Women and DUI Women and DUI

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					   California Association of Drinker Driver Treatment Programs
                          2007 Fall Forum


            Women and DUI
                    Deborah Werner
         Children and Family Futures, Inc.
     4940 Irvine Boulevard, Suite 202 * Irvine, CA 92620
          714/505.3525 * dwerner@cffutures.org
               www.cffutures.org/calwcf

This Presentation is Made Possible Through a Contract with the
 State of California Department of Alcohol and Drug Programs




                          Goals
To help DUI program staff understand
differences between male and female
participants
To help DUI programs identify ways to reach
and motivate women DUI offenders in order
to improve women’s retention and program
outcomes
Part 1:     Women AOD Use & Abuse
            W         U     Ab




Women and Men - Priorities
                            oriented.
Men are action and activity oriented
Women are people and process oriented.
Sex-Role stereotyping – males are societal,
women are familial


Body image, appearance key importance for
women; performance key importance for
males.
Men & Women - Communication
 Males tend to be linear in conversation –
 women tend to speak in a spiral.
 Males less comfortable with expressing
 “internal emotions” – compassion, love,
 sadness.
 Females less comfortable with expressing
 “external emotions” – anger.
 Women use more words.




 Male communication is problem solving
 oriented. Want to fix it.


 Female communicates to process problems.
 Want to express it.
      Women & Men - Disparities
•   In 2004, women's median annual earnings were only $.76 for every
    $1.00 earned by men. For women of color, the gap is even worse –
    only $.69 for African American women and $.58 for Latinas. (NOW)
•   In California 55% of women are in the labor force. (American
    FactFinder)
•   15.3% of California families with children below age 18 live below
    the poverty level. In female headed households with children under
    18 more than 32.5% are below poverty level (American FactFinder,
    California)
•       y      p                p y
    Fifty-five percent of all employed women work in female-dominated
    jobs (jobs in which women comprise 70 percent or more of the
    workforce) whereas only 8.5 percent of all men work in these
    occupations. (Men working in female-dominated jobs still receive
    about 20 percent more than women who work in female-dominated
    jobs.) (National Organization for Women)




Women’s Alcohol and Other
Drug Use is Different than
           Men
     Women’s Pathways to Use
  Partners
  Peer Pressure
  Low Esteem
  Self-Medicating/Coping with Pain
  Media Messages




        Women and Alcohol Use

  Past Month Alcohol Use Among People Aged 12 +
                           percent of percent of
                            females      males
Any use of alcohol              45.0%      57.5%
Binge alcohol use               15.1%
                                15 1%      30.8%
                                           30 8%
Heavy alcohol use                3.3%      10.5%

  Office of Applied Studies (August 2, 2007). Gender Differences in Alcohol Use and
  Alcohol Dependence or Abuse: 2004 and 2005. Rockville, MD: Substance Abuse and
  Mental Health Services Administration. Available at http://www.oas.samhsa.gov
         Alcohol Abuse by Race
          Race and Alcohol Abuse/Dependence by Gender
                                      percent of percent of
                                       females     males
 White                                      5.6%      10.6%
 African American/Black                     3.5%       9.7%
 Latino/Hispanic                            3.8%      12.1%
 American Indian/Native American           13.7%      19.5%
 Pacific Islander                           5.7%      12.8%
 Asian                                      2.3%       5.4%
 Two or More Races                          7.7%       9.9%

 Office of Applied Studies (August 2, 2007). Gender Differences in Alcohol Use and
 Alcohol Dependence or Abuse: 2004 and 2005. Rockville, MD: Substance Abuse and
 Mental Health Services Administration. Available at http://www.oas.samhsa.gov




          Alcohol Abuse by Age

   Age and Alcohol Abuse/Dependence by Gender
                           percent of percent of
                            females      males
Ages 12 ‐17                      6.0%       5.5%
Ages 18 ‐ 25                    12.9%      22.0%
Ages 26 ‐ 49                     5.4%
                                 5 4%      12.4%
                                           12 4%
Ages 50 or older                 1.6%       5.0%

