Cognitive Behavioral Therapies & Practicum Course #39457 Current Professionals Track Substance Abuse...

Cognitive Behavioral Cognitive Behavioral Therapies & Practicum Therapies & Practicum

Course #39457Current Professionals Track

Substance Abuse Studies Training Program

UNM Continuing Education

Behavior TherapyBehavior Therapy

Behavior therapy is a method Behavior therapy is a method of counseling that focuses on of counseling that focuses on modifying the patient’s modifying the patient’s learned behavior that are learned behavior that are negatively affecting his or negatively affecting his or here life.here life.

Cognitive TherapyCognitive Therapy

Cognitive therapy holds that the Cognitive therapy holds that the principal determinant of emotions, principal determinant of emotions, motive and behavior is an motive and behavior is an individual’s thinking, which is a individual’s thinking, which is a conscious process.conscious process.

Change perception, alter emotions = Change perception, alter emotions = changes in lifestyle.changes in lifestyle.

Classical ConditioningClassical Conditioning

A model where a particular A model where a particular response to a stimuli can be response to a stimuli can be elicited overtime by elicited overtime by association with a related association with a related stimulus.stimulus.

Unconditioned Unconditioned stimulusstimulus(UCS)(UCS)

A component of classical A component of classical conditioning: an event that conditioning: an event that produces an unconditional produces an unconditional response when present.response when present.

Unconditioned Unconditioned ResponseResponse (UCR) (UCR)

A natural reaction to an A natural reaction to an unconditioned stimulusunconditioned stimulus

Conditioned ResponseConditioned Response

AA response that is identical to response that is identical to an unconditioned response, an unconditioned response, yet it is elicited by the yet it is elicited by the conditioned stimulus, not the conditioned stimulus, not the unconditioned stimulus.unconditioned stimulus.

Operant ConditioningOperant Conditioning

This model is based on the This model is based on the theory that where behavior is theory that where behavior is reinforced and learned based reinforced and learned based on the consequences of the on the consequences of the behavior. behavior.

ReinforcementReinforcement

Something that is added to a Something that is added to a situation that increased the situation that increased the likelihood of that even or likelihood of that even or behavior of occurring again.behavior of occurring again.

Negative Negative ReinforcementReinforcement

Something that is taken away Something that is taken away or removed from the situation or removed from the situation that increase the likelihood of that increase the likelihood of the behavior occurring again.the behavior occurring again.

ModelingModeling

A principle where a behavior A principle where a behavior is learned by observing the is learned by observing the consequences of someone consequences of someone else’s experience.else’s experience.

ShapingShaping

The procedure of rewarding The procedure of rewarding successive approximations successive approximations to the desired response.to the desired response.

Coping Skills TrainingCoping Skills TrainingInterpersonalInterpersonal

Coping skills deficits are Coping skills deficits are considered a major cause of considered a major cause of drinking/using, which is likely to drinking/using, which is likely to continue in the absence of continue in the absence of adequate skills for coping with adequate skills for coping with the events that trigger and the events that trigger and follow us.follow us.

Introduction to Introduction to AssertivenessAssertiveness

PassivePassive

AggressiveAggressive

Passive-aggressivePassive-aggressive

AssertiveAssertive

See handout #1See handout #1

Receiving Criticism about Receiving Criticism about DrinkingDrinking

Type of CriticismType of Criticism

1.1.ConstructiveConstructive

2.2.DestructiveDestructive

See handout # 2See handout # 2

Refusal SkillsRefusal Skills

•Learned in the CRA ClassLearned in the CRA Class

Developing Social Developing Social Support NetworkSupport Network

• There are many stresses associated There are many stresses associated with problem drinking and drug use. with problem drinking and drug use. (relationships, illness, job loss, etc.)(relationships, illness, job loss, etc.)

• Often, people who stop using still have Often, people who stop using still have friends who drink and use drugs.friends who drink and use drugs.

• Many people feel that drinking and Many people feel that drinking and using helps them to socialize.using helps them to socialize.

• See handout #3See handout #3

Other Coping SkillsOther Coping Skills

•Communications skillsCommunications skills•Nonverbal communicationsNonverbal communications•Listening skillsListening skills•Refusal skillsRefusal skills•Resolving Relationship problemsResolving Relationship problems

•See Monti et al., (See Monti et al., (2002)Treating 2002)Treating Alcohol Dependence,Alcohol Dependence, Guilford Press. Guilford Press.

