Recovery and Dual Diagnosis

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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

17 17

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.

33 Thank you!

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