 Office of Applied Studies (August 2, 2007). Gender Differences in Alcohol Use and
 Alcohol Dependence or Abuse: 2004 and 2005. Rockville, MD: Substance Abuse and
 Mental Health Services Administration. Available at http://www.oas.samhsa.gov
                  Binge Drinking
College Alcohol Study conducted by Harvard
University found that 50% of males and 39%
of female college students on US Campuses
binge drink. (Wechsler et al. 1995).
Nearly half of high school girls drink alcohol
and more than one in four binge drink.
(Grunbaum, et al., 2004)


23% of alcohol fatalities are female                             (inferred from
ADP Fact Sheet: Driving Under the Influence Statistics, Nov. 2004)




                  DUI Prevalence
                             11.4%
Among adults (21 and older) 11 4% of
females and 22% of males reported driving
while under the influence. (NSDUH, 2005)
Among youth aged 16 – 20, surveyed in
2002-2003, 18% of females report driving
under the influence of alcohol or illicit drugs
in the last year. (24% of males)
Young women use substances to:
 Improve mood
 Self-medicate mood disturbances
 Increase confidence
 Lose inhibitions
 Lose weight
 Access to alcohol and other drugs
 Partners, boyfriends & peers encourage use
 Higher incidence of dependency associated with
 child abuse and neglect




The experience women have with substance
  use is very different then the experience
                    of men.
Problems and Consequences
The problems and consequences of substance
for women tend to be personal and self-
destructive.

The problems and consequences of substance
use for men tend to be societal and destructive
to others.




     Worse Health Effects
          drink
Drink for drink, women’s brains and organs
are exposed to a higher concentration of
alcohol compared with men.
Women are more likely to develop
inflammation of the liver and to die of
cirrhosis.
Telescoping effect
 Sexual Related Consequences
 More likely to experience sexual assault
 More likely to have unplanned sex
 Unplanned/teenage pregnancy and STDs


                           violence
 More likely to experience violence, domestic
 violence




                 Children
Women are often primary care-takers of
 children.
  • Alcohol use can lead to endangerment,
    chaotic up-bringing, poor role modeling,
    increased risk of abuse or neglect, CPS
    involvement
 Children are a barrier to accessing services.
  • Child care, safety, fear of removal
 Children are a motivator for change.
         Women and DUI
Less Prevalence
Less Arrests
Barriers to Intervention and Participation
Reaching Women
Women with Multiple Problems
Relapse Factors




               Prevalence
                             10 6%
In 1988 women made up only 10.6% of DUI
arrestees. By 1997 it had grown to 13.2% of
arrestees.
In 1997 more than 25,000 women arrested
for DUI.
2005 women = 17.5% of arrestees 31,160
women arrested.
Females Arrested for DUI less likely to
  be Hispanic than Male Arrestees.
             percent of       percent of         percent of
               males           females             total
   White            46.1%             65.4%              41.8%
  Hispanic          47.8%             19.4%              44.1%
   Black              6.6%              7.3%              6.7%
   Other               .4%              7.9%              7.5%
   Total          100.0%            100.0%             100.0%

              Criminal Justice Statistics Center Report Series, Vol 1 No 1, Report on
              Arrests for Driving Under the Influence, 1997, April 1999




                2005 California

             percent of       percent of         percent of
               males           females             total
   White            46.4%             60.7%                40.7
  Hispanic          44.7%             23.8%                45.5
   Black              7.1%              8.1%                 7.1
   Other              6.7%              7.4%                 6.7
   Total          100.0%            100.0%             100.0%

              Criminal Justice Statistics Center Report Series, Vol 1 No 1, Report on
              Arrests for Driving Under the Influence, 1997, April 1999
Females are older at time of arrest
           than males

                 percent of percent of percent of
                   males     females     total
 Juvenile              0.9%       1.1%       0.9%
  18‐24               22.3%      18.2%      21.8%
  25‐29               19.3%      16.4%      18.9%
  30‐39               30.8%      33.9%      31.2%
  40‐49                   %
                      17.4%          %
                                 21.1%          %
                                            17.9%
  50 or older          9.4%       9.2%       9.3%
  Total              100.0%     100.0%     100.0%

                Criminal Justice Statistics Center Report Series, Vol 1 No 1, Report on
                Arrests for Driving Under the Influence, 1997, April 1999




                           CA 2005


 Median Age – Males 33.0
 Median Age – Females 33.3

 42.7% of Males and 40.9% of Females
 between 21 – 30
                          8 2%
 9% of males under 20 and 8.2% of females
 under 20
Fatal crashes among female drivers with BACs of .10 and
higher, by driver age*




 *Computed from NHTSA 1997 Fatality Analysis Reporting System data.




