The Life Link has provided treatment services to homeless and non-homeless substance abusers, and those with serious mental illness since 1989. The initial program was aimed at dually diagnosed homeless individuals and utilized a group therapy approach. In 1995, the program expanded to include DWI offenders, court referrals and self identified addicts. Since inception, The Life Link has successfully worked with a cross-section of the local population, including the Native American, Hispanic, and Anglo population. We have worked with individuals with varying degrees of disability, and have consistently made appropriate accommodations for culture, language, physical, mental, and emotional disability. To be of assistance to those who speak only Spanish, we have staff that offer both group and individual counseling. Diversity training has been provided to our staff at least annually.

The treatment philosophy includes Cognitive-Behavioral Therapy (CBT), Community Reinforcement Approach (CRA), Community Reinforcement and Family Training (CRAFT), and Motivational Interviewing modalities. We teach social skills, stress/anxiety management, and financial basics. When appropriate and indicated, the CRA program utilizes prescription alcohol reducing medications such as Disulfiram, Naltrexone, and newly approved Acamprosate. For those who need medication to lessen the pain of depression, anxiety, bipolar disorder, and other forms of mental illness, we have a psychiatrist on staff who specializes in psychotropic medication. Recovery and well-being takes on many forms at The Life Link. Foremost, we work hard at helping those improve their quality of life.

 

Cognitive-Behavioral Therapy (CBT)

Cognitive-Behavioral Therapy (CBT) is well established as an effective treatment for a range of disorders (e.g., anxiety, affective disorders) and is recognized as an evidence-based practice. As the name suggests, CBT utilizes a combination of behavioral and cognitive techniques to target a patient's symptoms. The focus is on teaching clients how to control their symptoms, correct faulty thinking patterns and manage their own disorders. Ideally, at the end of treatment, clients should be able to use the strategies they have been taught to deal with any future problems and possible return of symptoms. The content of CBT should be determined according to client need and the duration should be time limited.

Cognitive Behavior Therapy combines two very effective kinds of psychotherapy — cognitive therapy and behavior therapy.

Behavior therapy helps weaken the connections between troublesome situations and habitual reactions to them. Reactions such as fear, depression or rage, and self-defeating or self-damaging behavior can be avoided by changing behavioral responses to certain stimuli. It also teaches clients how to calm the mind and body, so they can feel better, think more clearly, and make better decisions.

Cognitive therapy teaches how certain unhealthy thinking patterns are causing emotional and behavioral symptoms. Clients learn how their beliefs can create a distorted picture of what's going on in his or her life, making him or her feel anxious, depressed, or angry for no good reason, or leading to unhealthy or counterproductive behaviors. Gaining control of one’s thoughts and beliefs is a key to better emotional health.

CBT has been shown in clinical trials to help ease symptoms of various mental health problems (e.g., depression, anxiety, psychosis, substance disorders, eating disorders). Research studies have shown that a course of CBT is just as effective as medication in treating depression and certain anxiety disorders. In addition, CBT has been proven to offer long-term benefits, as the techniques taught to the client can be utilized across a variety of difficulties over the course of a lifetime.

For further information on Cognitive-Behavioral Therapy, visit www.nacbt.org

Community Reinforcement and Family Training (CRAFT)

In the past, there have been few options to help those who are concerned about a loved ones drinking or drug use. Alcohol and drug programs tend to focus most all the attention on the user. CRAFT, on the other hand, gives help first to those who are frustrated with trying to get their loved one or friend into treatment. We call this person a CSO, or a Concerned Significant Other. CSO's can be anybody - a spouse, a mother, a brother, a sister - just about anybody. If you have cared about someone that you believe drinks or drugs too much, you might be a concerned significant other. You have done all you know how to do - pour the bottle down the drain, nag, and plead with the person to get help. Some give up and leave; some have stayed many years in a relationship that has led to discouragement and despair. Others have watched some of their loved ones die due to drinking or drugging.

CRAFT teaches those who have loved ones how to get the drinker or drug user into treatment who has formerly been resistant to getting help. In addition, CRAFT has been shown to reduce anxiety and depressive symptoms for CSO's. That's good news - learning how to get your loved one into treatment, and be able to help yourself at the same time.

In CRAFT the therapist uses a cognitive-behavioral approach to teach the concerned significant other how to use behavioral principles to reduce the loved one's substance use and to encourage the user to seek treatment. Additionally, it assists the concerned significant other in alleviating other types of stress and in introducing meaningful reinforcers into his or her own life.

Specific components of this intervention will include:

1. Teaching the significant other to recognize the potential for domestic violence as behavioral changes are introduced at home, and introducing precautions to reduce the risk of harm to self and others.

2. Utilizing a functional analysis to outline the substance user's triggers for using alcohol and/or drugs as well as the consequences. The latter includes the significant other's coping responses.