Coping Skills TrainingCoping Skills TrainingIntrapersonalIntrapersonal• Managing urges to drink/useManaging urges to drink/use

• Problem solving (CRA)Problem solving (CRA)

• Increasing pleasant activities (CRA)Increasing pleasant activities (CRA)

• Anger Management (CRA- FA)Anger Management (CRA- FA)

• Managing negative thinkingManaging negative thinking

• Seemingly irrelevant decisionsSeemingly irrelevant decisions

• Planning for emergenciesPlanning for emergencies

Managing urges to Managing urges to drink/usedrink/use•See handout #4See handout #4

•Positive Thinking worksheet &Positive Thinking worksheet &

•Urge control information Urge control information sheetsheet

Urge ControlUrge Control

•Urges and Cravings are normalUrges and Cravings are normal

•They happen more in the early They happen more in the early part of tx.part of tx.

•They have triggers, physical, They have triggers, physical, environmental and environmental and psychological.psychological.

•Urges are time Limited ******Urges are time Limited ******

Urge ControlUrge Control

• Teach client to recognize triggers.Teach client to recognize triggers.

1.1. Exposure to cueExposure to cue

2.2. Watching others drinking or usingWatching others drinking or using

3.3. Contact with people, places, activities.Contact with people, places, activities.

4.4. Elicit emotional states (anger, stress, Elicit emotional states (anger, stress, etc)etc)

5.5. Examine physical feelings (shakes, etc.)Examine physical feelings (shakes, etc.)

Urge Control - StepsUrge Control - Steps

• Avoid identified urgesAvoid identified urges• Find competing behaviorsFind competing behaviors• Talk to a friendTalk to a friend• Surf it (discuss urge surfing)Surf it (discuss urge surfing)• Challenge and change the thoughtChallenge and change the thought• Review positive things since stopped Review positive things since stopped

usingusing• Wait 15 minutes before you actWait 15 minutes before you act• Use self talk. What is the worst that can Use self talk. What is the worst that can

happen?happen?

Managing negative Managing negative thinkingthinking•Triggers (event, person, place)Triggers (event, person, place)

•Thoughts (I can’t do this)Thoughts (I can’t do this)

•Feelings (Scared, depressed, angry)Feelings (Scared, depressed, angry)

•How do you change each one of the How do you change each one of the above?above?

• See handout #5See handout #5

Seemingly irrelevant Seemingly irrelevant decisionsdecisions

•Many events are seemingly unrelated Many events are seemingly unrelated to a relapse but lead to one, Right?to a relapse but lead to one, Right?

•What is a behavioral chain of events?What is a behavioral chain of events?

•Can we change the outcome and Can we change the outcome and where do we intervene?where do we intervene?

Planning for emergenciesPlanning for emergencies

•See handouts # 6 for See handouts # 6 for exerciseexercise

ContingencyContingency ManagementManagement•The theoretical foundation of CM was The theoretical foundation of CM was

derived from principles of operant derived from principles of operant conditioning.conditioning.

•Behaviors are controlled by its Behaviors are controlled by its consequences, and is amenable to consequences, and is amenable to change by altering its consequences.change by altering its consequences.

ContingentContingent

•Dependent on something Dependent on something conditionalconditional

•Something that may or may not Something that may or may not happen.happen.

ContingencyContingency ManagementManagement•Patients are offered some Patients are offered some

attractive options, including attractive options, including tangible goods and services, tangible goods and services, immediately contingent on immediately contingent on demonstrating objective demonstrating objective evidence (i.e., drug-free urine evidence (i.e., drug-free urine samples).samples).

Voucher ProgramVoucher Program

• For every clean Urine, client gets For every clean Urine, client gets monetary rewardsmonetary rewards

• First drug-free urine = $2.50, each First drug-free urine = $2.50, each consecutive drug-free urine the amount consecutive drug-free urine the amount given was increased by $1.50.given was increased by $1.50.

• For every 3 consecutive drug-free urines For every 3 consecutive drug-free urines the client received a $10.00 bonus.the client received a $10.00 bonus.

• In 12 weeks the client could earn up to In 12 weeks the client could earn up to $1000.00$1000.00

Voucher ResultsVoucher Results

•75% of the clients who 75% of the clients who received the vouchers received the vouchers completed 24-weeks of completed 24-weeks of abstinence compared to only abstinence compared to only 40% in the non-voucher 40% in the non-voucher group.group.