            Women Not Arrested
           g youth aged 16 – 20, surveyed in
      Among y         g                 y
      2002-2003, 18% of females report driving
      under the influence of alcohol or illicit
      drugs in the last year. (24% of males)
      Among those reporting driving under the
      influence 6% of males and 2% of females
      reported being arrested and booked for
      DUI in the last year.
                                                            OAS, 2004
   No Arrest – No Services
                             11.4%
Among adults (21 and older) 11 4% of
females and 22% of males reported driving
while under the influence. (OAS, 2005)
Among all adult drivers 1.1% of males and
.2% of females report an arrest for DUI.
(OAS, 2005a)




 Is It Really Giving Them a
            Break?
        Story.         old
Erica’s Story 14 years old, driving under
influence and crashed car. On scene – no
DUI checks. At Court    12 hours of
community service.
Police not wanting to see girls/young women
in jail, bring them home instead of arresting
them.
Messages that Reach Women
National Highway Traffic Safety Administration
study explored young women's views of
impaired driving messages.
The data analysis showed that women were
most affected by
• emotional appeals
• graphic images of negative consequences
• PSAs depicting realistic situations
• those in which they could identify with the
  characters




Reaching Women Continued
Authoritative messages were rejected by the
participants, especially the youngest women.
Using celebrities in these messages was not
viewed as effective.
Humor in PSAs was seen positively by some
participants and negatively by others.
The data indicate that impaired driving
messages targeting young women would be
more effective if they were tailored for them.
Barriers to Women’s Participation

 Trauma
 Powerlessness
 Self-Efficacy
 Family Responsibilities
 Life Challenges
 STIGMA




 DUI Programs and Women
    g
Designed for Men
Male dominated settings
How are family responsibilities addressed?
How is a woman with low self-efficacy and
powerlessness assisted?
Economic and other hurtles to
participation/case management?
STIGMA faced by women is greater than men.
Men with AOD problems also judge women more
harshly.
                                         Paris Hilton hit Les Deux for her first visit
                                         to a club since being released from jail
                                         after serving more than three weeks for a
                                         probation violation in an alcohol-related
                                         driving case.
                                         d     g case




Britney Spears didn't just make a
financial settlement with the owner of
a car she hit – she offered, to make a
personal apology.




Actress Michelle Rodriguez
                                            Cynthia Watros, who plays Libby
speaks out about her sentence
                                            on ABC's hit series "Lost,"
for violating probation.
                                            pleaded guilty to drunken
                                            driving in Hawaii.
              Nicole Richie, who is six months
              pregnant, has enrolled in a lengthy
              anti-drinking education program.
              Papers filed with the Superior Court
              of California show that on Sept. 26
              Richie signed up for a 18-month anti-
              drinking driver course, known as the
              SB 38 Alcohol Program.

              She was "pleasantly surprised" to be
              released after serving 82 minutes of
              her four-day jail sentence for a
              second DUI conviction.




Lindsay Lohan pleaded guilty to two counts of being
under the influence of cocaine and pleaded no
contest to driving with a blood alcohol level of .08
percent or higher and reckless driving.

She will serve at least 24 hours in jail in her
drunken-driving cases under the terms of a plea deal
reached Thursday. Lohan was also placed on three
years probation and ordered to complete an 18-
month alcohol education program.

