Treatment Levels and Types of Treatment | Addiction Counselor Exam Review

Welcome to the Addiction Counselor Exam Review. This presentation is part of the Addiction Counselor Certification training. Go to. Learn more about our specialty certificates structure starting at $149. Hey there everybody and welcome to the Addiction Counselor Exam Review Treatment approaches and settings. This presentation is available on our YouTube channel@allce.com YouTube or you can subscribe to the Addiction Counselor Exam Review podcast on your favorite podcast app. In this session we're going to review self help approaches, identify different approaches to and levels of treatment, and define evidence based practices and clinical guidelines and figure out where you can find those things. So let's start out with the ASAM dimensions. I'm going to talk about the ASAM a lot today and pretty much in any presentation I do so be familiar with the ASAM. More than 33 states require the ASAM. And for those of you whose states don't require it, it's a good thing to be aware of because it really helps conceptualize a patient's need for treatment. So the levels acute intoxication or withdrawal potential is the first thing that we're going to consider when we're going to think about what types of treatment would be appropriate for this client. What setting does this person need when we're talking about this? We do want to consider protracted withdrawal. The client may not be currently under the influence of anything. They may have gone through detox, they did their 72 hours, whatever. But certain drugs like opiates, methamphetamine, marijuana, benzodiazepines and cocaine are all known for having what's called protracted withdrawal. So up to a month later, the person could suddenly start experiencing cravings and really intense cravings and basically the same symptoms that they were experiencing in, in the initial withdrawal period, probably just to a lesser intensity. But this is really risky. If somebody is in outpatient treatment and they start experiencing these really intense cravings and they start feeling really bad and their mood takes a new nosedive. Oh boy, what are we going to do and how are we going to help this person stay clean and sober? If they're taking any of these substances and they're in outpatient, you're going to want to make sure that you have got a rock solid relapse prevention and emergency plan for them. But acute intoxication withdrawal potential is just the first dimension. Then we look at biomedical conditions. Do they have something else that's going on that could complicate the picture, such as chronic pain, hepatitis, hiv, diabetes, anything that might make it more difficult for them to stay clean and Sober and also anything that might be worsened should they relapse. Diabetes, for example, can be exacerbated significantly when somebody relapses. So it's really important to look at those biomedical conditions and say, you know, if this person relapses, you know, is it going to significantly jeopardize their life? That's one. And the other one is, given this person's current medical situation, how likely is it that they may relapse because of the medical issues? And I've worked with a lot of veterans and people with chronic pain who have been on opiate medications, and that really sets up and on benzodiazepines, and that really sets up a quandary in terms of their safety and relapse potential. Even if their drug of choice was not opiates or benzos, if they have access to it and they start experiencing protracted withdrawal or something, they may turn to that. The third dimension is emotional, behavioral and cognitive conditions. So basically all their mental health all lumped into one. But we want to look at this, do they tend to emotionally dysregulate? That means do they go from 0 to 250 in no time flat? That is often a warning sign for relapse because when people go to that 250, when they feel like completely overwhelmed is when they're at greater risk for relapse and impulsive behaviors. We want to look at some of their behavioral conditions that are going on. How likely are they to relapse? Have they relapsed in the past? And any cognitive conditions that may make it difficult for them to make the best choice, such as fetal alcohol spectrum issues or alcohol related dementia or, you know, anything like that. So we want to look at their emotional profile. We also want to look at any other DSM diagnoses, anxiety, depression, bipolar, that may be coexisting. Because a lot of people develop addictions as a way of self medicating a current mental health issue. So if they've got this mental health issue and it's unstable, guess what? They are ripe for relapse. They are in a dangerous place. So we want to consider that when considering their placement level. Fourth dimension is readiness for change. If they come in and they go, po said, I had to be here, I'm here, let's get it over with. Their readiness for change and to do the next right thing and to follow a treatment plan is way low. If they come in and they go, I'm about to lose my kids, I already lost my job, I really want to stop being sick and tired all the time. You know, what can we do? Help me out, Doc. Okay. Their readiness for change is really high. So we want to look at that. If you have somebody who has an extreme risk for acute intoxication or withdrawal, they have some biomedical conditions, they have concurrent depression and they're not ready for change, then when you score it out, they're probably still going to score out for a higher level of care because the risk of relapse could be so detrimental to them that they may need to be forced into treatment. I have worked with involuntary clients for 20 some odd years and I truly believe that involuntary treatment can work if it's presented correctly. Now, if you try to treat the