Implementing a Voucher Implementing a Voucher ProgramProgram

• Describe the program to patientsDescribe the program to patients

• Target AbstinenceTarget Abstinence– One drug at a time works bestOne drug at a time works best

• Set up a reinforcement scheduleSet up a reinforcement schedule– Escalating payEscalating pay– Reset the pay for non-complianceReset the pay for non-compliance

Implementing a Voucher Implementing a Voucher ProgramProgram

•Frequent Urine MonitoringFrequent Urine Monitoring

•Provide FeedbackProvide Feedback

•Minimizing delay in Voucher exchangeMinimizing delay in Voucher exchange

•Frequent and regular voucher Frequent and regular voucher spendingspending

•Voucher RedemptionVoucher Redemption

•Abstinence Reinforcement SummaryAbstinence Reinforcement Summary

Give examples of CMGive examples of CM

•Being on Probation?Being on Probation?•Ultimatum from spouse?Ultimatum from spouse?•Boss says next time you come in Boss says next time you come in

late your fired?late your fired?•Condition of Probation is not going Condition of Probation is not going

to bars?to bars?•How else can you use CM in your How else can you use CM in your

practice?practice?

Behavioral ContractingBehavioral Contracting

•This is a means of scheduling This is a means of scheduling reinforcements (verbal, reinforcements (verbal, behaviors, events) between behaviors, events) between two or more people.two or more people.


• Involve all relevant parties.Involve all relevant parties.

•Write contracts, do not leave it to Write contracts, do not leave it to memory.memory.

•Have all parties sign the contract, Have all parties sign the contract, which in effect is a review process.which in effect is a review process.

•Be sure contracts are understood by Be sure contracts are understood by asking each party to describe what asking each party to describe what they have agreed to.they have agreed to.


• Role-Play the contact .Role-Play the contact .

• Clarify each parties responses.Clarify each parties responses.

• There must be a benefit for each party.There must be a benefit for each party.

• No value judgments.No value judgments.

• What is the pay-off or the desirable long What is the pay-off or the desirable long term goal of the contract?term goal of the contract?

• There should be some reinforcer There should be some reinforcer samplingsampling


•There should be flexibility, if one party There should be flexibility, if one party refuses an agreement suggest refuses an agreement suggest alternatives.alternatives.

•Always teach how to compromise.Always teach how to compromise.

•Small agreements will lead to larger Small agreements will lead to larger agreements.agreements.

•You can build in sanctions for failure You can build in sanctions for failure to follow through.to follow through.


•The therapist should The therapist should eventually let the clients take eventually let the clients take the lead on making the lead on making agreements.agreements.

•Use positive wording making Use positive wording making out contracts.out contracts.

Behavioral Contracting Behavioral Contracting GuideGuide• Select one or two behaviors that you Select one or two behaviors that you

want to work on first.want to work on first.

• Describe those behaviors so that they Describe those behaviors so that they may be observed or measured.may be observed or measured.

• Identify rewards that will help provide Identify rewards that will help provide motivation to succeed.motivation to succeed.

• Monitor or make sure someone monitors Monitor or make sure someone monitors the contract and rewards success.the contract and rewards success.


•Write the contract so everyone Write the contract so everyone understands it fully.understands it fully.

•Troubleshoot if needed.Troubleshoot if needed.

•Rewrite the contract whether there is Rewrite the contract whether there is improvement or not.improvement or not.

•Continue to monitor the contract over Continue to monitor the contract over time.time.

•Select new behaviors to work on.Select new behaviors to work on.

Aversion TherapyAversion Therapy

•Aversion therapy attempts to interrupt Aversion therapy attempts to interrupt the drinking behavior by creating a the drinking behavior by creating a aversion or distaste for alcohol.aversion or distaste for alcohol.

•Alcohol is repeatedly paired with an Alcohol is repeatedly paired with an US which is extremely unpleasant. US which is extremely unpleasant. That unpleasantness then generalized That unpleasantness then generalized and becomes associated with alcohol.and becomes associated with alcohol.


•Alcohol is paired with drugs, electrical Alcohol is paired with drugs, electrical shock, imagery, smell or other very shock, imagery, smell or other very unpleasant stimulus.unpleasant stimulus.

•Began in 1935 with injections of Began in 1935 with injections of emetine, which cause nausea and emetine, which cause nausea and vomiting.vomiting.

•Drank alcohol – injection = sick, sick, Drank alcohol – injection = sick, sick, sicksick


•Aversion therapy has mixed Aversion therapy has mixed results. results.