3. Motivating the significant other to make some difficult changes through reminders about the specific reasons for starting treatment in the first place, and the potential gains.

4. Demonstrating more effective ways to communicate with the substance-using loved-one.

5. Teaching the appropriate use of positive and negative reinforcement to discourage harmful using behavior.

6. Providing instruction in how to reduce other types of stress that are experienced by the significant other, and in how to introduce meaningful "rewards" into their own life.

7. Preparing the significant others to suggest treatment at the most appropriate time and in a manner that is most likely to succeed.

8. Arranging to have treatment available at the time the decision is made to enter therapy, and preparing the significant other to support the substance user during treatment.

Studies have shown that approximately 60-80% of CSO's get their resistant substance abuser into treatment. Both the concerned significant other as well as the substance user has had an average of about 7 out of 12 sessions. From our SAMHSA grant between January 2001 and April 2004, we engaged approximately 6.5 - 6.8 loved ones out of 10. This was not a clinical trial, but a demonstration project. For more information regarding our project, call 438-0010 and ask for Raymond Anderson.

CRAFT Bibliography from the University of New Mexico - Here
Training in CRAFT from the Life Link Training Institute - Here

 

Community Reinforcement Approach (CRA)

CRA is a broad-spectrum behavioral treatment approach for substance abuse problems. It was developed to utilize social, recreational, familial, and vocational reinforcers to aid clients in the recovery process. CRA acknowledges the powerful role of environmental contingencies in encouraging or discouraging use, and attempts to rearrange these contingencies such that sober behavior is more rewarding than using behavior. The overall philosophy is to use individuals and the community to reward non-using behavior so that the clients make healthy lifestyle changes.

CRA has been shown effective in clinical trials. Typically there are 12 individual sessions, but also parts of CRA have been used in group format.

The CRA induction is a motivational method for introducing the CRA program to the client. It demonstrates from the start that CRA is based upon positive reinforcement instead of confrontation. It is set up to help the client work toward getting whatever is important to him or her.

The CRA Functional Analysis: The therapist and client examine the triggers (thoughts, feelings, and behaviors) leading up to behavior and the immediate and long-term consequences of this behavior. The CRA Functional Analysis is unique in its additional emphasis on examining non- behavior. The client also is helped to recognize the chain of events that lead to enjoyable activities not involving alcohol consumption. By highlighting the long-term positive consequences of a particular non- activity, the therapist encourages the client to engage in the activity more often and experience its rewards.

CRA works to replace a client's maladaptive behaviors with new coping strategies. Sobriety Sampling is a technique that teaches the client to abstain from alcohol for a mutually agreed-upon limited amount of time. This lets the client experience sobriety and to reflect on how sobriety may be a positive experience. Sobriety sampling operates on the assumption that you can be more successful in engaging clients in treatment by not overwhelming them with rigid rules and frightening expectations about never being able to drink again for the rest of their lives.

An addition to the CRA program is the use of Disulfiram or Naltrexone. The assessment as to whether this will be helpful to the client will be made early in treatment with the primary therapist. Proper use of these medications brings additional benefits to the treatment program, including:

1) reduction in worry about future episodes,

2) an increase in family trust, since their utilization demonstrates a commitment to stop,

3) a reduction in "slips" that result from impulsive,

4) an increase in productive use of therapy time, since the client can now deal objectively and constructively with other current life problems,

5) a necessary increase in the reliance on new coping skills, since is no longer an option,

6) a reduction in complicated, agonizing daily decisions about , and

7) an increase in opportunities for positive reinforcement, since at the very least the client will be praised daily by the Concerned Other who is monitoring "the taking of the pill". Typically a spouse or close friend is trained as a "monitor" to aid in consistent drug administration and to praise the problem drinker for his or her efforts.

Communication Skills Training is an important component of CRA behavioral skills training. It helps the client increase positive interchanges with loved ones. Clients also are taught to develop more appropriate strategies for coping with their stressful environments with resorting to alcohol use through Problem Solving Training. The therapist works with the client to define the problem, generate alternatives for action, decide on a solution, and evaluate the outcome. Drink Refusal Training aids the client with his or her assertiveness skills by teaching several ways to refuse a drink. Trigger situations are avoided, and thought substitution is used to replace the types of thoughts and feelings that lead to episodes with new thoughts.

Additional methods for encouraging and rewarding sobriety may also be employed. Job finding procedure aid the client in finding and keeping a meaningful job, which can serve as a powerful, positive reinforcer. Social and Recreational Counseling is a critical part of CRA, since many clients have great difficulty replacing their lifestyle with a non- one when it comes to free time. CRA encourages clients to change to peer reference groups who will less likely be engaging in activities involving alcohol consumption and to develop healthier alcohol-free social outlets. If the client is married or has a significant relationship, the spouse or significant other is typically is brought in for Marital/Couple Therapy. The purpose is to enhance many aspects of the couple's relationship, and to teach the spouse/other to reinforce non- behavior.