She has completed her second treatment program,
has support of family and friends and a sober
companion for follow-up.
                   References
Office of Applied Studies (August 2, 2007). NSDUH Report:
Gender Differences in Alcohol Use and Alcohol Dependence or
Abuse: 2004 and 2005. Rockville, MD: Substance Abuse and
Mental Health Services Administration. Available at
http://www.oas.samhsa.gov
Office of Applied Studies (July 1, 2005). NSDUH Report: Driving
Under the Influence Among Adult Drivers Rockville, MD:
Substance Abuse and Mental Health Services Administration.
Available at http://www.oas.samhsa.gov
Offi    f A li d St di (S t       b 2 2005)           R
Office of Applied Studies (September 2, 2005). NSDUH Report:t
Arrests for Driving Under the Influence Among Adult Drivers
Rockville, MD: Substance Abuse and Mental Health Services
Administration. Available at http://www.oas.samhsa.gov
Criminal Justice Statistics Center Report Series, Vol 1 No 1,
Report on Arrests for Driving Under the Influence, 1997, April
1999




           pp             (December 31, 2004). NSDUH Report:
Office of Applied Studies (           ,     )          p
Driving Under the Influence Among Young Persons. Rockville,
MD: Substance Abuse and Mental Health Services
Administration. Available at http://www.oas.samhsa.gov
Grunbaum, J.A., Kann, L., Kinchen, S., Ross, J., Hawkins, J.,
Lawry, R., et al. (2004). Youth Risk Behavior Surveillance:
United States, 2003. Morbidity and Mortality Weekly Report:
Surveillance Summaries, 55 (SS-2).
          et.al. (1995) Am J             Health 85 921 926 )
(Wechsler et al (1995). Am. J. of Public Health. 85. 921-926.)
ADP Fact Sheet: Driving Under the Influence Statistics, Nov.
2004. Available at www.adp.ca.gov
California Association of Drinker Driver Treatment Programs
                      2007 Fall Forum




 Women and DUI Part II
                        Deborah Werner
                 Children and Family Futures, Inc.
            4940 Irvine Boulevard, Suite 202 * Irvine, CA 92620
                714/505.3525 * dwerner@cffutures.org
                      www.cffutures.org/calwcf

              This Presentation is Made Possible Through a Contract
      with the State of California Department of Alcohol and Drug Programs




Part 1I:               Gender Responsive Services
Gender Differences at Treatment
   Reasons cited for not getting treatment by
   women classified as needing but not receiving
   treatment and who felt a need for treatment
   included:
    • 33% felt not ready to stop using
    • 27% felt could handle the problem on their own
    • 22% were concerned with stigma (compared to 10%
      of men)
              ld    t ff d t   t
    • 17% could not afford treatment t
    • 9 % did not have time (compared with 2% of men)
    • 8% did not know where to go, 7% indicated the
      program type unavailable, 4% no openings and 4%
      transportation.
               Source: Online analysis of the NSDUH 2003 Public Use file




Male-Based Approach
• Knowledge of factors that contribute to DWI and
  high-risk driving almost exclusively from studies of
  males.
• Factors: demographic characteristics; excessive
  alcohol use; personality traits; acute states of
  emotional distress; and driving-related attitudes.
• DUI Services based on a cognitive-behavioral model
  that integrates the influence of these factors on
          risk.
  driving risk

                                         (Donovan et al., 1983).
    Treatment for Women
 GENDER DIFFERENCES                                          SERVICE RESPONSES
                                                       80s/90s Gender Specific:
      Biological
    • Bi l i l                                                • S     t facilities
                                                                Separate f iliti
    • Psycho-social                                           • Separate groups/services
    • Parenting/Family                                        • Childcare
    • Motivators & Barriers                            2000s Gender Responsive:
    • Treatment Needs                                         • Trauma Informed
    • Recovery Support Needs
             y pp                                             • Strengths Based
                                                                     g
                                                              • Relational Theory


      Adapted from Christine Grella, Ph.D., What’s so Special About Specialized Treatment for Women presented
      at National Conference on Women, Addictions and Recovery, July 2006.




