Gerald D. Shulman
#1 - A New Look at Relapse Prevention
to one day - can be combined with ASAM training)
This presentation develops an approach
to relapse prevention which begins at the point of initial assessment, integrates Gorski's approach to relapse prevention
(e.g., warning signs of relapse) with the cognitive-behavioral approach of Alan Marlatt (e.g., triggers, high-risk situations
and the abstinence violation effect) with Structured Relapse Prevention (an approach based on stages of changes). All of this
is presented using the DAM-IV five axes and ASAM six dimensions as the structure for doing an assessment of relapse risk and
developing a relapse prevention plan.
This topic can be addressed as a plenary or as a one half
to one day workshop.
Sample Learning Objectives
1. Apply harm reduction principles to relapse
Discriminate between patient/client and provider-
related antecedents to relapse;
3. Use the ASAM PPC six dimensions
to create an
assessment for relapse prevention;
4. Understand the relationships between co-occurring
health disorders and relapse to substance use;
5. Understand the relationship between relapse and
the "Stages of
This workshop can be expanded to include ASAM PPC-2R training and/or to include assessment
training relevant to relapse prevention.
- Designing Outcomes-Based Treatment & Funding:
The New Paradigm in Addiction and Mental Health Disorders
This workshop describes an approach for designing, delivering and funding/reimbursing treatment services
for a defined population to meet purchaser goals rather than merely providing access (e.g., days or visits). The goals are
based on consensual agreement and rely on effective treatment delivered in a cost-effective manner. Private sector purchasers
may contract for reduction in use of healthcare benefits or employee turnover. Public sector purchasers may set reductions
in substance related crimes or achieving employment as endpoint goals rather than abstinence rates per se. This system has
the potential for making current managed care practice irrelevant.
The topic can be presented in
timeframes ranging from a brief overview in 60 minutes to a one-day workshop which includes opportunity for development and
negotiation of purchaser/provider goals.
Sample Learning Objectives
1. Identify three practices associated
treatment as outlined by the Institute of Medicine(IOM);
2. Describe the roles and relationships
purchaser, payer, provider and consumer in an outcomes-
3. Understand the advantages
of such a treatment and
funding system over current systems;
4. Distinguish between proximal, process and post-
5. Identify at least 3 potential problem areas in
contracting for outcomes-based treatment.
material can be oriented to administrators, clinicians or both. The workshop gives participants an opportunity to identify
the issues to be resolved before proceeding with implementation.
- Assessment Instruments/Systems For the Addiction
This workshop is
for clinicians conducting assessment (DUI, triage, precertification, screening, intake, placement, referral). Recognizing
that the level of treatment delivered can never rise above that of the assessment on which it is based, the goal is to aid
clinicians in employing appropriate, effective, and efficient instruments and procedures. The training will emphasize distinctions
among screening, diagnostic and other assessment functions. Copyrighted and non-copyrighted screening, assessment, placement
and treatment planning instruments and systems will be presented and their assets and liabilities discussed. An overview of
the ASAM PPC-2R as an assessment system will be presented.
Basic instruction can be done in a plenary
(without the distribution of instruments). Full training can be provided in one to two full days.
Sample Learning Objectives
1. Understand the purposes for screening;
2. Understand the difference between screening and
3. Use at least one screening, one diagnostic(in full
day training) and one readiness to change
4. Understand the relationship between assessment for
substance abuse and re-offense in
5. Use the ASAM PPC-2R as an assessment tool without
full day training).
The one and two day training provides opportunity for use of some of the instruments.
This training can be combined with ASAM PPC-2R training.
- Harm Reduction, Moderation Management
and Living Sober One Day at a Time
will first define each of the approaches to treatment and examine the myths and misinformation about each. There will be
a presentation of a continuum of substance use disorders which requires different types of interventions. A case will be
made that by employing comprehensive assessment, avoiding commonly used but imprecise terms and non-diagnostic nomenclature,
harm reduction, moderation management and a 12 Step abstinence models all can be appropriate and responsible treatment approaches
when based on accurate diagnosis.
An overview can be presented as a plenary or the workshop with
case example as a half-day presentation.
Sample Learning Objectives
1. Give examples of three current
harm reduction models;
2. Understand why a significant reduction in cigarette smoking does not qualify as harm
3. Understand the problems created by the terms "alcoholism" and "addiction" when making decisions
about treatment strategies;
4. Describe how harm reduction, moderation management and living sober one day at
a time can each be appropriate treatment strategies;
5. Describe the three major components of successful outcome.
studies presented that illustrate the appropriateness of each of these approaches and participants will be asked to determine
most appropriate strategy for a number of different situations including the issue of "controlled drinking for whom?"
