TREATMENT TOOLS

SESSION 8 C

• This session will identify various treatment tools and techniques that have been found useful in working with a dual diagnosis population• A review of outcomes regarding identified

evidence based programs will also be included

SEVEN PRINCIPLES OF INTEGRATED CARE

• Mental health and substance abuse treatment are integrated to meet the needs of people with co-occurring disorders• Integrated treatment specialists are trained to

treat both substance use disorders and serious mental illness• Co-occurring disorders are treated in a stage-wise

fashion with different services provided at different stages

SEVEN PRINCIPLES

• Motivational interventions are used to treat consumers in all stages , but especially in the persuasion stage• Substance abuse counseling, using a cognitive-

behavioral approach, is used to treat consumers in the active treatment and relapse prevention stages• Multiple formats for services are available

including individual, group, self-help, and family• Medication services are integrated and

coordinated with psychological services

BASIC CHARACTERISTICS OF INTEGRATED TREATMENT

• Multi-disciplinary teams• Integrated treatment specialists• Stage-wise interventions• Access to comprehensive services• Time unlimited access to services• Outreach• Motivational interventions

BASIC CHARACTERISTICS

• Substance abuse counseling• Group treatment for co-occurring disorders• Family interventions for co-occurring disorders• Alcohol and drug self-help groups• Pharmacological treatment• Interventions to promote health• Secondary interventions for non-responders

TREATMENT TOOLS

• Non-silo’d care• Integrated treatment approach• Use of medications• Strengths based model• Trauma informed treatment• Motivational interviewing• Matching treatment interventions based upon stage of

change• Cognitive behavioral therapy• Skills Building• Thought Stopping• Peer Support/12 Step Programs

BENEFITS OF INTEGRATED CARE

• Integrated treatment is associated with the following positive outcomes:

Reduced substance use Improvement in psychiatric symptoms and

functioning Decreased hospitalizations Increased housing stability Fewer arrests Improved quality of life

STAGES OF CHANGE/STAGES OF TREATMENT

• STAGES OF CHANGE• Pre-Contemplation• Contemplation• Preparation• Action•Maintenance

• STAGES OF TRT• Engagement• Persuasion• Persuasion• Active Treatment• Relapse Prevention

ASSESSMENT RECOMMENDATIONS

• Integrated assessment tool that looks at both the mental health as well as the addictions the individual client is presenting with• By doing a dual assessment, treatment will be

integrated at a basic level and both mental health and addictions professionals will be able to use the data collected to implement programming

PRINCIPLES OF SCREENING AND ASSESSMENT

1. Because many consumers have substance use disorders, screen all consumers for both disorders

2. In addition to speaking with consumers, gather information from multiple sources

3. If information does not agree, ask consumers to help resolve the discrepancies in a matter-of-fact and non-threatening way

4. It is important to continue the assessment over time

INTEGRATED SCREENING AND ASSESSMENT

• Comprehensive longitudinal assessment• Functional status•Mental health symptoms, treatment, and response to treatment• Substance use, treatment, and response to treatment• Interactions between mental illness, substance use, and treatment

CONTEXTUAL ASSESSMENT

• Another important part of the integrated assessment is a detailed description of current substance use patterns, including factors that cause consumers to continue using

SUICIDE RISK ASSESSMENT

• Previous attempts and their seriousness• Whether the attempt was intended or accidental• Relationship of the previous suicidal behavior to

the psychiatric symptoms• Current psychiatric symptoms• How specific is the plan?• What method will be used?• When will it happen?• How available are the materials?

INTEGRATED TREATMENT PLANNING

• Using a team approach to develop the treatment goals• Addressing the entire person• Identifying behavioral health as well as substance

use disorder goals• Empowerment• Building on strengths and not deficits• Inclusive in nature

MOTIVATIONAL INTERVIEWING

1.Express empathy2.Develop discrepancy3.Avoid argumentation4.Roll with resistance5.Instill self-efficacy and hope

COGNITIVE BEHAVIORAL SKILLS

• Identify negative thoughts•Categorize negative thoughts•Stop negative thoughts•Replace negative thoughts with positive thoughts

CATEGORIZING NEGATIVE THOUGHTS

•Unrealistic Goals (Perfectionism)• Imagining Catastrophe•Overgeneralization• Expecting the Worst• Putting Self Down• Black and White Thinking

WAYS TO REDUCE NEGATIVE THINKING

• Recall the good things in life and about yourself• Challenge and refute irrational beliefs• Avoid assuming catastrophe• Re-label the distress• Make a hopeful statement about yourself• Blame the event, not yourself• Remind yourself to stay on task• Pat yourself on the back

