Substance Misuse

“Is marijuana a gateway drug?” – Any substance abuse counselor at this point is probably sick of hearing that redundant and often misleading question. The following explanation is time-tested, reasonable and easy to understand for just about everyone. See for yourself:

This downloadable PDF is designed to give to students or others being trained as counselors. There is a compehensive list of essential knowledge and skills for counselors focused on engagement with challenging clients with substance use and coexisting mental health issues.

Successfully engaging difficult and resistant clients in substance abuse treatment is a frequent and prevalent obstacle for counselors particulalry when client's insight and motivation levels may be limited or questionable. Learning to utilize a Change Initiative is a critical guildeline for effectively managing these challenges

The book: Taking the Escalator: An Alternative to the 12 Steps explains the assessment of one's Change Initiative as a simple measure for insight and motivation. The following document explains how to use a Change Initiative measure in greater detail specifically for substance abuse counselors who are attempting to engage difficult clients in treatment

Brief Group Module and Icebreaker Collection 1  - Taking the Escalator releases brief icebreakers and group therapy modules about twice per week in the “Forum” section on the Taking the Escalator: Group Activities by Topic page of the website. This is a printable collection of these brief therapy modules and icebreakers released in that forum for the six-month period from October 2020 through March 2021

In todays changing world where treatment has become increasingly client-centered and accepting of incremental change, it makes to sense to re-examine how we view addiction, reccovery, abstinence and sobriety and the overall process of postive change

The following is published on the www.takingtheescalator.com website but is also being made available on Academia.edu for review. It is designed for groups as an in-depth look at self esteem from a realistic perspective, with substance use issues in mind.

The vast majority of people in this world have heard about the idea of "hitting bottom" when it comes to addiction and making positve changes,  which can be a reality, but often can be a fallacy. "Topping Out" may be a more crucial consideration for young people who find themselves caught up in a lifestyle of drug and alcohol use, abuse and misuse

This activity is designed for active preparation for an upcoming event that may be challenging to deal with as related to substance use and co-occurring mental health issues. Often events can bring with them various triggers and other obstacles that can make it challenging to maintain a course of progress. It makes sense to plan ahead when a challenging event is on the horizon so as to prevent setbacks.

One-size-fits-all therapy has not worked well for a majority of substance users seeking help. New approaches to substance abuse treatment are desperately needed. Traditional models of service delivery offer lithe, if any, help to people who may not choose abstinence as a goal. to address this concern, the Bridging the Gap Conference was sponsored by the San Francisco Department of Public Health. The overall goals of the conference were to improve standards of care, to develop best practice principles for integrating harm reduction approaches into traditional substance abuse services and to increase the accessibility of quality services to people in need of alcohol and drug treatment. G. Alan Marlatt gave a keynote address on the integration of Harm Reduction Therapy with traditional treatment services, an expanded version of which in presented in this article.

This tool has been edited to correct some formatting errors

This tool is free for download and use. If you or your agency is going to use this tool, please email takingtheescalator@gmail.com just to notify

In spite of the extent of the substance use problem in many parts of the world, the number of available comprehensive substance use assessment tools is limited. Some of the tools that are available are extremely outdated. The E13 Comprehensive Integrated Substance Use Assessment is modern and inclusive as it considers aspects of motivation, insight,  MAT and Harm Reduction as well as including ASAM criteria and DSM 5 diagnosis components. In addition the assessment fully integrates coexisting mental health, medical and behavioral issues as well as multiple other relevant life area assessments.

Free for download and use.  If you plan on using the E13 Assessment in your clinical practice or agency, please simply email takingtheescalator@gmail.com to inform. Modifications can be made in the assessment tool for your specialized needs

Medically underserved rural communities struggle to meet challenging needs in response to the opioid crisis. The purpose of this study was to measure any benefit of an occupational therapy (OT) intervention group with participants in an addiction recovery program. Supervised OT graduate students implemented a five-week program at a faith-based non-profit organization in a small metro community. A weekly time management occupational-based intervention group based on the Action Over Inertia (AOI) manualized protocol focuses on motivating and providing strategies to successfully reintegrate individuals into the community by using meaningful activity and positively influencing levels of occupational balance and engagement (Krupa et al., 2003). Outcome measures included self-report of time use, occupational balance, occupational engagement, and goal identification, satisfaction, and performance. The need to effectively treat individuals with SUD is a public health priority. Results demon...

