TREATMENT FORMULATION

1
TREATMENT FORMULATION
2
RISK ASSESSMENT

• Immediately after the assessment a judgement has
  to be made concerning how serious the persons
  immediate risk to self and risk to others is.
• Suicidal risk
• Risk of violence to others
• Risk of harm to others because of drug addiction
  (e.g., pilot, train conductor, bus drivers)

3
PREDICTORS OF SUICIDE

• expressed intent
• having a plan
• previous attempts
• male
• older than 45
• Aboriginal
• living alone with no social supports
• additional mental disorder
• drug abuse
• hopelessness
• severity of depression

4
APPROPRIATE ACTION IF THE CLINICIAN FEELS THERE
IS A GENUINE RISK OF SUICIDE

• Let client know that you are obliged to notify
  certain people
• Notify guardians (in case of adolescent)
• Notify spouse or extended family
• Have weapons, knives, medications, rope locked
  away
• Establish verbal or written contract with client
  not to do anything rash without first calling
  yourself or a trusted friend
• Consider hospitalization

5
PREDICTORS OF VIOLENCE (in order of importance)

• significant past history of violence
• expressed intent to commit violent acts
• teenager or early 20s
• male
• substance abuse
• Antisocial personality or Conduct disorder

6
APPROPRIATE ACTION IF THE CLINICIAN FEELS THERE
IS A GENUINE RISK OF HARM TO OTHERS

• Notify any person who has been threatened with
  violence
• Do not necessarily notify your client that you
  will be doing this
• Notify employer (i.e., in case of a substance
  abusing bus driver, pilot, etc.)
• Let client know you will be doing this

7

• However, in most cases you assess, there will be
  no immediate risk of harm to self and others, and
  your main task will be to establish a treatment
  plan

8
ALBERTA SUBSTANCE ABUSE TREATMENT OPTIONS
9

• Detoxification Centres
• 9 across Alberta operated or funded by AADAC
  closest is in Fort McLeod
• Short-term detoxification
• May also act as overnight shelters
• Outpatient Counselling
• 35 AADAC Area Offices located in most major
  centres (200- 5th Ave S. Lethbridge)
• mostly offer a common-sense problem-solving and
  supportive counselling approach, sometimes
  cognitive-behaviour therapy or motivational
  interviewing
• Individual tx, sometimes supplemented by family
  therapy or group therapy
• Treatment has no set duration
• Family physicians are most commonly accessed for
  treatment provision
• Many people see counsellors through their
  employee assistance program
• Some people see private counsellors (e.g.,
  psychologists) or religious advisors
• ALCOHOLICS ANONYMOUS NARCOTICS ANONYMOUS
• Outpatient support groups that meet regularly

10

• Outpatient Medication
• Medication from family physician (Antabuse,
  naltrexone, Zyban)
• Day Treatment Programs
• 11 across Alberta operated or funded by AADAC
  closest is South Country Treatment Centre
• intensive 2-4 week programs
• Typically offer individual, group, couple, and
  family counselling
• Often have a 12-step AA orientation
• Typically specialize in women, men, Natives or
  youth
• Short-Term Residential Programs
• Usually 2-4 weeks
• 12 AADAC funded facilities across Alberta South
  Country has 21 beds
• staff typically recovered addicts and treatment
  typically 12-step oriented
• A few are hospital based (e.g., Addiction Centre
  in Calgary)
• often offer individual, group, couple, and family
  counselling
• Often have a 12-step AA orientation
• Usually specialize in women, men, Natives or youth

11

• Long-Term Residential Programs
• 8 across Alberta Southern Alcare Manor has 25
  beds
• Alberta Adolescent Recovery Centre in Calgary for
  adolescents (involuntary)
• therapeutic community style
• Tend to be highly regimented residential settings
  with treatment facilitated by paraprofessionals,
  but run by the residents themselves. Members
  progress through a hierarchy of responsibilities
  within this community of former substance
  abusers.
• typically 12-step oriented
• Usually specialize in women, men, Natives or
  youth
• Drug Substitution
• Methadone Clinic in Edmonton Calgary (opening
  Aug 2003) local pharmacy or physician will then
  dispense

12
ALBERTA PROBLEM GAMBLING TREATMENT OPTIONS
13

• Fewer options compared to substance abuse
• Outpatient Counselling
• AADAC, EAP counsellors, private counsellors
• GAMBLERS ANONYMOUS
• modelled after AA disease model 12 steps
  total abstinence
• In Lethbridge meetings are held 5 nights a week
  at either Chinook Club (408 - 13 Street North) or
  South Country Treatment Center
• Outpatient Medication
• anti-obsessional medications (clomipramine)
• Antidepressants (e.g., Prozac)
• anti-craving medications (naltrexone)
• Day or Residential Treatment
• There are no day or residential treatment
  facilities exclusively for gambling
• Several substance abuse day treatment programs
  have a gambling treatment stream
• There are about 8 residential facilities
  primarily geared toward drugs and alcohol that
  provide a few beds for gambling patients
• South Country Treatment Centre (Research Center
  Road) and Southern Alcare Manor (520 7th St. S)
  both allocate a few beds for gambling (South
  Country typically a 3 week stay and Southern
  Alcare longer term)

14
BASIC TREATMENT PROTOCOL FOR ALL CLIENTS
15

• In most cases, free, brief, outpatient, group
  therapy will be the most cost effective and least
  disruptive approach (especially for employed
  people).
• Ensure there is an ongoing support group
  post-treatment
• Provide comprehensive services (e.g., financial,
  marital, employment, mental health, etc.)
• Utilize a behaviourally oriented skills
  training motivational interviewing and/or
  12-step approach

16

• Exceptions to the basic treatment protocol
• Need for detoxification -gt detoxification centre
• Cater to patient preference
• May prefer inpatient or residential
• May prefer individual or couple tx
• May prefer women, men or aboriginal only
• May prefer medication or transpersonal approach
  athiest not a good fit for 12 step programs
• Be wary of catering to a controlled use treatment
  goal as it rarely succeeds (usually only in
  milder cases and younger individuals)
• Prior failures with less structured treatment
  (e.g. outpatient) may merit a more structured
  approach (day tx residential tx)
• Patients with more severe problems and greater
  social instability benefit more from longer or
  more intensive treatment.