Concurrent Disorder Comprehensive Assessment: Every Interaction is an Intervention

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1 Concurrent Disorder Comprehensive Assessment: Every Interaction is an Intervention Presented by: Kristin Falconer, Gillian Hutton & Stacey Whitman November 12, 2015

2 Disclosure Statement We have not received any financial support, nor in-kind support We do not have any conflicts of interest in presenting here today

3 Who we are? Kristin Falconer MC, R. Psych o Psychologist Gillian Hutton MSW, RSW o Clinical Social Worker Stacey Whitman RN BN o Manager For more information please feel free to contact the Addiction Centre at

4 Where do we work? The Addiction Centre, is a Concurrent Disorder out patient program located at the Foothills Hospital in Calgary, AB We provide out patient services to individuals that present with addiction and mental health concerns Our Adolescent team provides treatment to clients (as well as their parents/guardians Our Adult team provides treatment to clients 18 and up Services may include: individual therapy, group therapy, family therapy, couples therapy, The focus of today s presentation will be on the adult population

5 My client has been screened for a concurrent disorder, now what?

6 Concurrent Capability

7 Best Practices in Assessment of Concurrent Disorders Use of multiple assessment methods Multiple assessments over time Do not aim for levels of specificity that exceed assessment goals Conduct assessment when he/she is sober and stable Verify with other sources (i.e., old reports, collateral interview)

8 Best Practices in Assessment of Concurrent Disorders Sensitive to consumer s concerns Provide assurance of confidentiality Establish rapport before going into detail Frame questions to normalize different substance use patterns

9 Working with Concurrent Disorders Family Issues Mental Health Physical Health Addiction

10 Crisis

11 ASAM Patient Placement Criteria

12 Intake Assessment Purpose of initial assessment Review previous reports or referral information if applicable Engage client and obtain information Demographics Medical history Legal/social/family history Substance use/behavioural addictions Mental health Goals Risk assessment Begin case formulation/provisional diagnosis Initial sense of treatment goals Treatment plan Determine if fit for program or need for referral

13 Initial Assessment outcomes Family Physician referral/ request for more support Detox Outpatient Addiction Outpatient Mental health Concurrent Disorder Specialized Program Residential Treatment Inpatient

14 Continues in Active Addiction Family Physician referral/ request for more support Detox Outpatient Addiction Concurrent Disorder Specialized Program Residential Treatment Outpatient Addiction Outpatient Addiction Residential Treatment Outpatient Mental health Discharge Community Supports Residential Outpatient Mental Health Outpatient Addiction Outpatient Addiction Outpatient Mental Health Sober Housing Outpatient Mental Health

15 Client abstinent Family Physician referral/ request for more support Outpatient Addiction Outpatient Mental health Discharge Community Supports Outpatient Mental health Concurrent Disorder Specialized Program Community Supports Sober Housing

16 Client - Pam Substance use Alcohol use disorder Cannabis use disorder Mental Health MDD, Recurrent Demographics/social, family, medical Isolation, working FT, chronic back pain Treatment plan Start with least intrusive (outpatient, 1:1, intro groups)

17 After a few sessions Pam reports continued daily use of alcohol and cannabis. She continues to work during the day, comes home and drinks and uses to numb emotions. Pam has not been following through on assigned homework and is contemplative about her use and wondering if therapy will work for her. She states that she likes group, however she does not feel that it s enough.

18 How are they doing in group o What are they learning? o Are they practicing new strategies? o Reducing use? o Mood? o Risk assessment o Do they need additional support (mutual aid, 1:1, other resources) Pam Ongoing Assessment o Engages well o Sets goal to be abstinent by end of week 4

19 Abstinence based groups Assess client availability Assess abstinence and stability in recovery Assess mood and mood stability Assess psychological awareness Throughout program assess Participation Mood Abstinence Behavioural change safety Abstinent

20 Next Steps Assess for need for ongoing support o Transitions group o Community groups (mindfulness, mutual aid) o Relapse prevention groups o Recreational activities o Family therapy o Individual therapy o Return to work

21 Readiness for Discharge - Client has support outside of therapy - Client mood stable - Client addiction stable - Treatment goals are met - Client disengages from treatment

22 Tom 56 year old, divorced male, currently in a common-law relationship on LTD from his job of 25 years as a mail carrier Not experiencing any financial difficulties Has two adult children

23 Initial Assessment Tom was recently discharged from short stay inpatient unit for suicidal ideation while intoxicated no current ideation/intent/plans Completed mental health day program last year for depression and anxiety Alcohol use increased after being placed on LTD, takes benzodiazepines to cope with anxiety, admits to taking more than prescribed

24 First Steps Detox? Outpatient mental health? Outpatient addiction? Concurrent disorders program? Inpatient hospitalization? Residential addictions treatment?

25 Outpatient treatment for Tom Work on a taper for alcohol and benzodiazepines Assess o Patient progress on taper o Mood stability (suicidal ideation, depressed mood, isolation) o Supports o Coping strategies

26 Residential treatment While in treatment, Tom opened up about his triggers and admitted that he primarily drinks to cope with anxiety and depression. He shared that mental health therapy in the past was helpful, but he continued to drink throughout the program Assess next steps o Suicide risk o Supports o Home environment o Severity of alcohol use risk of relapse o Mental health symptoms

27 Inpatient Concurrent Program Tom spends 12 weeks at Claresholm Centre for Mental Health and Addictions He maintains abstinence from all substances and works on Relapse Prevention He meets with a psychiatrist and medications are assessed and trialed He attends individual and group therapy to work on emotional regulation, coping strategies, relationships What s next?

28 Outpatient Tom returns to the concurrent disorders outpatient program following discharge from CCMHA He attends outpatient groups to continue to work on emotional coping, communication, relationships, and relapse prevention Tom finds an AA group that he likes and is working towards finding a sponsor Partner is referred to the Family support program (could also be referred to outpatient addictions, al-anon, community counsellors)

29 Readiness for Discharge Tom has been regularly attending AA and has a sponsor He has been openly communicating his needs to his partner and they have agreed to no alcohol in the house Tom has not been experiencing any depressive symptoms and his anxiety has been manageable with mindfulness practice, exercise, and seeking familial support as needed Medications can be managed by GP

30 Necessity! Collaboration with other clinics Learn what resources are available in the community Involve those agencies in programming brochures, education to staff, information to clients Align services when it makes sense Learn about Alberta Detox locations Learn about Residential treatment

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