This chapter will: explore the social context in which ‘problem drug users’ and ‘inadequate parents’ are constructed; outline key issues and difficulties involved in working with problem drug users whose children are considered to be at risk of abuse or neglect; draw on research carried out with social workers, health visitors, drugs clinic workers and parents to examine the barriers of working together to assess children’s needs where parents misuse drugs; and  explore strategies for better partnership approaches.

Objectives: To determine the extent of pharmacists' participation in methadone services, type of services provided, views on current service provision and suggestions for future service developments. Methods and setting: An anonymous postal questionnaire was distributed to all community pharmacies in the greater Dublin area (n=291) and in Glasgow (n=200), excluding 12 pharmacies in each city that had participated in the pilot study. Key findings: The response rates were 50% (146/291) and 56% (112/200) for Dublin and Glasgow respectively. Participation in methadone services was considerably higher in Glasgow (80%, 90/112, of respondents) than in Dublin (38%, 55/146) and the number of patients per pharmacy was higher. A majority of pharmacists participating in methadone services (76% in Dublin, 92% in Glasgow) felt they had a professional responsibility to provide such services. In both cities the most common grounds for lack of service provision were business reasons, including risk to staff or property and theft. Current non?participants identified increased demand for the service and improved security measures as two factors that may encourage their participation in the future. Conclusion: Pharmacists in Dublin and Glasgow differed significantly in the extent and types of services provided. This may be because a structured scheme was in place in Glasgow but not in Dublin at the time of the study. Despite these differences in service provision, views were very similar in both cities.

Conversations about rehabilitation and how to address the drugs-crime nexus have been dominated by academics and policymakers, without due recognition of the experience and knowledge of practitioners. Not enough is known about the cultures and conditions in which rehabilitation occurs. Why is it that significant numbers of practitioners are leaving the alcohol and other drugs field, while disproportionate numbers of criminal justice practitioners are on leave?

Rehabilitation Work provides a unique insight into what happens behind the closed doors of prisons, probation and parole offices, drug rehabs, and recovery support services drawing on research from Australia. This book is among the first to provide a dedicated empirical examination of the interface between the concurrent processes of desistance from crime and recovery from substance misuse, and the implications for rehabilitation work. Hannah Graham uses practitioner interviews, workforce data and researcher observations to reveal compelling differences between official accounts of rehabilitation work, and what practitioners actually do in practice. Practitioners express a desire to be the change rather than being subject to change, actively co-producing progressive reforms instead of passively coping with funding cutbacks and interagency politics.

Applied examples of how practitioners collaborate, lead and innovate in the midst of challenging work are complemented with evocative illustrations of insider humour and professional resilience. This book is a key resource for students, academics and practitioners across fields including criminology and criminal justice, social work, psychology, counselling and addiction treatment.

The practice of psychology covers the range of ages from conception through to the end of life and palliative care. Psychologists practice in a variety of roles, but the majority of these roles involve interactions with nonprofessionals of varying ages. These interactions are governed by codes of ethical practice, whether these are developed by the funding bodies for research activities, professional associations, or regulatory bodies. Ethical codes vary in their format and emphasis, but all have the protection of the public as a major purpose. Often there are special provisions in these codes for particular populations or circumstances. Here we describe the development of ethical guidelines for the practice of psychology with older adults in Australia and report on those guidelines and their supporting literature.

Este articulo esta enfocado en el uso de la secrecion psicoactiva del Bufo alvarius. Esta práctica que crece en popularidad actualmente lleva consigo riesgos y controversias, así que para amplificar el conocimiento sobre el uso tradicional de este preparado revisamos sistemáticamente los textos indizados por PubMED, Web of Science y Scopus. Posteriormente hicimos la reseña literaria y buscamos evidencia sobre el uso ritual de anuros en los códices precolombinos y libros de misioneros y conquistadores. Nuestros resultados demuestran que no existe evidencia literaria sobre la tradicion de uso ritual de Bufo alvarius. Los rituales organizados en el ultimo tiempo son productos basados en la invencion neo chamanica. EnglishThis article focuses on the use of Bufo alvariuspsychoactive secretions. This practice that is growing in popularity nowadayscarries with it risks and controversies. To amplify the knowledge about the traditional use of this preparation, we systematicallyreview the t...