client who's there involuntarily the same as the client who's there voluntarily, no, it's going to fall flat. What we need to do is talk to the client who's there involuntarily and go, okay, what is your goal? If your goal is to get out of here, then let's talk about what you have to do to make that happen. If your goal is to get off papers, get off probation, let's talk about what we need to do to make that happen and help them do that. They are not going to be ready to talk about never using again for the rest of their life. That's just not even something they're willing to consider. That's okay. Let's talk about what you need to do right now in order to help you achieve your goal of getting off probation or saving your marriage or whatever it is, and then we can talk about the rest later. You want to move them from that level of pre contemplation to contemplation or preparation, but you're not going to move them from pre contemplation to maintenance in 30 days. It ain't going to happen, so don't even try it. And that's why people often say that involuntary treatment doesn't work. Well, you know, we're starting from a different place. Involuntary treatment can work and it can help people. We can plant the seeds, so to speak, and start them on the process to living happier and healthier and thinking about whether they want to continue this behavior. That's success in my book. They may need to come back, but that's success in my book. The person who comes into treatment, who's in the action phase, they were in pre contemplation at one point and they just didn't seek services until they were at this ready place. So, okay, Readiness for change we want to look at, but that doesn't necessarily mean that if somebody's not ready for change, then they're going to go to outpatient or no treatment at all. We may still recommend IOP or residential. The next dimension is relapse and continued use potential. Have they been through treatment before? What is their relapse potential? If they've relapsed multiple times, well then they have a high relapse or continued use potential. If they are in pre contemplation and they've already said they're not going to stop using, well, they've got a high probability of continued use. We want to look at this. Just because they've relapsed doesn't mean they're going to relapse again. And I try to emphasize that to clients, relapse means we have an opportunity to learn what we missed. Relapse is an opportunity to tighten up that relapse prevention plan and figure out what why using became more rewarding than sobriety. So relapse is a learning opportunity. But if somebody is at high risk of relapse, it is really important for us to make sure that they have the supports in place and finally the recovery environment. You know, if they are living in a house where they've got it's domestically violent and everybody's using, or they're homeless or whatever, they have an unstable recovery environment, it's going to be hard for them to stay clean and sober when they're surrounded by criminogenic thinking and drugs and stress and all that other stuff. So sometimes people may not score out really severely in any of the other dimensions. But the recovery environment is so poor and there's an absence of sober living that it's going to be really important to, to make sure that they've got a good recovery environment in order to even help them have any hope of recovery. So those are your ASAM dimensions. Know them, love them, learn them, Self help approaches. So some people aren't going to score out or even want to go to treatment. They may say, nope, I ain't going to do it. And you know, we may not have any sort of leg to stand on to make them do it. So okay, so what can you do 12 step wise, or if you have a client that you know or somebody you know that is not ready for treatment yet, what can they do? 12 Steps is the first thing that comes up. And there is a 12 step program for almost literally everything. There's emotions, anonymous alcohol, anonymous schizophrenics, Anonymous, double trouble, which is for dual disorders where somebody has an addiction plus a mental health issue. So there's lots of 12 step programs. But if the 12 step philosophy doesn't fit the client, then none of these programs is going to work for them. And yes, the 12 steps does work for some people, but this 12 steps does not work for everybody. And we need to bear that in mind. There are reasons the 12 steps may not work. And we'll talk about that in a second. So the first part of the 12 steps is they've got to admit that one cannot control their condition, their alcoholism, their addiction, or their compulsion. All right, that's hard for some people to admit, especially people that have been traumatized. Admitting powerlessness is re traumatizing. They feel re victimized. So 12 steps may not work. Starting with step one. Second principle recognizes that a higher power can give strength. Not everybody believes in a higher power. Some people are very angry at their higher power. Some people have decided that their higher power doesn't exist because of everything they've been through. And even though you're saying, well, your higher power can be a doorknob or good orderly direction, just hearing that concept of higher power repeatedly can be not palatable for some people. For people who are abused within a religious system by clergy or something, and it happens constantly. Hearing about a higher power that's supposed to rescue you doesn't work a lot of times. So we want to be sensitive from a trauma informed perspective, especially to how the 12 steps may not be a great fit. You have to examine past errors with the help of a sponsor, which is great if they've got a good sponsor. If you've got good sponsors in the area, you make amends for these errors. Most programs are going to have you do that. Learn to live a