CSAT Model of Comprehensive Services
for Women & Children




                         CSAT Women, Youth and Families Task Force (2004). Unpublished draft.
     Comprehensive Model includes:
  Components
  • Clinical treatment services for women
  • Clinical support services for women
  • Community support services for women
  • Clinical treatment services for children
  • Clinical support services for children
  • Community support services for children

  Cultural Competence, Gender Competence and
    Developmentally Appropriate




Characteristics of Gender Responsive
Services
     •   Relational
     •   Strength-based, motivational
     •   Comprehensive
     •   Trauma informed
     •   Address the different pathways to use,
         consequences of use, motivations, treatment
         issues and relapse prevention needs unique to
         women
     • Provided in an environment where women feel
       comfortable and safe
Culturally Relevant Treatment
 •    Honors traditions and values
 •    Acknowledges cultural pain and racism
 •    Builds appropriate efficacy and support
 •    Staff, management and Board reflective
 •    Respects individuals
 •    Differentiates drug culture from culture itself
 •    Helps people learn cultural traditions
 •          i
      Relational




 Clinical Treatment Services
     FOR WOMEN                          FOR CHILDREN
     • Outreach and Engagement          • Intake
     • Screening                        • Screening
     • Pharmocotherapy
         a ocot e apy                   • Medical Care a Services
                                            e ca Ca e and Se v ces
     • Drug monitoring                  • Therapeutic Child Care
     • Treatment planning               • Development Services
     • Mental health Services           • Mental Health and Trauma
     • Detoxification                     Services
     • Medical Care and Services        • Assessment
     • Assessment                       • Residential Care in Residential
     • Substance Abuse Counseling and     Settings
       Education                        • Case Management
     • Trauma Informed and Trauma-      • Substance Abuse Education &
       Specific Services                  Prevention
     • Crisis Intervention              • Care Planning
     • Case Management
     • Continuing Care
     Clinical Support Services
 FOR WOMEN                        FOR CHILDREN
 • Life skills                    • Primary health care services
 • Advocacy                       • Onsite or healthy child care
 • Primary health care services   • Recovery community
 • Family programs                  support services
 • Parenting and child            • Advocacy
   development education          • Educational services
 • Housing support                • Recreational services
 • Education remediation and      • Prevention services
   support                        • Mental health and
 • Employment readiness             remediation services
   services
 • Linkages with legal system
   and child welfare systems
 • Recovery community
   support services
 • Life skills




Community Support Services
 •   Transportation
 •   Child care
 •   H    i       i
     Housing services
 •   Family strengthening
 •   Recovery community support services
 •   Employer support services
 •   TANF linkages
 •   Vocational and academic education services
     V      i  l d     d    i d     i      i
 •   Faith based organization support
 •   Recovery management
        Strategies for Working with Women




Characteristics of Gender Responsive
Services
    •   Relational
    •   Strength-based, motivational
    •   Comprehensive
    •   Trauma informed
    •   Address the different pathways to use,
        consequences of use, motivations, treatment
        issues and relapse prevention needs unique to
        women
    • Provided in an environment where women feel
      comfortable and safe
Selected Strategies
•   Welcoming/Relational
•   Strength-Based
•   Trauma
•   Relationships
•   Motivational




Welcoming
• Welcoming environment
• Trusting relationship
• Building self efficacy
• Strength-based
• Perceived utility
• Ancillary services
• Empathetic counseling style
• Motivational interviewing
• Knowing consequences and alternatives
Relational
•   Role Models
•   People who Care
•   People to Talk with
•   Safe Environment
•   Not a Tool for the Group Process
•   Female Staff and Peers




Strength-Based Focus

• What does she have - rather than what she
  d      th
  does not have
• What can she do - rather than what she
  cannot do
• What has she been successful at rather than
  how she has failed
Trauma

Major and/or repeated trauma becomes the core
event in the life of the woman that defines:
   • Sense of self
   • Sense of efficacy
   • World view
   • Coping skills
   • Relationships with others
   • Ability to regulate emotions
   • How one approaches services
   • How one approaches the culture of the courts




 Trauma
 A meta-analysis of 126 studies on co-occurrence
   between childhood abuse and substance abuse
   found an average of 45% of adult women in
   f   d               f     f d lt         i
   treatment experienced childhood sexual
   abuse and 39% childhood physical abuse. For
   adolescent girls prevalence was 61% for sexual
   abuse and 46% for physical abuse. (Simpson
   and Miller, 2002)
3 Selves
• The Real Self – contains the true self – the highest
  potentialities for self realization and the actual self – those
               p           y              g
  elements of personality such as strengths and weaknesses,     ,
  assets and liabilities
• The Despised Self– all of the unacceptable character defects
  which make one “unlovable” and despicable are stored.
  Contains shame, hurt, anger, inadequacy and fear.
• The False Self – delusion based on how people believe they
  should be, think, behave and feel. Can be grandiose or self-
  effacing, Based on others.
               from Sandel, James “From Self to Self: Making Recovery Real” The Counselor, Nov/Dec 1990


         Women benefit from nurturing strategies
             for actualizing the Real Self.