According to Cunningham (1992), leadership is a term worthy of global concern, especially considering the growing internationalization of industry, of which the health and social care sector is a part. Many researches and a substantial body of knowledge exist on leadership, the result, some argue, of an inherent frustration with many theories. The attributes of an outstanding leader, the relationship between personality dimensions and leadership, and the impact of leadership on group behavior and success are just a few of the topics covered.
Hitt (1993) compared attempting to “piece together” a systematic theory of leadership from the various threads running through the extensive literature to “trying to find one's way out of a forest without a map.” Nonetheless, as Sarros and Woodman point out (1993), although the factors that influence leadership effectiveness are not well understood, multiple studies have shown that leadership can influence organizational efficiency.
The impact of key management, leadership, and motivation theories on success and the overall goals of health and social care service providers will be evaluated in this study. It will also look at how important internal organizational processes like performance management are in performance management

Below is a review of some reasons why engagement has become an ever-increasing challenge for clients and counselors in today's world, particularly in the world of substance abuse and mental health treatment. The fact is that there are many obstacles we as counselors often face, particularly when working with challenging clients in substance abuse and mental health treatment.

This tool has been edited to correct some formatting errors

This tool is free for download and use. If you or your agency is going to use this tool, please email takingtheescalator@gmail.com just to notify

This brief assessment is designed as a supplemental short substance use assessment. It can be used as a "stand alone" substance use brief substance use assessment when perhaps time is limited or it can be an additional substance use focused substance use assessment tool during a longer full biopsychosocial assessment. The questions are in simple, easy to read format for clinician who may have only basic substance use/addiction assessment training.

Forgiveness is a topic that will never go away, not in this world. In substance use treatment the topic of forgiveness is guaranteed to come up sooner or later. This is especially true after you start digging deeper into the hurt, trauma, resentment and pain that often can help start or sustain and addiction.

Background: In recent years, there has been increasing attention to "lower BAC" drinking drivers, typically those whose blood alcohol content (BAC) is under the legal limits defined in criminal law. In 2009, legislation was enacted in Ontario, Canada that enabled police to issue roadside license suspensions to individuals caught driving with BAC between 0.05% and 0.08%, known as the "warn range". Multiple warn range (MWR) offenders are required to attend the Back on Track (BOT) remedial measures program. This study aimed to provide: (1) a preliminary characterization of MWR drivers charged under warn range legislation; and (2) an initial assessment of outcomes associated with BOT participation among MWR offenders. Methods: A subsample of 727 MWR offenders was drawn from program records, and compared to samples of 3597 first-time Criminal Code (CC) offenders (those caught driving with a BAC of 0.08% or higher) and 359 second-time CC offenders. To provide an initial assessment of outcomes associated with BOT participation, another subsample consisted of 394 MWR participants from whom pre-and post-workshop questionnaires were collected and successfully matched using probabilistic matching processes. Results: Similarities in demographic profile and driving history between MWR and first-time CC participants were apparent. MWR offenders scored higher on risk of problem drinking and drink-driving recidivism than either of the CC offender groups. Second-time CC offenders scored higher on these measures than first-time CC offenders. Following BOT participation, MWR participants demonstrated positive change including improved knowledge of and intentions to avoid drink-driving. Conclusions: MWR offenders share a similar demographic profile to that of first-time CC offenders and they report significantly higher risk of problem drinking and recidivism. MWR offenders may include high-functioning problem drinkers who are likely to continue drink-driving and who may escalate to a CC drink-driving offense. Like CC offenders, MWR offenders benefited from BOT participation.