new life with a new code of behavior and help others who suffer from the same alcoholism, addiction or compulsion. Now, most people don't have issues with the rest of those things. It's the first part that the admitting powerlessness and the higher power, that's a bugaboo for a lot of people. So if they're going into these meetings and it is sending off warning bells and it is triggering them, then obviously the 12 steps is not going to be a good place for them. Key features of 12 step programs that do make them accessibility. There are 12 step programs literally everywhere. In churches, in church basements, in community centers. They're everywhere and online. So there is no excuse for not being able to access a 12 step meeting. Anonymity and they take this very seriously where they are. They don't take rosters. And anonymity is of paramount importance because some people who wouldn't seek treatment otherwise because of fear of reprisal from their job or their spouse or whatever, may seek help through a 12 step program because of the anonymity, social support and mutual aid. When you've got other people who've been through it and they can empathize with you, it can be really helpful. Promotion of self esteem and efficacy, encouraging people to, you know, do the next right thing, to take the next right step, to keep coming back. It works if you work it all that kind of stuff. Introspection and insight for some, you know, it depends on your sponsor and the meeting. But ideally it provides a lot of options for people to develop insight into their own behaviors and where they want to go. It encourages spiritual recovery and advocacy to promote social and legal remedies. It was founded by Bill W. And Dr. Bob and about 1 million people are estimated to have achieved recovery through AA. Well, that sounds like a lot and it is a lot. But you've also got to remember that this has been going on for, you know, 80 some odd years now in and internationally. So when you take all the people in all the world over that period of time who've recovered, you know, it's still a pretty small amount and you know, we don't have any good research to show, you know, how many people exactly. And how long they stay sober. They may recover and they may stay sober for three months or 30 years. Does it mean it doesn't work? No, it works for some people. And I really want people to explore this because this is one of the most affordable, accessible ways. But if your client is just adamant that they are not going to do it, it doesn't work for them, or they don't believe in it, then forcing them to go is basically saying, I don't care what you think, you need to do it my way instead of individualizing treatment. Self help was designed with the main purpose to help people stay sober and help others. They believe that abstinence is the only treatment. Now this gets a little hinky when you get into Sex Addicts Anonymous and Overeaters Anonymous because you can't abstain from food and most people choose not to permanently abstain from sex. So then we need to look at, you know, how that works for them. The three legacies of AA are recovery, unity and service. So they work, people work together and they feel this commonality and they feel a Connection which helps them stay clean and sober. It helps them develop those relationships. Now, Al Anon is designed for the significant others of people with addictions. The lessons that people gain in Al Anon are not to suffer because of the actions or the reactions of others, including the person with the addiction. To not allow themselves to be used or abused by others, including the person with the addiction. To not do for others, that is the person with the addiction, things that they can do for themselves. To not cover up for others mistakes and to not create a crisis, not to prevent a crisis if it's in the natural order of events. So we don't want to create a crisis. But if there's going to be some natural consequences, if the person's going to go to jail or lose their job, sometimes it's important to let that happen in order to help them, as we say, hit their own bottom. Now, there are repercussions, obviously if you are married to somebody and you know that if they keep drinking, they're going to lose their job, and you let them lose their job, it's going to have significant financial repercussions on the family. So we do need to be sensitive to those sorts of things that are going on. But that means helping that significant other plan because eventually the person with the addiction is probably going to lose their job. So if they plan ahead of time, then when that crisis does happen that they weren't able to prevent, it's not going to hurt the entire family. Other types of self help approaches. Rational recovery is out there and it is pretty radical. But there are certain factions that embrace it. So it's important to know about it. The air traffic control union people actually endorse rational recovery as an alternative to 12 steps. So, you know, this is important to know about the primary force. According to rational recovery, the primary force driving an addict's predicament is what Trimpy, the guy who designed it, calls the addictive voice. When the desires of this voice are not satisfied, the addict experiences anxiety, depression, restlessness and irritability. Well, you know, that makes sense. When the craving is not satisfied, when there's not enough dopamine, we're going to experience these things because dopamine helps us not feel those things. The rational recovery method is to first make a commitment to planned permanent abstinence from the undesirable substance or behavior, and then equip oneself with the mental tools to stick to the commitment. Well, that sounds pretty rational, doesn't it? But it doesn't really look at the whole scope of Things, you know, sometimes