1 Recovery and Dual Diagnosis Martha Levey, Ed.D. Affiliated Service Providers of Indiana, Inc. The mission of ASPIN is to provide innovative educational programs, resource management, program development, and network management in collaboration with all healthcare entities to address health disparities.
2 Today s Goals To acknowledge the prevalence of dual diagnoses (mental illness and substance use) To understand the consumer perspective on effective dual diagnosis treatment To recognize the bridge to recovery from dual diagnoses offered by an integrated recoveryoriented approach
3 Recovery and Dual Diagnosis Presentation Abstract: This presentation will utilize lecture, video clips and personal reflection to understand dual diagnosis recovery from the consumer s perspective. A focus on recovery-oriented care principles as a major bridge to treatment planning and service provision for dual diagnosis recovery will be shared.
4 What is Dual Diagnosis? In pairs identify what the term means to you and consider: 1. How helpful is the term to consumers? 2. How helpful is the term to practitioners? 2. Are there better terms?
5 Dual diagnoses are an expectation, not an exception. Have you found this to be true?
6 Why focus on dual disorders? Substance use disorders are common in people with severe mental illness Mental illness is common in people with substance use disorders Dual disorders lead to worse outcomes and higher costs than single disorders
7 Definitions Co-morbidity 2 or more disorders or illnesses occurring in the same person simultaneously or in succession (Can include physical and behavioral) Co-occurring Disorder (COD) - People who have substance use disorders as well as mental health disorders are diagnosed as having co-occurring disorders, or dual disorders. This is also sometimes called a dual diagnosis. Recovery - A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.
8 Definitions Substance Use Disorder - A substance use disorder includes alcohol or drug abuse or alcohol or drug dependence Mental Health Disorder - Some of the most common mental health disorders found in chemically dependent people include mood and anxiety disorders. An even higher percentage of people with severe mental illness also have cooccurring substance use disorders. Called severe because of the severity and length of episodes of illness, these mental health disorders include schizophrenia and schizoaffective disorder.
9 Dual Diagnosis video clip Integrated treatment 2:24 What is Integrated Treatment?
10 What do we think we know? SAMHSA (2011)estimated that 42% (8,000,000)of adults with an SUD had a cooccurring disorder 56% received no care, 32% received mental health care 6.9% received care for both 4% received care for SUD alone
11 What are some barriers to early intervention and integrated treatment? Different Laws commitment/confidentiality Different funding streams, silo audits, etc. Different personnel Different training Different certification Different sites Different norms Bias and stigma
12 Course of Dual Disorders Both substance use disorders and severe mental illness are chronic, waxing and waning Recovery from mental illness and substance abuse occurs in stages over time Pre-contemplation Contemplation Preparation Action Maintenance (Prochaska, DiClemente, & Norcross 1992; Miller & Rollnick 1991)
13 Video Clip Dual Diagnosis Co-Occurring Disorders Time: 18:42
14 12 Guiding Principles Handout Do these apply equally to recovery from mental illness and recovery from substance use?
15 Principles of Integrated Dual Disorder Treatment Integrated Same team of dually trained people Same location of services Both disorders treated at the same time Stage-wise services Different services offered at different stages of treatment
16 Principles - Stagewise Treatment Pre-contemplation - Engagement Outreach, practical help, crisis intervention, develop alliance, assessment Contemplation & Preparation - Persuasion Education, set goals, build awareness of problem, family support, peer support Action - Active Treatment Substance abuse counseling, medication treatments, skills training, family support, self help groups Maintenance - Relapse prevention Relapse prevention plan, continue skills building in active treatment, expand recovery to other areas of life
18 Recovery Model Summarized Consumer driven Unconditional respect and compassion Clinician responsible for helping client with motivation for treatment Focus on client goals and function, not on adherence to treatment Client choice and shared decision making are important
19 A CLOSER LOOK AT RECOVERY
20 Who is the expert? Each patient carries his own doctor inside him. They come to us not knowing that truth. We are at our best when we give the doctor who resides within each patient a chance to go to work. -Albert Schweitzer
21 Recovery Dual disorders are treatable Many people attain stable remission of both disorders over time Recovery encompasses other areas of adjustment: Health, work, housing, relationships Mead et al., 2000
22 Recovery Capital Recovery Capital refers to: Strong social support network of friends and family Jobs Education Housing Range of coping skills (Cloud & Granfield, 2001)
23 Recovery Capital - Resources that Support Recovery Social capital supportive persons Physical capital employment, housing, jobs, food, services Human capital internal capacities and skills
24 Meet Ray
25 People in Recovery Are Not Passive Recovery stories include: new perspectives and insights, important decisions, critical actions taken, discovery of previously hidden healing resources within and beyond the self give prominence to the role of diverse religious, spiritual, and secular frameworks critical roles of peer support and family or other communities in making a difference in their recovery (Allott, Loganathan, & Fulford, 2002; Davidson et al., 2005; Davidson et al., 2006a; Ridgway, 2001).