#5 - Senior Moments - Substance Abuse and Mental Health Problems Among Older Adults: The Challenge of Assessment, Intervention
More older adults are admitted to acute care hospitals for alcohol-related
disorders than for heart attacks. This workshop will describe six major problems areas encountered when working with older
adults with substance related disorders: (1) identification; (2) diagnosis; (3 assessment; (4) intervention; (5) referral;
and (6) treatment. Appropriate responses to problems in each of the areas will be presented. A broad-based gerontological
assessment process will be discussed. Emphasis will be given to co-occurring disorders.
can be presented in a plenary as an overview to a two day workshop.
Sample Learning Objectives
5 diagnostic problems with older adults;
2. Identify 3 characteristics that discriminate between early- and late-onset
3. Select the most appropriate screening instruments for substance use disorders and depression in
4. Understand the 3 factors most likely to motivate older alcoholics to change their behavior.
adult specific assessment instruments for depression and substance use disorders will be presented, including the newest screening
instrument for problems with alcohol, prescribed and over the counter medications. Treatment Improvement Protocol (TIP) 26,
a best practice manual, entitled "Substance Abuse Among Older Adults" published by CSAT, will be provided at no cost to the
participants or the sponsoring organization.
- Effective & Efficient Treatment Planning:
What, Why, When, With Whom, How?
will answer the questions of: (1) what is treatment planning and what are its purposes; (2) why perform treatment planning
and its importance beyond any regulatory or reimbursement requirements; (3) when to do treatment planning; (4) with whom and;
(5) how to do it efficiently and effectively? Case studies will be used to allow participants to identify assessment and
treatment planning deficiencies. A model for dimensional assessment leading naturally to a treatment plan will be developed
using case studies. Emphasis will be placed on specificity and measurability of treatment plan objectives with a discussion
of problem definition and selection.
This workshop can be done in one half to one full day formats.
1. Learn how to describe problems precisely;
2. Construct behavioral, measurable,
achievable and precise treatment plan objectives;
3. Understand the linkage between assessment and treatment planning;
4. Understand the linkage between treatment planning and progress notes.
The relationship of progress
notes to the treatment plan and the role of language which differs from agency to agency will be discussed. A system will
be presented which forces connection between individual problems identified in the assessment, associated treatment plan objectives
and associated progress notes. This workshop can be combined with ASAM PPC-2R training.
- The ASAM Patient Placement Criteria, Second Edition, Revised (ASAM PPC-2R):Updating, Understanding and Using the Criteria
to Provide Quality, Cost-Effective Treatment
Workshop participants will learn how to do
a multidimensional assessment using the ASAM PPC-2R Criteria by determining severity of problems in each of the ASAM six
dimensions and then using that information to determine appropriate level of care and develop treatment plans. Case studies
will be used to give participants hands on experience. Emphasis will be placed on substance abuse clients with
co-occurring mental health problems, both those who do and do not have sufficient signs, symptoms and traits to reach the
An introduction can be done as a plenary, an overview in a half day to full
day workshop, and an in-depth training of two to three days, the goal of which is to have participants leave and begin to
use the Criteria.
Sample Learning Objectives
1. Perform a severity assessment in each of the six ASAM
2. Understand the relationship between the DSM IV,5 Axes and the ASAM Dimensions;
each of the ASAM PPC-2R outpatient and residential/inpatient levels of care;
4. Describe each of the ASAM PPC-2R
5. Describe the different levels of co-occurring disorders in clients and appropriate services to
meet their clinical needs.
This two-day workshop is designed for clinicians who are experiencing difficulty
with using the ASAM Patient Placement Criteria, those who are without experience in the use of the Criteria and those who
want to sharpen their assessment and placement skills. Participants will learn how to develop individualized, behavioral,
measurable, achievable and time limited treatment plans that reflect the specific clinical needs, preferences and strengths
of each client. It is applicable to clinicians in states that have modified the ASAM Criteria to meet state need. It can
be combined with Assessment or Treatment Planning training. Workshops can be focused on adults, adolescents or both.
- Adolescents Are Not Short Adults
This presentation will explore the differences between
adolescent and adult substance use that result in the need to approach assessment and treatment differently. Specific attention
will be given to those differences which require adolescent-specific assessment, treatment approaches relevant to the developmental
levels of adolescents, and issues which create potentially greater obstacles to their recovery. The presentation will point
out the inappropriateness of using adult models for case finding, assessment, treatment and post treatment continuing care.
May be presented in one-half to full day.
Sample Learning Objectives
the six stages of adolescent substance use;
2. Identify at least five areas of adolescent-specific vulnerability
to substance use problems;
3. Discriminate between primary and secondary co-occurring mental health disorders
and describe the 5 subdomains within Dimension 3 of the ASAM Adolescent PPC-2R Criteria;
4. Identify at least
ten symptoms of adolescent substance use disorders.