it's. This is. Rational recovery relies more on willpower and it's asking you to think about it and use mental tools to stick to this commitment. That's, that's willpower. When we may have somebody who has, you know, some sort of co occurring mood issue or schizophrenia and it's not considering all those other dimensions on the asam. So rational recovery can work for some people. You know, obviously it can or it wouldn't still be around. But it's important to recognize that it's probably not going to be really effective for people with dual disorders or other situations. Women for Sobriety is another program that's out there that uses positive reinforcement, approval and encouragement. Cognitive strategies including positive thinking, letting the body help. So relaxation techniques, meditation, diet, physical exercise, which in other circles we call this vulnerability prevention and dynamic group involvement. So basically it's approaching the woman from a biopsychosocial perspective to help her achieve recovery. And you can go to the Women for Sobriety website and learn more about that. They're not everywhere, you know, the accessibility is somewhat limited, but it's not hard to open a Women for Sobriety chapter in your local area if you think your area could benefit from it. Smart Recovery. Now this comes in like second, right? Under 12 steps as far as popularity. Smart Recovery is also available online, which is really awesome because it means there are meetings lots of times and it's international. So if you're up at 2 in the morning, and I don't do time zones in my head, well, but that means, you know, across the pond it's probably, there's probably a meeting going on. So you may have to jump into one of those meetings. But there's generally a meeting going on right then or in a short order that you can log onto. Smart Recovery teaches self empowerment and reliance using a cognitive behavioral approach by building and maintaining motivation, helping people learn how to cope with urges, helping them manage thoughts, feelings and behavior, and living a balanced life. And when you look at these, it sounds really similar to dialectical behavior therapy too. And a lot of the skills and tools that we use in smart recovery are very, very similar to DBT skills and cognitive behavioral. I mean, one of the basic tools we use in Smart Recovery is the ABC worksheet. So we want to help people learn how to manage all of these things. Smart Recovery, like rational recovery, is largely cognitive in nature, so it misses some of the other stuff. But it's helpful to have, have in there and it's a great alternative for somebody who just can't seem to allow themselves to embrace the 12 step philosophy. Celebrate Recovery. And I apologize for the text on this, but I wanted to get everything on the same page because it spells out the acronym is Recovery. So what does that stand for in Celebrate Recovery Rec? Realize that I'm not God. Admit that I'm powerless to control my tendency to do the wrong thing and that my life is unmanageable, which is equivalent to 12 steps. Step one. Step two in Celebrate Recovery is to earnestly believe that God exists, that I matter to him and that he has the power to help me recover. That's step two in the 12 steps. Three is consciously choose to commit all my life and will to Christ's care and control. Which parallels step three in the 12 steps. Now step four for celebrate recovery parallels steps four and five in the 12 steps. And it talks about openly examining and confessing my faults to myself, to God and to someone I trust. The next one is to voluntarily submit to any and all changes God wants to make in my life. Humbly ask him to remove my character defects. That's step six and seven in the 12 steps. Evaluate all my relationships, offer forgiveness to those who have hurt me and make amends for harm I've done to others when possible, except when to do so would harm them or others. That parallels steps 8 and 9 of the 12 steps. The next one is to reserve a daily time with God for self examination, Bible reading and prayer and in order to know God and His will for my life and to gain the power to follow his will. That's roughly equivalent to steps 10 and 11 of the 12 steps. And finally, why means to yield myself to God to be used to bring this good news to others both by my example and by my words. And that equates to Service or the 12th step. So Celebrate Recovery largely parallels the 12 steps but there is an emphasis on God and there's an emphasis on biblical principles. So this is a great option for people again who are spiritual, who are very. Who are Christian, who embrace the Bible. But it has the same drawbacks as the 12 steps for people who are have been traumatized and who have who have been victimized in their past. So we need to be some sensitive to that because they're not going to probably be able to trust God as much until they work through their stuff that revolves around their trauma benefits to self help approaches. It provides a network outside of treatment because they can only be in treatment so many hours a day unless they're in residential and eventually they got to Leave residential. It teaches recovery skills. It helps people take responsibility for their own recovery. They reach out. They say I need to go to a meeting or I need to go to church or I need to do this. It's their responsibility and they feel empowered to do so. It provides a sense of belonging because they don't feel ostracized. Everybody else in the room has dealt with something similar and it helps them develop a new identity. They're no longer an addict or an alcoholic. They are Jim, Sally or whomever. Alright, so let's take a little break here. Addiction Counselor Exam review is produced by all CEUs. All CEUs offers unlimited continuing education for $59 as well as pre certification training