26 Whether they are living with a mental illness, an addiction, or both, people in recovery need to have hope (Allott et al., 2002; Phillips & B., 2009; Ridgway, 2004). They also want to: manage or eliminate their symptoms increase their capacity to participate in valued social roles and relationships, embrace purpose and meaning in their lives, and make worthwhile contributions to their communities, and experience joy and love (Davidson et al., 2006; Davidson, 2003).
27 The Integrated Vision Recognizes that recovery looks different for each person. Adopts a strengths-based, long-term, longitudinal perspective within a developmental framework for matching the person's point in the recovery process to appropriate interventions. Focuses on the person environment fit and interactions. Recognizes the nonlinear nature of recovery and the fact that it is a process and a continuum as opposed to an outcome. Engages the power of communities family and friends, professional involvement, peer support, education and work, and spirituality in supporting the recovery process.
28 What Do Dual Recovery Services Look Like? Instill hope Are person- and family-centered Offer choice Elicit and honor each person's potential for growth Build on a person's/family's strengths and interests Attend to the person's overall life, including health and wellness.
29 Recovery-oriented practices embody the core elements of trauma-informed care, which include safety, trustworthiness, choice, collaboration, and empowerment.
30 Integrated Recovery Model Substance Use Diagnosis Trauma Informed Person-Centered Strengths Based Recovery Principles Motivational Interviewing Recovery Capital Whole Health Mental Health Diagnosis
31 In conclusion Always screen for both disorders Effective dual diagnosis recovery incorporates recovery oriented practices, integrated treatment, whole-health, and traumainformed approaches. Most of recovery occurs outside of the clinical setting.
32 References Cloud, W. & Granfield, R. (2001).Natural recovery from substance dependency: Lessons for treatment providers. Journal of Social Work Practice in the Addictions, 1(1), Hewitt, A. (2004). Post-traumatic growth in substance misuse. Annegatan, Finland: Nordic Counsel for Alcohol and Drug Research. Prochaska, J, & DiClemente, C. (1984).The transtheoretical approach: crossing traditional boundaries of therapy. Homewood, IL: Dow Jones-Irwin. Sheedy C. K., and Whitter M.(2009). Guiding Principles and Elements of Recovery-Oriented Systems of Care: What Do We Know From the Research? HHS Publication No. (SMA) Rockville, MD: Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration White, W. Kurtz, E., & Sanders, M. (2006). Recovery Management. Great Lakes Addiction Technology Transfer Center: Chicago, IL. White, W. & Kurtz, E. (2005). The Varieties of Recovery Experience. Chicago, IL: Great Lakes Addiction Technology Transfer Center.