Examples of adolescent substance abuse screening
and dual diagnosis instruments will be presented in the full day workshop. This training may be combined with the ASAM PPC-2R
Adolescent Criteria, totally revised in 2001.
- Advanced ASAM PPC-2R Training
ASAM Criteria Updated
Among the content of the ASAM
PPC-2R which will be discussed will be: (1) new uses for Level I; (2) redefining admission and continued stay criteria for
Level III.7; (3)performing continued stay and discharge/transfer reviews; (4) the expansion of Level III.5 residential services
beyond only therapeutic communities; (5) the greater emphasis in co-occurring mental health problems and disorders in Dimension
3; and (6) the adolescent criteria with its new paradigm for assessment in Dimension 3. Significant attention will be paid
to co-occurring disorders. The workshop will include a case study and the presentation of a model of an ASAM-based clinical
record which avoids simply adding more paperwork and ties together the assessment, treatment plan and progress
This is a full day workshop.
Sample Learning Objectives
the changes in the ASAM PPC-2R Levels III.5 and III.7;
2. Understand the differences among the three types of
patients with co-occurring disorders and three types of services identified when using the Dimension 3 Criteria;
an assessment in each of the six ASAM dimensions;
4. Describe the new paradigm for Dimension 3 as applied to adolescents.
one day training is designed specifically for participants who are experienced clinicians and who have also been through
previous formal or informal ASAM training and have had experience with the use of the Criteria.
- Training of Trainers in the Use of the ASAM PPC-2R
In this workshop ASAM training will
be modeled and issues that are likely to arise in participants' training of end users will be discussed. Areas of difficulty
for end user trainees will be identified and recommendations for effective approaches will be made. The workshop will include
case studies and the presentation of a model of an ASAM-based clinical record which avoids simply adding more paperwork
and ties together the assessment, treatment plan and progress notes. Recommendations for helping end user trainees understand
their own processing of assessment information will be demonstrated.
This is a two day workshop.
1. Describe the system for forcing a relationship between the ASAM assessment problems,
the treatment plan and the progress notes;
2. Recognize one or more problems in processing assessment information
in each of the Dimensions;
3. Help end user trainees perform an assessment in each of the six ASAM dimensions;
4. Communicate how matching severity of illness and intensity of treatment differs among the Dimensions
and create significant differences in the assessment and placement.
This two day training is designed
specifically and restricted to participants who are experienced clinicians and who have experience and are comfortable with
the use of ASAM Patient placement Criteria (experience with the previous version of the ASAM PPC-2 is adequate). The workshop
will be a combination of ASAM content and presentation approach. Given the numbers of clinicians not familiar or comfortable
with the use of the ASAM Criteria, the number of states, agencies and behavioral managed care companies who employ the ASAM
Criteria and the relatively high rate of clinician turnover resulting in a deficit of ASAM trained counselors, this workshop
was created to develop a group of local trainers of the ASAM Criteria.
- Using the ASAM PPC-2R
Throughout the Treatment Process
This workshop will present
information on the use of the ASAM PPC-2R from the point of intake/assessment though placement to discharge and referral for
continuing care. This system will illustrate: (1) the assessment process; (2) the development of a problem list organized
by priority based on severity and risk; (3) the batching of patient problems; (4) the development of measurable,
behavioral and achievable treatment plans; (5) what constitutes appropriate, meaningful clinical progress notes related to
individual treatment plan objectives and; (6) a coding system which forces tight linkages between the assessment problems
identified, treatment plan goals and objectives and the clinical progress notes. Case studies will be used to demonstrate
appropriate and inappropriate documentation at all points along the process.
This is a two day workshop.
1. Perform a six Dimension ASAM assessment;
2. Describe and use the coding
system for forcing a relationship between the ASAM assessment problems, the treatment plan and the progress notes;
3. Understand how to create measurable, behavioral and achievable treatment plans;
4. Understand and be able
to create meaningful, appropriate clinical progress notes related to the treatment plan objectives.
option will be presented for using an ASAM-based clinical record system which forces the relating of the assessment, treatment
plan and progress notes into a tightly integrated clinical record. A new instrument will be presented to guide clinicians
though the assessment process
#12 Using Empirical
and Evidenced-Based Findings to Achieve Better Treatment Outcomes with Limited Resources:
(A Primer for Counselors and
This workshop combines knowledge from a variety of evidence-based and empirical
sources, provided within the framework of NIDAs Principles of Drug Addiction Treatment, designed to improve
treatment outcome, often with little or no additional cost to the provider. Among the materials presented will be that of
expanding levels of care, providing more individualized treatment both at the individual and program level, the role of continuing
care, role of medication, case mix concerns, length of service and outcomes for various subpopulations of addicted individuals,
seven day coverage models for inpatient/residential programs and different treatment models for patients with different severities
of co-occurring mental health disorders.