BEHAVIORAL TECHNIQUES

Behavioral techniques to reduce or stop using substances include helping consumers: Improve conversation skills Learn assertiveness and relaxation skills Replace substance use activities with

other pleasant and useful activitiesManage mood problems

MAT

• Medication Assisted Therapy• Coordinating care so that the client received the

care he/she needs• Effective use of anti-psychotic, anti-anxiety,

and/or other drugs that will help sustain recovery• Educate about medication compliance• Use of peer educators regarding the utilization of

medication and monitoring of compliance

STRENGTHS BASED MODELS

• Building self-efficacy• Focusing on strengths and what the client CAN

accomplish (rather than their deficits)• Positive reinforcements• Token economy• Allowing client to feel empowered

TRAUMA INFORMED TREATMENT

• Understanding the importance of addressing any trauma in the client’s life• The prevalence of trauma in a co-occurring client• Utilization of trauma elements in therapy• Teaching stress management and coping

techniques

COGNITIVE BEHAVIORAL THERAPY

• Integrating thought processes with behavioral change• Altering behavior through conscious will• Consistent feedback and positive reinforcement• Treating the whole person

SKILLS BUILDING

• Stress management• Development of coping skills• Communication skills• Job skill development• Basic living skills• Medication management• Development of relapse prevention strategies

PEER SUPPORT/12 STEP PROGRAM

• NAMI• Self Help Groups • Mentoring • Peer Support

FOUR PHASES OF PARALLEL PROCESS RECOVERY

• Acute stabilization- detoxification of substances and treatment of psychotic symptoms• Engagement- establishment of treatment

relationship• Prolongs stabilization- maintaining complete

abstinence from the drug(s)• Rehabilitation- continued participation in the

program and self growth

IMPORTANT CATEGORIES OF MENTAL ILLNESS

• Psychotic disorders• Mood disorders• Personality disorders• Anxiety disorders

PSYCHOTIC DISORDERS

• Disturbances in thinking, perception, communication, and behavior• Usually first observed during adolescence or early

adulthood• Chronic, variable course• Most common is schizophrenia

PSYCHOSIS

• Refers to the degree of severity of symptoms, not to a specific psychiatric disorder• Thinking is so impaired that it interferes with

ability to meet the ordinary demand of life• Two types of psychotic symptoms• Delusion- false belief that an individual holds in spite of

logical proof to the contrary-interferes with social adjustment

• Hallucination- a false perception; a sensation of sight, hearing, smell, or taste that has no real world stimulus to cause it

OTHER PSYCHOTIC SYMPTOMS

• Disturbance of affect of emotions• Bizarre behaviors• Paranoid behaviors• Cognitive disturbances• Thought disorder

MOOD DISORDERS

• Disturbances of a person’s mood, which are not due to alcohol or drugs, physical illness, or other mental illness• Two extreme abnormalities of mood- depression

and mania- exist on either end of the continuum of the two basic normal moods of sad and happy

MOOD DISORDERS

• Bipolar disorders-are shown by distinct manic episodes that occur with or without the presence of history of depression• Depressive disorders involve depression

symptoms only

DEPRESSION SYMPTOMS

• May appear in emotional, cognitive, motivational, and physical ways including dejected mood, negative feelings toward self, withdrawal, crying, lack of energy, sleep and appetite disturbances

MANIC SYMPTOMS

• A distinct period of abnormally and persistently elevated, expansive, or irritated mood that is severe enough to cause marked impairment in occupational, social, or interpersonal functioning

ANXIETY DISORDERS

• Anxiety- sensations of nervousness, tension, apprehension, and fear that come from the anticipation of danger, which may be internal or external• Panic attack- distinct period of intense fear or

discomfort that developed abruptly, usually peaking within a few minutes or less• Phobias- the focus of anxiety is a person, thing, or

situation that is dreaded, feared, and probably avoided

ANXIETY DISORDERS

• Obsessive-compulsive disorders- obsessions or compulsive rituals or both• Post-traumatic stress disorder (PTSD)- persistent

re-experiencing of a psychologically traumatic stress when the person experienced intense fear, helplessness, or horror; may experience recurrent and intrusive images and thoughts of the stressor

ANXIETY SYMPTOMS

• Most common psychiatric symptoms seen in individuals with substance use disorders• Substance induced or withdrawal-related anxiety

symptoms usually resolve within a few days or weeks. Most resolve with substance abuse treatment• Coexisting anxiety disorders may range from

mildly to seriously debilitating