Integrated Dual Disorder Treatment and Co-occurring Disorders RANDI TOLLIVER, PHD HEARTLAND HEALTH OUTREACH, INC. ILLINOIS ASSOCIATION OF PROBLEM-SOLVING COURTS OCTOBER 8, 2015 SPRINGFIELD, IL Parallels
Integrated Dual Disorder Treatment (IDDT) Jeff Stenseth Assistant Regional Director Southeast Human Service Center Department of Human Services Commission on Alternatives to Incarceration 9-13-2012 *Source:
Implementation Strategies for Effective Integrated Treatment Services Ric Kruszynski, LISW, LICDC Center for Evidence Based Practices at Case/Ohio SAMI CCOE Mandel School of Applied Social Sciences Department
The Revolution of Emerging Transformation Recovery Leadership: The Renewing of the Mind, Heart and Soul A Performance Domain Analysis of the NCPRP Credential Compiled and written by Trudi L. Griffin, MS,
Integrated Treatment for Co-Occurring Disorders An Evidence-Based Practice What Are Evidence-Based Practices? Services that have consistently demonstrated their effectiveness in helping people with mental
Engagement and Recovery for People with Complex Needs: yale program for recovery and community health from double trouble to dual recovery Larry Davidson, Ph.D. Professor of Psychiatry and Director Program
NYAPRS 28 TH Annual Conference Integrating Mental Health and Addiction Recovery into our Lives and Systems Presenter: John Challis B.A., B.S.W., Dip Teach. Director of Technical Assistance Thursday September
UNDERSTANDING CO-OCCURRING DISORDERS Frances A. Campbell MSN, PMH CNS-BC, CARN Michael Beatty, LCSW, NCGC-1 Bridge To Hope November 18, 2015 CO-OCCURRING DISORDERS What does it really mean CO-OCCURRING
Co-occurring Disorders: the chicken or the egg Christopher W. Shea, MA, CRAT, CAC-AD Clinical Director Father Martin s Ashley Havre de Grace, Maryland email@example.com Objectives To identify what is
Georgetown University, National Technical Assistance Center for Children s Mental Health, Webinar Series Designing a Recovery-Oriented Care Model for Adolescents and Transition Age Youth with Co-Occurring
Presented by Pamela Messore LICSW, LCDP Co-Occurring Disorder - formerly Dual Diagnosis - was once a challenge to providers. Historically, clients were treated in separate modalities - even separate agencies.
What Are Co-occurring Disorders? Some people suffer from a psychiatric or mental health disorder (such as depression, an anxiety disorder, bipolar disorder, or a mood or adjustment disorder) along with
ADOLESCENT CO-OCCURRING DISORDERS: TREATMENT TRENDS AND GUIDELINES AMANDA ALKEMA, LCSW BECKY KING, LCSW ERIC TADEHARA, LCSW INTRODUCTION OBJECTIVES National and Utah Statistics Best Practice Guidelines
Building the Continuum of Integrated Treatment for Co-Occurring Disorders 2015 AMHCA CONFERENCE PHILADELPHIA, PA 1 THE AFFORDABLE CARE ACT The Patient Protection and Affordable Care Act (ACA) aims to expand
FAMILY PROGRAM Addiction takes a toll not only on the individual, but on the family, as well. When using, addicts are selfish and selfcentered; their wants and needs are placed ahead of the ones they love.
Tweet Chat Script from Andre Evans of Sovereign Health Treatment Center discussing Alcohol Complications for Those Struggling with Dual Diagnosis February 12, 2015 AH: Welcome to today s #AHchat! Our topic
information for families Schizophrenia & Substance Use Schizophrenia and Substance Use Index 2 3 5 6 7 8 9 10 Why do people with schizophrenia use drugs and alcohol? What is the impact of using substances
FOCUS ON INTEGRATED TREATMENT COURSE OBJECTIVES INDEX FIT The Complete Program Pages 2-6 FIT Complete Clinician Collection Pages 7-11 FIT Screening & Assessment Page 12 FIT Motivational Interviewing Page
Practice Guidelines for the Identification and Treatment of Co-occurring Mental Health and Substance Abuse Issues In Children, Youth and Families June, 2008 This document is adapted from The Vermont Practice
Agency of Human Services Practice Guidelines for the Identification and Treatment of Co-occurring Mental Health and Substance Abuse Issues In Children, Youth and Families The Vermont Practice Guidelines
Co-Occurring Disorders: A Basic Overview What is meant by Co-Occurring Disorders (COD)? Co-Occurring Disorders (COD) refers to two diagnosable problems that are inter-related and occur simultaneously in