Addressing Trauma
• Avoid retraumatizing women
   • Non-confrontational soft approach
   • Traumatized women over-respond to neutral cues
     and under-respond to danger
• Create safe environments
• Be aware of possible triggers and avoid triggering
            p
  trauma response.
• Develop referrals and linkages to support clients to
  identify triggers, self-soothe, ground and remain in
  services.
Trauma Programs
• Clark, C., Fearday, F. (eds) (2003) Triad Women’s Project: Group
                           p
  facilitators manual. Tampa, FL: Louis de la Parte Florida Mental
  Health Institute, University of South Florida. (contact Colleen
  Clark at cclark@fmhi.usf.edu)
• Covington , S. S. (2003) Beyond Trauma: A Healing Journey for
  Women. Center City, MN: Hazelton Press. (Contact Stephanie
  Covington at sscird@aol.com)
• Ford, J.D., Mahoney, K., Russo, E., Kasimer, N., & MacDonald, M.
  (2003). Trauma Adaptive Recovery Group Education and Therapy
  (TARGET): Revised Composite 9-Session Leader and Participant
  Guide. Farmington, CT: University of Connecticut Health
  Center. (Contact Julian Ford at ford@psychiatry.uchc.org )




Trauma Programs continued
• Harris, M. (1998). Trauma, Recovery and Empowerment: A
  Clinician’s Guide for Working with Women in Groups. New York,
  NY: Free Press. (Contact Rebecca Wolfon Berley at
  rwolfson@ccdc1.org)
• Miller, D., & Guidry, L. ( 2001). Addictions and Trauma Recovery:
  Healing the Mind, Body, and Spirit. New York: W.W. Norton.
  (Contact Dusty Miller at dustymi@valinet.com)
• Najavits, L. (2001). Seeking Safety: Cognitive-Behavioral Therapy
  for PTSD a d Substance Abuse. New York: Guilford. (Go to
  fo    S and Substa ce buse. ew o : Gu o d.
  www.seekingsafety.org)
• Saakvitne, K. W., Gamble, S.J., Pearlman, L.A., Lev, B.T. (2000).
  Risking Connection: A Training Curriculum for Working with
  Survivors of Childhood Abuse. Maryland: Sidran. (Go to
  www.sidran.org)
Supportive Relationships

 • Women, compared to men, are:
           i                       i        /
   • More likely to report that their spouse/partners
     encouraged initial and current drug use and less likely to
     pressure them to enter treatment
   • Less likely to report help/support from family or friends
   • More likely to report that family or friends used drugs in
     the past year (Grella & Joshi, 1999)


 • Outcomes all improve when a partner/family
   participates in treatment BUT




 • More than three-fourths of women participating
   in the RWC/PPW reported that their families
   were involved in alcohol- or drug-related
   activities

 • Almost half (42.9%) of women in the RWC/PW
   programs reported having fewer than two friends
    h        t     d
   who did not use drugs (Conners et al., 2004).
Relationships

• Counselor:Client relationship
• Peer support (what is a healthy friendship?)
• Family (as defined by client)
• Self-esteem building interactions
• Reduced powerless … more assertiveness
• Communication skills
• Knowing children are safe
• Filling the “empty hole inside”




Relapse and Recovery

• Recovery - act of regaining or returning
  toward a normal or healthy state
• Relapse - slip or fall back into a former worse
  state (as of illness) after a change for the
  better.
   • Must first admit have problem
   • Relapse does not occur until after action
• Moving from Acute to Chronic Perspective of
  Treatment
 Current Drinking Pattern of Individuals Meeting Criteria
         for Alcohol Dependence in the Past Year
                                  percent of percent of
                                   females      males
No past month alcohol use                0.9%        1.9%
Past month use but not binge use         3.5%        4.3%
Binge use but not heavy use            17.5%
                                       17 5%        19 2%
                                                    19.2%
Heavy use                              44.9%        44.6%