Relapse Prevention is an integral component of many phases of the CRA program. One of the skills taught within CRA is learning to recognize when temptation is building or a slip is close. Slips typically do not occur in response to just one trigger, but after a sequence of triggers. This set of events is called a Behavioral Chain. The therapist shows the client where costly negative decisions were made surrounding a slip. Cognitive restructuring and problem solving would be introduced again to train appropriate ways to cope. Early Warning System is a specific relapse prevention self-monitoring procedure designed to track the behaviors of clients that appear to be the antecedents, or triggers, to using behavior. The system is most successful when a concerned other is trained in the procedure along with the client. In addition to providing valuable input regarding triggers, the concerned other can often recognize the earliest signs of an impending relapse before the client.

One of the unique aspects about CRA is its compatibility with many other approaches to substance abuse treatment. It is appropriate for individuals who are striving for either lifelong abstinence or moderation. CRA's positive, motivational approach has much to offer in the struggle to gain full cooperation from clients.

CRAFT Bibliography from the University of New Mexico - Here
Training in CRA from the Life Link Training Institute - Here

Motivational Interviewing

Motivational interviewing is a client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence. The Life Link utilizes a Motivational Interviewing approach with its clients. This science-based approach respectfully addresses client's issues without hard confrontation. Along with CRA, Motivational Enhancement has been listed in the top five effective treatment modalities for alcohol.

The spirit of motivational interviewing (taken directly from www.motivationalinterviewing.org)

We believe it is vital to distinguish between the spirit of motivational interviewing and techniques that we have recommended to manifest that spirit. Clinicians and trainers who become too focused on matters of technique can lose sight of the spirit and style that are central to the approach. There are as many variations in technique there are clinical encounters. The spirit of the method, however, is move enduring and can be characterized in a few key points.

1. Motivation to change is elicited from the client, and not imposed from without. Other motivational approaches have emphasized coercion, persuasion, constructive confrontation, and the use of external contingencies (e.g., the threatened loss of job or family). Such strategies may have their place in evoking change, but they are quite different in spirit from motivational interviewing which relies upon identifying and mobilizing the client's intrinsic values and goals to stimulate behaviour change.

2. It is the client's task, not the counsellor's, to articulate and resolve his or her ambivalence. Ambivalence takes the form of a conflict between two courses of action (e.g., indulgence versus restraint), each of which has perceived benefits and costs associated with it. Many clients have never had the opportunity of expressing the often confusing, contradictory and uniquely personal elements of this conflict, for example, "If I stop smoking I will feel better about myself, but I may also put on weight, which will make me feel unhappy and unattractive." The counsellor's task is to facilitate expression of both sides of the ambivalence impasse, and guide the client toward an acceptable resolution that triggers change.

3. Direct persuasion is not an effective method for resolving ambivalence. It is tempting to try to be "helpful" by persuading the client of the urgency of the problem about the benefits of change. It is fairly clear, however, that these tactics generally increase client resistance and diminish the probability of change (Miller, Benefield and Tonigan, 1993, Miller and Rollnick, 1991).

4. The counselling style is generally a quiet and eliciting one. Direct persuasion, aggressive confrontation, and argumentation are the conceptual opposite of motivational interviewing and are explicitly proscribed in this approach. To a counsellor accustomed to confronting and giving advice, motivational interviewing can appear to be a hopelessly slow and passive process. The proof is in the outcome. More aggressive strategies, sometimes guided by a desire to "confront client denial," easily slip into pushing clients to make changes for which they are not ready.

5. The counsellor is directive in helping the client to examine and resolve ambivalence. Motivational interviewing involves no training of clients in behavioural coping skills, although the two approaches not incompatible. The operational assumption in motivational interviewing is that ambivalence or lack of resolve is the principal obstacle to be overcome in triggering change. Once that has been accomplished, there may or may not be a need for further intervention such as skill training. The specific strategies of motivational interviewing are designed to elicit, clarify, and resolve ambivalence in a client-centred and respectful counselling atmosphere.

6. Readiness to change is not a client trait, but a fluctuating product of interpersonal interaction. The therapist is therefore highly attentive and responsive to the client's motivational signs. Resistance and "denial" are seen not as client traits, but as feedback regarding therapist behaviour. Client resistance is often a signal that the counsellor is assuming greater readiness to change than is the case, and it is a cue that the therapist needs to modify motivational strategies.

7. The therapeutic relationship is more like a partnership or companionship than expert/recipient roles. The therapist respects the client's autonomy and freedom of choice (and consequences) regarding his or her own behaviour.

For more about Motivational Interviewing click the link below.

Motivational Interviewing Organization - Here
Training in MI from the Life Link Training Institute - Here