Recovery as an Organizing Principle for Integrating Mental Health and Addiction Services yale program for recovery and community health Larry Davidson, Ph.D., Director Program for Recovery and Community
The extent and nature of mental health issues among problem drug users and issues in treatment. Well, that rules out a coalition DIAGNOSIS? Diagnosis implies identifiable clinical picture Often associated
Dual Diagnosis and Integrated Treatment of Mental Illness and Substance Abuse Disorder What are dual diagnosis services? Dual diagnosis services are treatments for people who suffer from co-occurring disorders
Co-Occurring Disorders PACCT 2011 CAROLYN FRANZEN Learning Objectives List common examples of mental health problems associated with substance abuse disorders Describe risk factors that contribute to the
Embracing Complexity: Building better practices to support people affected by Concurrent Disorders Wayne Skinner, MSW, RSW Deputy Clinical Director Addictions Program, CAMH Assistant Professor, Psychiatry
Co-occurring Disorders - Substance-Related and Mental Disorders Questions from paper 1 1) Which presents as a wide variety of symptoms that are characteristic of other mental disorders? a) substance-abuse
SHIAWASSEE COUNTY COMMUNITY MENTAL HEALTH AUTHORITY POLICY AND PROCEDURE MANUAL Section: Clinical Effective Date: 9/23/08 Last Revision Date: 1/30/14 Page 1 of 13 Policy It is the policy of the Shiawassee
THE INTEGRATED DUAL DIAGNOSIS TREATMENT PROGRAM OF VENTURA COUNTY BEHAVIORAL HEALTH Presented by Linda Gertson, Ph.D. Behavioral Health Manager The California Institute of Mental Health (CIMH) was awarded
- UNDERSTANDING - Dual Diagnosis TABLE OF CONTENTS Introduction 3 The Link Between Mental Illness and Substance Abuse 4 Characteristics of an Effective Dual Diagnosis Treatment Plan 6 Dual Diagnosis Treatment
Wisconsin Public Psychiatry Network Teleconference (WPPNT) This teleconference is brought to you by the Wisconsin Department of Health Services (DHS) Bureau of Prevention, Treatment, and Recovery and the
Integrated Dual Disorder Treatment In a (Dutch) rapid changing environment Strasbourg May 2010 Bas van der Hoorn firstname.lastname@example.org Who s talking? Psychiatrist Head of dual diagnosis treatment facility
FRN Research Report: July 2013 DDCAT Top Rating Shows Ongoing Commitment to Superior Services Background Foundations Recovery Network, headquartered in Nashville, Tenn., operates nine addiction treatment
Crestwood San Diego Mental Health Rehabilitation Center Core Program Description of Services/Scope of Services The mission of Crestwood San Diego is to provide an alternative to traditional psychiatric
Integrating Treatment for Co-Occurring Disorders Brought to you by: Today s Moderators Marty Harding Director of Training and Consultation Hazelden Publishing Gerald McCleery, Ph.D VP for Business Development
The American Association for the Treatment of Opioid Dependence, provider #1044, is approved as a provider for social work continuing education by the Association of Social Work Boards (ASWB) www.aswb.org,
A Breakthrough Approach to Integrating Substance Use and Mental Health Treatment Susan Whitley, MD Director of Chemical Dependency Services Date: September 17-21, 2012 In spite of the high percentage of
Minnesota Co-occurring Mental Health & Substance Disorders Competencies: This document was developed by the Minnesota Department of Human Services over the course of a series of public input meetings held
Mental Health 101 for Criminal Justice Professionals David A. D Amora, M.S. Director, National Initiatives, Council of State Governments Justice Center Today s Presentation The Behavioral Health System
James Madison University Department of Graduate Psychology PSYC 663-0001: Substance Abuse Counseling Sample Syllabus Inclement Weather: The University may close or limit its services based on inclement
American Society of Addiction Medicine Public Policy Statement on Treatment for Alcohol and Other Drug Addiction 1 I. General Definitions of Addiction Treatment Addiction Treatment is the use of any planned,
Preparing the Adult Mental Health Workforce to Succeed in a Transformed System of Care Co-Occurring Disorders: Treatment and Supports for Persons with Mental Health and Substance Use Disorders NASMHPD/OTA
Board Certification Examination There are 175 questions on this examination. Of these, 150 are scored questions and 25 are pretest questions that are not scored. Pretest questions are used to determine