  Office of Applied Studies (August 2, 2007). Gender Differences in Alcohol Use and Alcohol
  Dependence or Abuse: 2004 and 2005. Rockville, MD: Substance Abuse and Mental Health
  Services Administration. Available at http://www.oas.samhsa.gov




Considerations in Relapse
• Women have more barriers to sustained
  participation than men.
  Women are judged more harshly for alcohol/drug
• W          j d d      h hl f       l h l/d
  problems than men.
• Women take on the alcohol/drug patterns of their
  partners, where men do not.
• Women with alcohol/drug problems have more
            p
  emotional problems than men.
• Women are more likely to experience negative
  feelings prior to relapse. Men are more likely to
  experience positive experiences and use as a reward.
Motivational Interviewing &
Engagement Strategies




Motivational Interviewing
• Express empathy through reflective listening.
• Develop discrepancy between client s goals or
                                client’s
  values and their current behavior.
• Avoid argument and direct confrontation
• Adjust to client resistance rather than opposing it
  directly.
  Support self-efficacy and optimism.
• S     t lf ffi          d ti i

(source: SAMHSA TIP 35: Enhancing Motivation for Change in Substance Abuse Treatment)
  FRAMES approach

• Feedback:             regarding risk is given to individual.

• Responsibility:               for change is placed with individual.

• Advice:          about changing is clearly given in a non-judgmental
   manner.

• Menu:       of self-directed change options and treatment
   alternatives.

• Empathetic Counseling: showing warmth, respect, and
   understanding. (uses reflective listening).

• Self-Efficacy: optimistic empowerment is
   engendered to encourage change.
(source: SAMHSA TIP 35: Enhancing Motivation for Change in Substance Abuse Treatment)




  Listening
  • Empathy. Put yourself in someone else's shoes.
    Empathy is not the same as sympathy.
  • Non-judgmental behavior
  • Repeat what you hear (paraphrase)
  • Nod, Make statements like "Uh huh"
  • Speak clearly, slowly and simply
  • Be direct, do not use jokes
            g                        p      p
  • Avoid arguments about what the participant is
    experiencing, seeing, feeling
  • Understand how the situation affects the participant.
    What affects one person, may not affect another.
  • Help participant understand the available options
Body Language
• Be aware of your facial expressions
• Be aware of tone, volume, cadence (i.e. "Is there
                        you?
  something bothering you?" is a statement that could be
  said with caring and concern or with an "attitude.”)
• Be aware of your posture and stance
• Do not fold arms or clench fists. This represents an
  authoritative position which might threaten the client.
• Do not conceal your hands. An individual who is paranoid
      believe that you h
  may b li     h       have a weapon.
• Personal Space
• Avoid the challenge position which is eye-to-eye, toe-to-
  toe.
• Maintain 2-3 feet between you and participant for safety.




Enhancing Motivation

•   Distress levels
•   Critical life events
•   Cognitive evaluation or appraisal
•   Recognizing negative consequences
•   Positive and negative external incentives

  Clinician’s task i t li it d h
• Cli i i ’ t k is to elicit and enhance
  motivation

(source: SAMHSA TIP 35: Enhancing Motivation for Change in Substance Abuse
    Treatment)
 Motivators


   Contingency s
 • Contingency’s
 • Contracts
 • Carrots and Sticks
 • Build on Strengths
 • Building Self-Efficacy
            Self Efficacy
 • Do-able Goals and Objectives
 • Celebrating Successes




Comprehensive Development

  •   Knowledge
  •   Skill
      Skills
  •   Attitude
  •   Efficacy and Sense of Worth
  •   New Habits Emerge with Time

           do for … do with … cheer on
Program Analysis
• Staffing
• Education – female examples and experiences
• Education – uses emotional examples, non-
  shaming
• Counseling – addressing powerlessness
• Check-ins – resources and case management,
           g
  screening for mental health, violence
• Safe Environment

				
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