•Some treatment centers won’t Some treatment centers won’t release their results.release their results.

•Treatment (inpatient) usually lasts Treatment (inpatient) usually lasts for 5, 30 minutes sessions with 2 for 5, 30 minutes sessions with 2 booster sessions after discharge.booster sessions after discharge.


•There have been other drugs There have been other drugs used including a curare like drug used including a curare like drug that actually caused total that actually caused total paralysis, including breathing.paralysis, including breathing.

•Who’s next? Would you try it?Who’s next? Would you try it?


• ImageryImagery and smell has been used and smell has been used as well with mixed results. The as well with mixed results. The success rate varies from 50% success rate varies from 50% maintaining abstinence to 9% maintaining abstinence to 9% remaining abstinent.remaining abstinent.

Not used much anymore for obvious Not used much anymore for obvious reasons.reasons.

Cue ExposureCue Exposure

• CE is derived from learning and social CE is derived from learning and social learning theory models.learning theory models.

• Cues can include sight, smells, places, Cues can include sight, smells, places, people and emotional feelings (anger, people and emotional feelings (anger, stress, depressed, happy etc.).stress, depressed, happy etc.).

•Cues may play a role in Cues may play a role in resumption of using. resumption of using.


•Since cues play an important Since cues play an important part in triggering using behavior part in triggering using behavior cue exposure training (CET) cue exposure training (CET) gives the client a chance to gives the client a chance to practice new coping skills to practice new coping skills to effectively handle those cues effectively handle those cues (triggers).(triggers).


•First, repeated exposure to a cue First, repeated exposure to a cue should result in habituation, should result in habituation, (decreasing the strength of the cue).(decreasing the strength of the cue).

•Second, practice using coping skill in Second, practice using coping skill in the presence of cues should make it the presence of cues should make it easier to use them in a real situation.easier to use them in a real situation.


•Urge Control is part of cue Urge Control is part of cue exposureexposure

•Use “Daily record of Urges” to Use “Daily record of Urges” to help clients identify urges and help clients identify urges and how strong an urge becomes.how strong an urge becomes.

Behavioral Self-Control Behavioral Self-Control TrainingTraining

• BSCT can be used for moderation or BSCT can be used for moderation or a goal of abstinence.a goal of abstinence.

• Most likely to work for clients who Most likely to work for clients who are at the beginning of treatment, are at the beginning of treatment, and are experiencing less severe and are experiencing less severe problems.problems.

Why use BSCT?Why use BSCT?

•Those who refuse a goal of Those who refuse a goal of abstinence.abstinence.

•Attracts a broader range of drinkers.Attracts a broader range of drinkers.

• In may cases moderation leads to In may cases moderation leads to abstinence.abstinence.

DescriptionDescription

• Setting limits.Setting limits.

• Self-monitoring of drinking behaviorsSelf-monitoring of drinking behaviors

• Changing the rate of drinking.Changing the rate of drinking.

• Practice refusal skillsPractice refusal skills

• Setting up a reward system for achievement Setting up a reward system for achievement of goals.of goals.

• Learning which triggers result in Learning which triggers result in overdrinkingoverdrinking

• Learning new coping skills to resist drinkingLearning new coping skills to resist drinking

Practice ExercisePractice Exercise

• Develop a Treatment Plan, just pick one or Develop a Treatment Plan, just pick one or two areas to work on, (one or two goals)two areas to work on, (one or two goals)

• Then develop a strategy to accomplish Then develop a strategy to accomplish these treatment goals using one of the these treatment goals using one of the strategies we’ve discussed in this class.strategies we’ve discussed in this class.

• Don’t play the client from Hell. This is a Don’t play the client from Hell. This is a learning experience.learning experience.

• Debrief with groupDebrief with group

Recovery Maintenance Strategies:Recovery Maintenance Strategies: Marlatt and Gordon (1980) Marlatt and Gordon (1980) Cognitive-Behavioral ModelCognitive-Behavioral Model

• Distinguished Distinguished lapselapse from from relapse.*relapse.*

• Creation of a Relapse Prevention (RP) model Creation of a Relapse Prevention (RP) model based on Cognitive-Behavioral principles.based on Cognitive-Behavioral principles.