Brief Intervention Stages of Change and Motivational Interviewing James Bray, PhD Alicia Kowalchuk, DO Vicki Waters MS, PA-C InSight SBIRT Residency Training Program This project is funded by Substance
Sciacca, K. 1997. Removing barriers: dual diagnosis and motivational interviewing. Professional Counselor 12(1): 41-6. Reprinted with permission from Health Communications, publisher of Counselor (formerly
THE INTEGRATED DUAL DIAGNOSIS TREATMENT PROGRAM OF VENTURA COUNTY BEHAVIORAL HEALTH Presented by Linda Gertson, Ph.D. Behavioral Health Manager The California Institute of Mental Health (CIMH) was awarded
Program of Study: Bachelor of Science in with an Emphasis in Addiction, Dependency, and Substance Abuse Program Description The Bachelor of Science in with an Emphasis in Addiction, Dependency, and Substance
information for service providers Schizophrenia & Substance Use Schizophrenia and Substance Use Index 2 2 3 5 6 7 8 9 How prevalent are substance use disorders among people with schizophrenia? How prevalent
Kenneth Minkoff, MD 100 Powdermill Road, Box 319 Acton, MA 01720 781-932-8792x311 Kminkov@aol.com COMPREHENSIVE, CONTINUOUS, INTEGRATED SYSTEM OF CARE MODEL The Comprehensive, Continuous, Integrated System
Key Elements of Treatment Planning for Clients with Co Occurring Substance Abuse and Mental Health Disorders (COD) [Treatment Improvement Protocol, TIP 42: SAMHSA/CSAT] For purposes of this TIP, co occurring
ABOUT US n Riveredge Hospital maintains the treatment philosophy of Trauma Informed Care. n Our commitment to providing the highest quality of care includes offering Animal Assisted Therapy, and Expressive
FALL 2015 VOLUME #01 IN G E N UI TY HE A LTH : PRESCRIPTION DRUG REPORT A Review of Medication Monitoring Results of People in Treatment for Serious Mental Illness Knowing the Facts About Medication Adherence
Mental Health and Substance Use: Concurrent Disorders Capacity and Harm Reduction 2012 Ontario Harm Reduction Conference Allison Potts, MSW, RSW Concurrent Disorders System Integration Lead Mental Health
Counselors are standing by 24/7 waiting for your free call 1-800-861-1768 thewatershed.com Believe Again in Life. In The future. In Yourself. At The Watershed, our passion is helping addicts and alcoholics
CHAPTER VII CO-OCCURRING DISORDERS If we had no winter, the spring would not be so pleasant; if we did not sometimes taste of adversity, prosperity would not be so welcome. ANNE BRADSTREET TAY Resource
Substance Abuse and Addiction Carmen Finn LADC, ADC-MN Director of Treatment Services Wayside Family Treatment What is Addiction Addiction is a primary, chronic disease of brain reward, motivation, memory
New York State Health Foundation Center for Excellence in Integrated Care (CEIC): Support for Health Care Institutions Richard N. Rosenthal, MD Chairman, Department of Psychiatry St. Luke s Roosevelt Hospital
LEVEL I SA: OUTPATIENT INDIVIDUAL THERAPY - Adult Definition The following is based on the Adult Criteria of the Patient Placement Criteria for the Treatment of Substance-Related Disorders of the American
Winnipeg Region Co-occurring Disorders Initiative Clinical Training Guidelines for Co-occurring Mental and Substance Use Disorders September 2003 Clinical Training Guidelines for Co-occurring Mental and
Maplegrove Center Maplegrove Center Presentation Overview Brief Introduction of Henry Ford Maplegrove Center Define Peer Mentoring SAMHSA Guidelines for Peer Mentoring Peer Mentoring at Maplegrove Center
WORKING WITH THE DUAL DIAGNOSED Presenter Cherie A. Hunter Executive Director VIDEO Today s Overview : At the end of the workshop participants will be able to: 1 Review the Prevalence Data 2 Understand
What is CCS? Department of Health Services Division of Mental Health and Substance Abuse Services Bureau of Prevention, Treatment and Recovery Services Comprehensive Community Services (CCS) Comprehensive
Performance Standards Co-Occurring Disorder Competency Performance Standards are intended to provide a foundation and serve as a tool to promote continuous quality improvement and progression toward best
Evidence Based Practice Continuum Guidelines The Division of Behavioral Health strongly encourages behavioral health providers in Alaska to implement evidence based practices and effective program models.
