Triple Threat Beyond Dual Diagnosis

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1 Triple Threat Beyond Dual Diagnosis Dr. Louise Stanger Ed.D. LCSW, CIP Director All About Interventions Membership Chair NII Faculty SDSU Interwork Institute

2 Getting To Know You Hello! Tell your neighbor about yourself What brings you here today? What do you want to get out of our time together?

3 Objectives Learn to Identify multiple issues- Ecological approach Learn how to prioritize intervention strategies Identify therapeutic interventions

4 Objectives Understand while one disorder may be acting out another one is off in a different direction Discuss triangulation of data Picking the right treatment center

5 Which Came First? Other Legal, Physical, Family History Substance Abuse Mental Health

6 Importance of Family Mapping

7 Doing a Correct Assessment for Co-Occurring Family History with Triangulation of Data Establish period of abstinence (4-6 weeks) Establish SA as Primary or Secondary which came first Obtain Longitudinal History

8 Portraiture Qualitative evidenced based research method Assumes we are cocollaborators Use snowball sample which means we interview many people to gain data

9 Unique Factors for Triple Threat Interventions Often do not end up in a group meeting Can take more then one gathering- can go on for hours or days even months Require an active facilitator Can be volatile, may involve courts May involve law enforcement May involve medical facilities Must support family or accountability team MUST KNOW TREATMENT CENTERS

10 Importance of Knowing Mental Health Disorders

11 Interventions Personality Disorders + Avoid Power Struggles Be Direct Support Family Strong Boundaries Compliment Narcissists Confront Boarderline MI,CBT, SFT, DBT,PAUSE

12 SA-Bipolar and Other Mania Hypo-Mania Depressive Episode Join with client Nonthreatening Over empathize Instill hope go flat as client escalates Educate

13 Obsessive Compulsive Disorder- Borderline ++

14 Interventions Have Patience Be Consistent Be Understanding Indulge OCD Direct Firm Invitational Distract When Stuck

15 PTSD and TBI s and other hidden

16 Traumatic Brain Injury

17 Intervention with Trauma History Be upfront and honest No surprises Understanding-Attunement-Empathetic Educate all about PTSD, TBI etc Match client to interventionists or therapist Match treatment facility

18 During Intervention If perpetrator is family member assume others maybe victims Have perpetraor leave intervention or not be present this is where individual prescreening interviews is so important Do not let abuse become focus of intervention, focus on getting help Manage anger Track all members and ground when necessary

19 Psychotic-SA and Legal Schizophrenia Delusional Drug Induced Psychosis Paranoia Marijuana Budder Methamphetamines Alcohol Ecstasy Hallucinogenic

20 Case Studies

21 Intervention strategies Low stimulation May not use group setting Monotone voice May enter delusional system (need to be skilled to decide to or not) May involve commitment through that is very hard

22 Legal Cases Make sure to partner with a knowledgeable attorney Use legal as a motivator for long term change Do not use treatment as an escape plan Form a straegic partnership Role of Admissions Team, Court Liason< Case Managers impt.

23 Case Studies 20 somethings -FTL

24 Intervention Strategies Time and More Time Create a Firm Fence Use the Legal System to Help Do not be afraid to invite team members that are saboteurs to leave Patience-Perseverance-Determination Flexibility in Approaches

25 Professionals Drs.,Lawyers, Nurses, Teachers Pilots, Fireman, Police Officers

26 Case Studies

27 Case Studies

28 Public Figures

29 Intervention Strategies Require a different sort of Team Employers, Business agents, Personal Assistants, Fellow Performers, Administrative Assistants, Hair Dressers, Stylists Treatment Center Confidentiality Follow up Care At What Price

30 Older Adults Physical Difficulties Loss of Spouse or Partner Retirement or Loss of Job Loss of Friends Isolation Change of Environments Family Systems Spirtuality Have you ever checked out the check out line at CVS, RITE AID Etc.

31 Case Studies

32 Intervention Strategies Family Participation-Oh Dad or mom are just too old to change Putting Together the right Team-All the Drs, clinicians, treatment centers Clinicians knowing about normal, non pathological depression following the death of a spouse and about aging Clinicians knowing about the difference between divorce and widowers and widows Can be effective with team and with one on one

33 Physical Limitations

34 It Takes a Village

35 Evidenced Based Modalities Motivational Interviewing 12 Step Facilitation CBT DBT Solution Focused (SFT) Acceptance and Attunement Being honest and transparent

36 Questions

37 Resources DSM V NAMI

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