WORKING WITH THE DUAL DIAGNOSED. Presenter Cherie A. Hunter Executive Director

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1 WORKING WITH THE DUAL DIAGNOSED Presenter Cherie A. Hunter Executive Director

2 VIDEO

3 Today s Overview : At the end of the workshop participants will be able to: 1 Review the Prevalence Data 2 Understand the Interrelationship between SA and MI 3 Explore Best Practice Methods For Treatment & Recovery Strategies

4 What Is It? Definition dual diagnosis refers to having two primary illnesses (as defined by the DSM-IV R). Substance-related and mental disorders that are diagnosed as being present in an individual at the same time. Co-occurring disorders exists when at least one disorder of each type can be established independently of the other and is not simply a cluster of symptoms resulting from a single disorder. 4

5 Defining COD While these disorders may interact differently in any one person (e.g., an episode of depression may trigger a relapse into alcohol abuse, or cocaine use may exacerbate schizophrenic symptoms), at least one disorder of each type can be diagnosed independently of each other. SAMHSA Report to Congress pg 2

6 Prevalence Data

7 Prevalence of Serious Mental Illness 2002 National Survey on Drug Use and Health An estimated 17.5 million adults aged 18 or older with SMI This is 8.3% of all adults aged 18 or older Rate of SMI by Age Range 13.2% among persons aged % among persons aged % among persons aged 50 or older

8 Prevalence of Serious Mental Illness 2002 National Survey on Drug Use and Health Among adults the percentage of females with SMI are higher than for males: 10.5% for Females 6.0% for Males

9 Co-Occurrence of Serious Mental Illness with Substance Dependence/Abuse 2002 National Survey on Drug Use and Health 4.0 million adults had both SMI and SD/A in the past year. 0.8 million had SMI and dependent/abused alcohol and illicit drugs 0.9 million had SMI and dependent/abused only illicit drugs 2.4 million had SMI and dependent/abused only alcohol

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11 Interrelationship Between Substance Abuse & Mental Health

12 National Co 'morbidity Survey Co-occurring substance use disorders and mental disorders 42.7% of individuals with a 12-month addictive disorder had at least one 12-month mental disorder 14.7% of individuals with a 12-month mental disorder had at least one 12-month addictive disorder

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14 Epidemiological Catchment Area Survey 47% of individual with schizophrenia also had a substance use disorder More than 4 times as likely as general population 61% of individuals with bi-polar disorder also had a substance use disorder More than 5 times as likely as general population

15 Epidemiological Catchment Area Survey Current Youth Situation Nearly 43% of youth who receive mental health services have been diagnosed with a co-occurring disorder Alcohol or illicit drug dependence was reported by approximately 13% of adolescents with significant emotional problems 17% of those with significant behavioral problems

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18 What Works?

19 Best Practice Methods For Treatment & Recovery Strategies

20 Systems-Level Approaches Systems of Care for People with co occurring disorder must be: Comprehensive and appear seamless to the client Involve Multiple Systems Substance abuse - Criminal Justice Mental Health - Social Service Primary Care - Child Welfare

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22 Four Basic Characteristics 1. System Level Change 2. Efficient Use of Existing Resources 3. Incorporation of Evidence Based/Best Practices 4. Integrated Treatment Philosophy

23 Eight Principles of Treatment 1. Dual diagnosis is an expectation, not an exception 2. All people with COD are not the same; the national consensus four quadrant model for categorizing cooccurring disorders can be used as a guide for service planning on the system level. 3. Empathic, hopeful, integrated treatment relationships are one of the most important contributors to treatment success in any settings; provision of continuous integrated treatment relationships is and EB/BP for individuals with the most severe combinations Kenneth Minkoff, MD

24 Eight Principles of Treatment 4. Case management and care must be balanced with empathic detachment, expectation, contracting, consequences, and contingent learning for each client, and in each service setting 5. When psychiatric and substance disorders coexist, both disorders should be considered primary, and integrated dual (or multiple) primary diagnosis-specific treatment is recommended. Kenneth Minkoff, MD

25 Eight Principles of Treatment 6. Both mental illness and addiction can be treated within the philosophical framework of disease and recovery model with parallel phases of recovery (acute stabilization, motivational enhancement, active treatment, relapse prevention, and rehabilitation/recovery) 7. Each individual intervention must be individualized according to quadrant, diagnoses, level of functioning, external constraints or supports, phase of recovery/stage of change, and (in a managed care system) multidimensional assessment of level of care requirements.

26 Eight Principles of Treatment 8. Clinical outcomes for COD must also be individualized, based on similar parameters for individualizing treatment interventions. Kenneth Minkoff, MD

27 NOTE: There is no one type of dual diagnosis program for intervention. For each person, the correct treatment intervention must be individualized according to diagnosis, phase of recovery/treatment, level of functioning and/or disability associated wit each disorder, and level of acuity, dangerousness, motivation, capacity for treatment adherence, and availability of continuing empathic treatment relationships and other recovery support.

28 Other COD Treatment Strategies with some Evidence Base Motivational Interventions Cognitive/Behavioral Approaches Modified Therapeutic Communities Assertive Community Treatment (ACT) Intensive Case Management Contingency Management CSAT TIP 2004

29 Questions?

30 Resources SAMHSA report to Congress on the Prevention and Treatment of Co-Occurring Substance Abuse Disorders and Mental Disorders President s New Freedom Commission on Mental Health Achieving the Promise: Transforming Mental Health Care in America Improving Treatment of Co-Occurring Disorders, H. Westley Clark, MD,JD,MPH Director Center for Substance Abuse Treatment CSAT TIP 2004 Kathy Jasper, MS,ACADC Kenneth Minkoff, MD Christie A. Cline, MD, MBA, PC

31 For More Information Contact: Cherie A. Hunter Hunter Communications Group, Inc. P.O. Box 1055 Matteson, IL ( ) Huntercommunicationsinc.com

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