This material can be presented in a one to two day workshop.
An abbreviated version, entitled How Many Tools in Your Toolbox?, can be delivered as a plenary.
1. Develop a residential program where an inpatient program already exists at no additional
2. Determine appropriate services for patients with co-occurring mental health problems based on the severity
of those problems;
3. Develop at least one model for providing individualized program treatment components;
4. Understand the relationship between case mix, outcome and length of service;
5. Identify at least five
principles associated with quality treatment.
This workshop draws together disparate findings from
many different experiential and research sources which participants can choose in developing, modifying or reengineering their
own treatment services and treatment programs.
- The Dually Diagnosed Patient: Assessment and Treatment
This workshop provides an overview
of assessment, placement and treatment strategies for patients with co-occurring mental health problems, ranging from sub-threshold
to diagnosable disorders. Implications for treatment services, treatment intensity and level of care placement related to
severity of mental health problems will be discussed. Assessment strategies for co-occurring disorders in both adults and
adolescents will be presented.
One half to a full day.
Sample Learning Objectives
1. Identify a psychiatric, aversive and drug craving medications and their appropriate uses;
the relationship between sub-threshold and diagnosable co-occurring mental health disorders;
3. Match severity
of co-occurring mental health disorders and patient placement;
4. Understand the practical application of primary
and secondary disorders.
This workshop can serve as an introduction to dual diagnosis for
participants with little experience while providing value to the experienced clinician. It can be combined with ASAM and/or
The Following Are Plenary/Keynote
Sessions with Brief Descriptions
Chemical Dependency: Past, Present and Future
This is a
review of chemical dependency treatment and it changes, the current state of treatment and reimbursement/funding and a prediction
of the future of the field.
How Many Tools In Your Toolbox?
This plenary session will
compare and contrast the changes over time in persons with substance use disorders, the treatment for those disorders and
the implications for counselor competencies. Recommendations and rationale will be offered for the clinical attitudes, competencies
and strategies required to meet the challenges of todays clients and patients and systems by which to acquire them.
Resources for enhancing counselor skills will be provided. All of the material will be presented within the framework of
NIDAs Principles of Drug Addition Treatment.
Clinical Vs. Medical Necessity
presentation will mark the distinction between clinical and medical necessity and the implications for payment and program
design. Treatment which is inpatient, residential or outpatient with supportive living will be compared and a provider response
to the lack of approval for payment for continued treatment will be presented which has both payment and clinical advantages.
This presentation will demonstrate how the psychoeducational component
of a structured outpatient, residential or inpatient treatment program can be organized so that patients receive what they
need, when they need it. It permits a cost effective expansion of the current content of the psychoeducational component
and makes it clinically driven, individualized, and time relevant.
Effective Referral of Chemically
This presentation will describe the obstacles to successful chemically dependent patient referral,
whether for initial or ongoing treatment, and provide solutions to the obstacles with the goal of increasing the number of
patient who arrive and engage in the next step in the treatment continuum.
What Constitutes Quality
This will be a discussion of those characteristics associated with quality treatment and positive treatment
outcome. Recommendations will be made for implementing systems associated with quality treatment and customer service.
Zero-Based Clinical Programming
This presentation will discuss the relationship of a clinically and demographically
changing patient population and its implications for treatment. A system will be presented for assessing the match between
a programs patients and its treatment and how to align them.
Screening, Assessment and
Placement of Dually Diagnosed Individuals
This presentation will discuss way to screen (quickly, inexpensively and
easily), assess (more comprehensive) and determine the appropriate type and intensity of care based in the intensity and severity
of the co-occurring mental health problems. Four levels of co-occurring mental health problems will be discussed as well
as appropriate characteristics of programs treating the dually diagnosed individual.
Really a Disease? Are We Asking the Right Questions?
This presentation, designed for clinicians and modifiable for
people in the recovering community, reviews the current information about alcoholism, compares it to other chronic illnesses
and provides appropriate questions to ask about treatment and outcome, making the case for alcoholism as a chronic illness.
Risk to Children Living In A Chemically Dependent Home
This presentation is designed for addiction clinicians,
child welfare and dependency court workers and reviews what we know about the impact of substance use disorders in children
in those homes. Myths about those effects will be examined. Available screening tools will be presented and recommendations
made for reducing risk by developing ways in which addiction and child welfare agencies can work together.
Older Adults with Co-Occurring Disorders
The presentation will provide information about co-occurring disorders
among older adults including the relationship between substance use and mental health disorders, differentiating between depression,
delirium and dementia in older adults and presenting appropriate screening tools. Emphasis will be placed on barriers to
identification, diagnosis and treatment.