Objective: Anabolic androgenic steroid (AAS) use has been robustly associated with negative body image, and eating-and muscularity-oriented psychopathology. However, with AAS being increasingly utilized for both appearance and athletic performance-related purposes, we investigated whether comorbid body image psychopathology varies as a function of motivation for usage.

Method: Self-reported motivation for current and initial AAS use was recorded amongst 122 AAS using males, alongside measures of current disordered eating and muscle dysmorphia psychopathology.

Results: Those reporting AAS for appearance purposes reported greater overall eating disorder psy-chopathology, F(2, 118) = 7.45, p = 0.001, p 2 = 0.11, and muscle dysmorphia psychopathology, F(2, 118) = 7.22, p < 0.001, p 2 = 0.11, than those using AAS primarily for performance purposes. Additionally, greater dietary restraint, F(2, 116) = 3.61, p =0.030, p 2 = 0.06, functional impairment, F(2, 118) = 3.26, p = 0.042, p 2 = 0.05, and drive for size, F(2, 118) = 10.76, p <0.001, p 2 = 0.15, was demonstrated in those using ASS for appearance purposes.

Discussion: Motivation for AAS use may be important in accounting for differential profiles of body image psychopathology amongst users. Men whose AAS use is driven primarily by appearance-related concerns may be a particularly dysfunctional subgroup.

We have not had a War on Drugs, nor has the use of drugs for pleasure been prohibited. The 1961 UN Single Convention on Narcotic Drugs imposed strict controls and punishments on particular substances while other dangerous drugs (alcohol and tobacco in particular) were granted a privileged and promoted status. This socially constructed bifurcation of substances established a Drugs Apartheid that outlawed particular drugs so what we have is a 'War between Drugs' that ultimately became a war on people who used substances that didn't have government approval. Black and Minority Ethnic groups and the discarded working class have been major casualties in this war. Radical drug law reform rooted in scientific evidence and human rights is needed to end the oppressive and unjust drug laws that have caused more harm than good.

To follow the PREZI presentation while listening to the Podcast go to:

http://www.cjp.org.uk/events/cjp-lectures/cjp-lecture-2014/cjp-lecture-2014-presentation/

In the late 1980s illicit drug use became a major social problem in the UK. Since then policy and practice has largely been shaped by psychological and medical perspectives that emphasise the physiological and psychological nature of dependence. Concerned by the limited impact in reducing the number of problem drug users, in 2000 the Government shifted the emphasis away from voluntary treatment by the Health and Voluntary sector, towards coercive treatment, initially in the form of a Drug Treatment and Testing Order (DTTOs). The Drugs Interventions Programme (DIP), a £447m programme to ‘direct drug misusing offenders out of crime and into treatment’ (Home Office, 2004 p. 29) further illustrates and reinforces this shift. This article argues that this shift in approach is also likely to founder, as it continues to be dominated by a narrow focus on the individual and their drug dependence, and fails to adequately address the social context, nature and underlying causes of problem drug use.

The word “manipulative” gets thrown around a lot in the world of mental health and addiction. It can be very unfair to simply just label another person as “manipulative” as if it’s a black or white (yes or no) issue in that some people are completely manipulative while others aren’t manipulative at all. It makes a lot more sense to look at manipulation the same way as we view many other behaviors, as occurring along a spectrum with varying degrees depending upon circumstances, motives and overall intent.

"Assessing Your Change Initiative" is actually an older paper from the original Taking the Escalator text.  What is new in this updated version is the link to the video "Understanding Insight and Motivation for Positive Change" which is made for substance use treatment groups and explains the concepts of insight, internal motivation and external motivation. The video is 40 minutes so if your group has difficulty paying attention it may make sense to break it into two parts if needed (for less motivated groups)

If you work in an agency-based counseling setting, it is likely you are aware of the seemingly impossible mission thrust upon you during the intake/assessment process. During these first few crucial minutes with a new client, the counselor is expected to complete lengthy assessment paperwork, review dozens of forms and policies, while somehow forming a rapport with your new client, who often does not want to be there in the first place! - What are some of the skills and perspectives needed to successfully navigate Mission Impossible: Completing and assessment while establishing rapport under difficult circumstances.