1980s Early studies focused on providing integrated treatment for individuals who have dual diagnosis (adding SA counseling to community MH treatment) Early studies also showed that clients did not readily
YOUNG ADULTS IN DUAL DIAGNOSIS TREATMENT: COMPARISON TO OLDER ADULTS AT INTAKE AND POST-TREATMENT Siobhan A. Morse, MHSA, CRC, CAI, MAC Director of Fidelity and Research Foundations Recovery Network YOUNG
Web-Based Resources Locating Treatment http://dpt2.samhsa.gov/treatment/ -- This is the Substance Abuse and Mental Health Services Administration s (SAMHSA) page for locating both public and private opiate
Module One Motivational Interviewing Philosophy and Principles V188.8.131.52031 Helping patients change behavior is an important role for health care providers. Some providers feel that change is the patient
Clinical Treatment Protocol For The Integrated Treatment of Pathological Gamblers Presented by: Harlan H. Vogel, MS, NCGC,CCGC, LPC Purpose of Presentation To provide guidelines for the effective identification,
Youth Residential Treatment- One Step in the Continuum of Care Dave Sprenger, MD Outline Nature of substance abuse disorders Continuum of care philosophy Need for prevention and aftercare Cost-effectiveness
Integrating Dual Diagnosis Treatment: Achieving Positive Public Safety and Public Health Outcomes for Offenders with Co- Occurring Disorders Fred Osher, M.D. Director, Health Systems and Services Policy
How HOLiSTIC REHAB Benefits You Table of Content Holistic Rehab Centers are More Popular than Ever The Need for Drug & Alcohol Rehabilitation Programs Alcohol Abuse and Addiction These Issues Need Treatment
Integrating Behavioral Health and Primary Health Care: Development, Maintenance, and Sustainability Cici Conti Schoenberger, LCSW, CAS Behavioral Health Provider Sunshine Community Health Center Why Integrate?
National Survey of Substance Abuse Treatment Services The N-SSATS Report October 14, 010 Clinical or Therapeutic Approaches Used by Substance Abuse Treatment Facilities In Brief In 009, the majority of
DDCAT The Dual Diagnosis Capability in Addiction Treatment (DDCAT) Index Toolkit Adapted for use in the Improved Services for People with Drug and Alcohol Problems and Mental Illness Initiative for the
OAHP Key Adolescent Health Issue Area 1 Behavioral Health (Mental Health & Substance Abuse) Introduction In Ohio, the promotion of positive mental health and the prevention of substance abuse and mental
WITH OVER 20 YEARS OF EXPERIENCE, Unity Chemical Dependency is the Rochester area s most experienced and comprehensive treatment provider. Our highly trained and dedicated team of counselors and physicians
Complex mental health & substance misuse Dual Diagnosis Ian Wilson Aims & objectives Aim: To underline the importance of effective working with dually diagnosed clients Objectives: To define dual diagnosis
Saving Lives Through Recovery You or someone you love is abusing drugs or alcohol. You know it and you may be scared. You are not alone. Life does not have to continue this way. The fighting and uncertainty
Performance Standards Non-Hospital Rehabilitation Performance Standards are intended to provide a foundation and serve as a tool to promote continuous quality improvement and progression toward best practice
Los Angeles County Department of Public Health Substance Abuse Prevention and Control (SAPC) will implement an initial benefit package of Substance Use Disorder (SUD) services within the initial twelve