Recovery Maintenance Strategies:Recovery Maintenance Strategies:Marlatt and Gordon RP ModelMarlatt and Gordon RP Model

• Effective coping in high risk situations Effective coping in high risk situations leads to enhanced leads to enhanced self-efficacyself-efficacy**

• Enhanced self-efficacy = less relapse*Enhanced self-efficacy = less relapse*• Ineffective coping in high risk situations Ineffective coping in high risk situations

leads to decreased self-efficacy and leads to decreased self-efficacy and increase in positive outcome expectancyincrease in positive outcome expectancy

• Low self-efficacy + increased positive Low self-efficacy + increased positive outcome expectancies = more relapse*outcome expectancies = more relapse*


High risk situation High risk situation Effective coping response Effective coping response Increased self-efficacy Increased self-efficacy Less risk of relapse Less risk of relapse

High risk situation High risk situation Ineffective coping response Ineffective coping response Decreased self-efficacy + Positive outcome Decreased self-efficacy + Positive outcome expectancy expectancy Lapse Lapse AVE and perceived AVE and perceived positive effects positive effects Increased risk of relapse Increased risk of relapse

Marlatt and Gordon RP ModelMarlatt and Gordon RP Model..

High Risk SituationHigh Risk Situation

Effective CopingEffective CopingResponseResponse

Ineffective CopingIneffective CopingResponseResponse

Increased Self-Increased Self-EfficacyEfficacy

Decreased Self-Decreased Self-EfficacyEfficacy

Less Less Lapse/Relapse RiskLapse/Relapse Risk

Positive OutcomePositive OutcomeExpectancyExpectancy

More More Lapse RiskLapse Risk

Increased AVEIncreased AVE

More Relapse RiskMore Relapse Risk


Characteristics of a “high risk” situationCharacteristics of a “high risk” situation

• Unpleasant emotionsUnpleasant emotions• Physical discomfortPhysical discomfort• Pleasant emotionsPleasant emotions• Testing personal controlTesting personal control• Urges and temptationsUrges and temptations• Social problems at workSocial problems at work• Social tensionSocial tension• Positive social situationsPositive social situations

Outcome Expectancy* orOutcome Expectancy* orWhat the IP expects from usingWhat the IP expects from using

• Global positive changesGlobal positive changes• Sexual enhancementSexual enhancement• Physical and social pleasurePhysical and social pleasure• Social assertivenessSocial assertiveness• Relaxation and tension reductionRelaxation and tension reduction• Arousal and powerArousal and power

Expectancy plays a major role in the control and Expectancy plays a major role in the control and prediction of relapseprediction of relapse

Expectancy EffectsExpectancy Effects

ReceivedReceivedAlcoholAlcohol

Received NoReceived NoAlcoholAlcohol

Told theyTold theyReceivedReceivedAlcoholAlcohol YESYES YESYES

Told they Told they Received noReceived no

AlcoholAlcoholNONO NONO

Biphasic Effects of AlcoholBiphasic Effects of Alcohol

• Description of the usual physical Description of the usual physical effects of drinking alcohol*effects of drinking alcohol*

• BAC of 0.01 to 0.06, experience BAC of 0.01 to 0.06, experience positive mood effects (mostly due to positive mood effects (mostly due to expectancy)expectancy)

• BAC >0.06, experience negative BAC >0.06, experience negative mood effectsmood effects


Abstinence Violation Effect (AVE):Abstinence Violation Effect (AVE):

an individual’s an individual’s cognitivecognitive and and affectiveaffective response to a lapse.*response to a lapse.*

(Disease model focuses on physiology-driven loss of control)(Disease model focuses on physiology-driven loss of control)


– AVE AVE increasesincreases when cause of use is seen as: when cause of use is seen as: Internal (“I have a disease”)Internal (“I have a disease”) Stable (“My slip is about me, so it will happen Stable (“My slip is about me, so it will happen

again”)again”) Global (“My slip will happen in other places”)Global (“My slip will happen in other places”) Uncontrollable (“I have no willpower”)Uncontrollable (“I have no willpower”)

– AVE AVE decreasesdecreases if use seen as discrete event if use seen as discrete event and a function of their behaviorand a function of their behavior


Additional AVE FactorsAdditional AVE Factors– Degree of commitment to sobrietyDegree of commitment to sobriety– Effort exerted toward sobrietyEffort exerted toward sobriety– Length of sobriety (Length of sobriety (highest relapse highest relapse

rate within first 90 days of sobriety)*rate within first 90 days of sobriety)*

– Degree of progress to maintain Degree of progress to maintain sobrietysobriety


Less Obvious Relapse Factors and Less Obvious Relapse Factors and Opportunities for InterventionOpportunities for Intervention

