients to reduce or eliminate their substance abuse through collaboration with licensed peer educators. The peer educators must be trained in order to administer the intervention. Cocaine/opiate abstinence and marijuana abstinence are the projected outcomes for this intervention (NREPP, 2011). Research has shown that out of the Project ASSERT patients who were interviewed “91% were satisfied with their referral, 93% thought that the health promotion advocates did a good job explaining the need for treatment and what treatment included, and 99% thought that the health promotion advocates respected them as individual” (Bernstein, Bernstein, & Levenson, 1997, p.187). According to Bernstein, Bernstein, & Levenson (1997), “More than half attributed their cutting back in drinking and drug use directly to interaction with Project ASSERT staff” (p.187). The success of Project ASSERT further shown by its adoption “as a funded ED value-added service” by Boston Medical Center (Bernstein, Bernstein, & Levenson, 1997, p.182).

Intervention Two

CRAFT (Community Reinforcement and Family Training) “is an intervention designed to help a concerned significant other/family member (CSO) facilitate treatment entry/engagement for a treatment-refusing individual who is abusing drugs or alcohol (the family member)” (NREPP, 2013). It was developed on the belief that “an individual’s environment plays a critical role in recovery” (Smith, Milford, & Meyers, 2004, p.391). The environment consists of “family, friends, work, social activities, and sometimes spiritual affiliations” that impacts the individual’s substance use (Smith, Milford, & Meyers, 2004, p.391). CRAFT “is designed to help concerned significant others/family members become more independent and feel more empowered in his or her relationship with the substance-abusing family member” (NREPP, 2013). CRAFT’s major purpose and projected outcome is entry and engagement in treatment for “treatment-resistant” substance users (NREPP, 2013). This intervention is aimed for individuals ranging from ages 13-55+ and it takes place in an outpatient setting. CRAFT therapists are master’s degree counselors who have been trained for this specific intervention (NREPP, 2013).

According to Smith, Milford, & Meyers (2004), 86% of the CSOs, in a study of 12 individuals, were able to get their family members to enter treatment (p.398). In a later study of 130 individuals, 64% of the CSOs were able to get their family members to enter treatment (Smith, Milford, & Meyers, 2004, p.399). A pilot study was conducted and for the “62 CRAFT trained CSOs,” a 74% engagement rate was discovered (Smith, Milford, & Meyers, 2004, p.399). These research findings support the success and effectiveness of the CRAFT intervention program.

Contrast of Interventions

Project ASSERT and CRAFT differ in several ways. Project ASSERT focuses on the individual substance user whereas CRAFT prioritizes the user’s significant other/family member and community. Project ASSERT is an intervention used while a patient is in treatment. In contrast, CRAFT is an intervention aimed to motivate a “treatment-resistance” substance user to engage in treatment (NREPP, 2013). According to NREPP (2011), Project Assert is a very popular intervention with a minimum of “25,000 individuals being referred to treatment” through the program. On the other hand, “CRAFT has been used in 50 sites with more than 2,000 participant in at least 13 States” (NREPP, 2013).

Professional Application of Interventions

The application of Project ASSERT and CRAFT, in a professional setting, have their differences as well. Project ASSERT is implemented in both outpatient and inpatient settings. It is usually administered in 15 minutes depending on how severe the substance use and referral demands. Project ASSERT interventionists screen adolescents, young adults, and adults for substance use when they visit a participating health clinic or emergency department for medical treatment. The Brief Negotiated Interview (BNI) is used for those who test positive for their drug screening (NREPP, 2011). A BNI is a “semiscripted, motivational interviewing counseling session that focus on the negative consequences associated with drug use” (NREPP, 2011). It allows interventionists to build rapport with patients, discuss the pros and cons of substance use behavior, assess the patient’s desire to change, and develop an action plan (NREPP, 2011).

In contrast, CRAFT is implemented only in an outpatient setting. It consists of twelve to fourteen 60 minute counseling sessions that take place “twice weekly for the first 4 weeks and once weekly for the next 6 weeks” (NREPP, 2013). CRAFT can be delivered in a one on one or group setting and it “emphasizes learning new skills to cope with a substance-abusing family member” (NREPP, 2013). CRAFT sessions cover some of the following topics: “handling dangerous situations with the substance-abusing family member, using positive reinforcement to support abstinence and increase positive interactions, and communicating with the family using nonjudgmental feedback and reflective listening” (NREPP, 2013). Through the CRAFT program, significant others/family members are taught how to be a positive influence for their substance-using family member and they are equipped with essential tools to create an environment that supports abstinence (Smith, Milford, & Meyers, 2004, p.396).

Conclusion

In conclusion,there are numerous interventions programs available in order to promote abstinence from substance use. Therefore, it is vital for providers to accurately screen and assess patients in order to deliver the appropriate intervention that will meet the individual’s needs. Each intervention is specifically designed for its targeted group which makes each program unique. According to Doweiko (2015), interventions help individuals face the reality of their substance use problem and how it affects them as well as their family friends (p.420). For that reason, intervention programs are a major component in the treatment process.

References

Bernstein, E., Bernstein, J., & Levenson, S. (1997). Project ASSERT: an ED-based intervention

to increase access to primary care, preventive services, and the substance abuse treatment

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http://www.sciencedirect.com.lopes.idm.oclc.org/science/article/pii/S0196064497701409

Doweiko, H. E. (2015). Concepts of chemical dependency (9th ed.). Stamford, CT: Cengage

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Smith, J. E., Milford, J. L., & Meyers, R. J. (2004). CRA and CRAFT: Behavioral approaches to

treating substance-abusing individuals. The Behavior Analyst Today, 5(4), 391-403.

doi:10.1037/h0100044. Retrieved on April 5, 2016 from http://eds.a.ebscohost.com/eds/

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Substance Abuse and Mental Health Services Administration’s National Registry of Evidence-

based Programs and Practices. (2011). Project ASSERT. Retrieved on April 5, 2016 from

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Substance Abuse and Mental Health Services Administration’s National Registry of Evidence-

based Programs and Practices. (2013). Community reinforcement and family training

(CRAFT). Retrieved on April 5, 2016 from http://legacy.nreppadmin.net/ViewInterventio

n.aspx?id=378

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