in addictions and behavioral health starting at $99. Go to allce.com to learn more. And we're back. Types of Treatment Detox is generally the first step for a lot of people and detox can be ambulatory. That means they live at home and they just come to the doctor once a day. Or residential detox is used to minimize physical harm. It's often the point of first contact for people who are trying to get into treatment. It is important to remember though that alcohol, benzodiazepine and opioid withdrawal may require medical care for safety or humanitarian concerns. Alcohol and benzo withdrawal can be life threatening. So it is imperative that doctors, you know, really have a good eye on those particular clients. Opioid withdrawal can become really unpleasant and if the person gets sick enough, they can become really dehydrated. So it's important that they are supervised. Three components of detox evaluation what's going on with them? Stabilization. You know, get their heart rate, blood pressure stable while the drug gets out of their system and fostering client entry into treatment. Once they get through that initial fog, you know, they're feeling pretty miserable. They probably don't want to feel that way again. So let's help them increase their motivation to get into treatment. Outpatient treatment is ASAM level one. Remember I said know those stages and love them. ASAM level one is suitable for individuals who are working and have sufficient social support. They need to have a really good support system out there. It lasts between three months and a year and can be highly structured, such as one to three times a week they come in for group for one hour and yada yada. Or it can be drop in. So you can say I need to meet with you one hour a week and these are my office hours. Drop in when it's convenient. Intensive outpatient is ASAM level 2.1 and partial hospitalization is ASAM level 2.5. Intensive outpatient meets generally for a minimum of 9 to 15 hours a week, and PHP generally meets for a minimum of 16 hours a week and up just short of residential treatment in ASAM Level 2, 2.1 and 2.5, or IOP and PHP, in addition to counseling, you also have pharmacotherapy that's available. Sometimes that's methadone, sometimes that's antidepressants. You have relapse prevention, planning, individual counseling, family therapy, and vocational counseling. Those are all components. You know, we want to start hitting when we start seeing clients that many more hours, it means they need help, probably, and that many more domains. So we want to make sure that we're providing treatment to address issues in all of the domains where the person is having problems. Medication assisted therapy can be provided in an outpatient setting or in a physician's office. Medication assisted therapy combines pharmacotherapy with a full program of assessment, intervention and support. Medication assisted therapy can be Suboxone, which is generally done through a doctor's office, or methadone, which is done through a methadone clinic. Now, Suboxone doesn't have the same kind of regulations in most states that methadone does. Methadone clinics require patients to participate in a full range of drug testing and group counseling, etc. To help them develop the skills and tools they need to stay clean and sober and eventually wean off the methadone. The outcomes that they found when they've done studies that with medication assisted therapy and now with medication, we have Suboxone, we have Methadone, and Vivitrol has actually come on the scene for both opiate and alcohol abuse. Anyhow. Outcomes improve treatment retention when people are not craving, when they are not miserable, then when they're an outpatient, they have fewer cravings and less desire to go out and use decreased illicit opioid use. If they are feeling okay, if they're seeing colors, as one of my clients used to say, again, they're going to be less likely if they want to stay clean, they're going to be more able to make the right choices because they're not going to have this intense urge driving them. Increased abstinence from opioids and alcohol, decreased criminal justice involvement, because when they go to the criminal justice system, a lot of times they are dropped from their methadone and that's really awful. And you know, again, if they are not feeling those cravings as much, then they are more able to deal with life on life's terms and they're more able to keep a job or do whatever they need to do. So they're going to be less inclined to get involved with criminal justice. If they're going to a methadone clinic, then they're spending so much time going back and forth to the clinic and in counseling, they don't hardly have time for criminal justice involvement. They've also shown that people who are on medication assisted treatment have an increased employment rate and improved mental health. Drugs that are available for medication assisted therapy, Naltrexone, which goes by the trade name Vivitrol Disulfiram, which goes by the trade name Antabuse. That's the alcohol, the drug that people take that makes them really sick when they drink alcohol. Acamprosate, which goes by the trade name Campral, reduces the symptoms of protracted withdrawal from alcohol, including insomnia and anxiety. So some people, you know, in order to handle that protracted withdrawal period, that dimension one, Kamprol may be prescribed. Methadone, buprenorphine, are both out there for opioid withdrawal. And bupropion and varenicline, I always have a hard time pronouncing that 1. Are both available for nicotine withdrawal. Right now the only drugs or we have drugs for are methadone or our opiates, alcohol and nicotine. Any of your other drugs of abuse. We technically don't have any medication assisted options for them. Now that doesn't mean that there are no options for them. For a lot of