Lifestyle imbalance Lifestyle imbalance Desire for indulgence Desire for indulgence Urges and cravings Urges and cravings Rationalization, denial, AIDs Rationalization, denial, AIDs Lack of coping response Lack of coping response Decreased self- Decreased self-efficacy + positive outcome expectancies efficacy + positive outcome expectancies Initial Initial use (lapse) use (lapse) AVE AVE Relapse Relapse

Recovery Maintenance Strategies:Recovery Maintenance Strategies:Self-Efficacy*Self-Efficacy*

• Enter high risk drinking situationEnter high risk drinking situation

• Cognitive appraisalCognitive appraisal

• Reach judgment (efficacy Reach judgment (efficacy expectation) about ability to copeexpectation) about ability to cope

• Drink/use or not drink/not useDrink/use or not drink/not use

(Helen Annis)(Helen Annis)

Recovery Maintenance Strategies:Recovery Maintenance Strategies:Self-EfficacySelf-Efficacy• Analysis of client’s high-risk situations (Inventory Analysis of client’s high-risk situations (Inventory

of Drinking Situations - IDS-100)of Drinking Situations - IDS-100)

• Creation of Client ProfileCreation of Client Profile– GeneralizedGeneralized– PositivePositive– NegativeNegative– MixedMixed

• Develop hierarchy of risky situationsDevelop hierarchy of risky situations

• Identify strengths, resources and coping Identify strengths, resources and coping responsesresponses

• Monitor self-efficacy (Situational Confidence Monitor self-efficacy (Situational Confidence Questionnaire - SCQ-39)Questionnaire - SCQ-39)

Recovery Maintenance Strategies:Recovery Maintenance Strategies:Self-EfficacySelf-Efficacy

Effective Homework Assignments*Effective Homework Assignments*– Challenging tasksChallenging tasks– Moderate effortModerate effort– Little external aidLittle external aid– Pattern of improvementPattern of improvement– Increase in personal controlIncrease in personal control– Success directly relevant to recoverySuccess directly relevant to recovery

Recovery Maintenance Strategies:Recovery Maintenance Strategies:Functional AnalysisFunctional Analysis• Emphasis upon lapse/relapse as learning Emphasis upon lapse/relapse as learning

opportunityopportunity

• Reasons for becoming sober/clean may not be the Reasons for becoming sober/clean may not be the same as the reasons for staying sober/clean*same as the reasons for staying sober/clean*

• Assumes that lapse/relapse makes senseAssumes that lapse/relapse makes sense

• Examines the before, during and after of Examines the before, during and after of lapse/relapse behaviorlapse/relapse behavior

• Done in a non-judgmental attitudeDone in a non-judgmental attitude

• Want to get the “story”Want to get the “story”

• Remember to go far enough back in timeRemember to go far enough back in time

Behavioral ChainBehavioral ChainBored need a walkBored need a walk

go towards the park go into park go towards the park go into park

Go near friends house go into houseGo near friends house go into house

Friend asks you to get high give inFriend asks you to get high give in

ExerciseExercise

•Develop a relapse plan for your Develop a relapse plan for your clientclient

•Role play developing a relapses Role play developing a relapses plan using the relapse strategies plan using the relapse strategies discussed, and then discuss with discussed, and then discuss with the group your plan.the group your plan.

Cultural IssuesCultural Issues

• Cultural Barriers to treatmentCultural Barriers to treatment

• Lack of gender specific programmingLack of gender specific programming

• Cultural structures, beliefs or values Cultural structures, beliefs or values that discourage acknowledgment of that discourage acknowledgment of alcohol or drug related problems or alcohol or drug related problems or seeking formal treatment.seeking formal treatment.

• Language barriers.Language barriers.


• Lack of culturally specific Lack of culturally specific programming.programming.

• Lack of effective culturally specific Lack of effective culturally specific outreach and advertisement.outreach and advertisement.

• Lack of treatment to meet special Lack of treatment to meet special needs of the culture.needs of the culture.

• Lack of training in cultural issuesLack of training in cultural issues


•Respect for CultureRespect for Culture

•Give Dignity to all Give Dignity to all

•Never think you know the Never think you know the cultureculture

Cognitive Behavioral Therapies & Practicum Course #39457 Current Professionals Track Substance Abuse...

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Transcript of Cognitive Behavioral Therapies & Practicum Course #39457 Current Professionals Track Substance Abuse...