people, if they can get on some psychotropic meds that can help them with their mental health issues, then that helps a lot in their journey towards abstinence and recovery. Residential ASAM level 3.5. So if IOP doesn't work, PHP doesn't work. Some people need to go into residential 24 hour intensive medical, psychiatric and psychosocial treatment. The duration of treatment is 28 days to one year. Now most of the research out there has shown, and this is SAMHSA research, it's not just something I'm pulling out of the air, has shown that anything less than 90 days is really just kind of like spitting in the wind. So bearing that in mind, it's ideal if clients can stay for 90 days. But most programs just aren't set up that way. So when they finish their 28 days, they ideally need to step down to PHP or IOP, plus a whole lot of meetings in order to give them the structure they need for that first 90 days. Therapeutic communities are another residential option. They are highly structured six month to two year programs and operate on a hierarchical model. So when people come in, they have very little social responsibility and very few privileges at all. And as they stay in the program and do the next right thing, they earn more privileges and earn more responsibility. It has a system of rewards and punishments and tends to be more confrontational. So therapeutic communities really are, if they're run to fidelity, are really not ideal for people with significant trauma issues or mental health issues. Now there are some exceptions, but in general you need to be really sensitive to those sorts of things because therapeutic communities can be pretty confrontational. Halfway houses. All right, so now we're stepping back down. Halfway houses are an option for people who are not in residential, but their recovery environment where they were living is not ideal either. So they go to a recovery residence or a halfway house. Now there are multiple levels of recovery residences. And if you go to the national association of Recovery Residences, you can pull, pull down the chart that shows you there are four levels. Level one, they're self managed, it's a democratic thing. And then all the way up to level four where the clients live at the house, work and then receive treatment at the residence. So it's basically like php. Many times insurance can be billed for level 4 halfway houses. So it's important to look at insurance benefits when you're trying to work out a step down program for your clients. But please, please, please, this is not going to be on your test, but I implore you, if you have a client in residential, please don't step them down to just going to meetings. That is really challenging even for the people that are getting out of treatment with their best foot forward. Please step them down to IOP when at all possible. It may only be for a month of iop, but if they can go to IOP and then stay clean and sober doing that, then they can step down to just meetings if that's what they want to do. Treatment approaches and evidence based practices. You will hear these terms a lot. We're using evidence based practices. Well, what does that mean? That means practices that have gone through testing and had scientific evidence that produces that the, that the treatment produces measurable client outcomes like days of sobriety, days in the community, etc. The goal of evidence based practices is to integrate clinical expertise, external scientific evidence and client values to provide high quality services. So they talk to clients and they say, what do you need? What would help you? Let's put this all together in a program and then let's test it and see if it works. And if it does, great. If it doesn't, let's tweak it until we get something that that works. Available evidence based practices can be found at SAMHSA's National Registry of Evidence Based Programs and Practices at nrepp.samhsa.gov now unfortunately, right now the NREPP is going through kind of a transition because it's being transferred to another department in Health and Human Services. So it's kind of on hold, but you can still go there and find evidence based practices that existed that were put into the registry like a year ago and before that. So you go there now. One of the challenges with evidence based practices is oftentimes they require that everybody at the treatment center that's going to use the practice go through training curriculum, which can be really expensive, especially for smaller treatment programs. The program I worked at, you know, we had 85 clients in residence, we had five clinicians, and then we had, you know, 20 some odd techs and then a couple of nurses. But in the big scheme of things, you know, money wise, we didn't have $20,000 to just like suddenly plop on training the entire team on an evidence based practice. So the organization really has to be committed to this evidence based practice in order to drop the amount of money that they need to for a lot of them. Now some evidence based practices are free and we're going to talk about a couple of those. But it is important to recognize that and when you use an evidence based practice, it has to be implemented to what's called fidelity. That means you have to follow the curriculum exactly as written. You can't decide, oh, I don't like that unit, or I think I want to do this this way. It has to be implemented exactly as written, otherwise it's technically not an evidence based practice. Some examples of evidence based practices include Seeking safety, motivational interviewing, 12 step therapy, behavioral couples therapy, Cognitive Behavioral Therapy, Solution focused brief therapy, Community of reinforcement, Approach with vouchers, Dialectical Behavior therapy. So you can look these up online, learn about them. Motivational interviewing is available through SAMHSA Tip 35 and seeking safety is a manual that's available on Amazon. You can get that and train your staff relatively efficiently. Dialectical Behavior therapy. There are manuals and training programs that you can buy and train sample staff, but they also have a certification program that you can put staff through, which is best if you're going to try to implement the fidelity. Successful implementation of evidence based practices include changes in professional behavior. So if we're going to implement this practice, then we need to start doing these things differently. Changes in organizational structures and cultures to embrace that practice. Changes in relationships to service recipients and other potential partners. Because generally if we're implementing this practice, we saw a need, we saw that we weren't getting the job done. So we need to change. The clients don't need to change, we need to change to meet their needs. There can be significant implementation failure of programs and practices that are not delivered with fidelity. So if you don't follow the manual exactly, it's kind of like if you're baking bread and you just try to wing it, let me tell you, I baked a lot of bread in my life. Winging it doesn't work. You actually have to measure it out or you get, it's anybody's guess what you're going to get that's going to come out of the oven. Programs often lose their fidelity to new protocols over time or when they're implemented in unique settings. So if you're using dialectical behavior therapy in your treatment center with adults with co occurring disorders and then you decide to implement it in a program that is a mother baby program, you know, that's a unique setting, or with adolescents in the schools, that's a unique setting, the therapist may be doing all the same things, but it's a different setting and it may not fit quite as well. Fidelity checklists can be used to identify critical components of an approach. So supervisors and clinicians are going to go through those checklists and going, yes, I'm doing this, I'm doing this, I'm doing this to make sure that they are consistently implementing all the steps necessary to fidelity. Many evidence based practices today require extensive supervision and certification in that evidence based practice. In order to say you're doing an evidence based practice now, you can learn DBT techniques, you can learn solution focused techniques, and you can use them very, very effectively. But to say that you're using this evidence based practice in your literature, you may need to have certification in that particular protocol. The purpose of clinical guidelines is the same as for evidence based practices. To translate research into practice, increase the effectiveness of treatment, provide a framework for collecting data about treatment, and ensure accountability to funding sources. Encourage some consistency in practice. Well, that's great. The nice thing about clinical guidelines is they are freely available. It's not one of those things where you have to get tons and tons of treatment. So where do you find them? There are like three main places. And so let me bring this up here. The first place you can go to see if I can type, you go to samhsa. Fine, we'll do that. Samhsa.gov and their tips. TIP stands for treatment improvement protocol. And those are your clinical guidelines. Group therapy and service, comprehensive case management, substance use disorder treatment for people with physical and cognitive disabilities. There's I think 67 of them out right now. You can also find. Practices if you go to the APA website. So your clinical guidelines are here. Your APA guidelines for practitioners, guidelines for prevention, guidelines for practice with transgender and gender non conforming people, guidelines for the practice of telepsychology. So you get where I'm going here. So if you go to your professional association's website or samhsa, you're going to find these clinical guidelines. They're almost always freely available and you can just, you know, download them and look at them on the Internet. So if you're looking for a curriculum based group and individual activities for clients and not necessarily needing an evidence based practice. Journey to Recovery by Dr. Donnelly Snipes is available on Amazon and provides over 350 pages of activities. And I really designed it from my knowledge from when a person would come into treatment and what I would have them do step by step through the 30 days that they were with us in treatment. So most of the stuff that I would use with clients is in that book and I'm getting ready to do an update on that hopefully by the end of 2018. So treatment services are available in a range of settings from outpatient to full hospitalization based on the client's ASAM rating. Self Help provides a network of support outside of treatment. Evidence based practices are research based approaches designed to translate theory into practice. Clinical guidelines, on the other hand, are freely available through samhsa, the APA and other professional associations. Thank you for being with us today and I will see you on the next episode. All of Us at All CEUS wish you great success on your exam. Once you're certified or licensed, click please Remember to visit all CEUs for all of your continuing education needs. We offer unlimited CEUs for $59 for addiction and mental health counselors, social workers, and marriage and family therapists. If you're still thinking about becoming an addiction counselor, all CEUs offers the training you need in three online multimedia self study, self study plus live webinars or face to face weekend intensives which meet one weekend per month for 12 months. We can even present a training series at your facility. Just email support at allce. Com, go to allce. Com Acer. That's allce. Com acer to learn more.