10/20/2014. Timothy Bautch, MA, LPC, CSAC, ICS Connections Counseling Madison, WI

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1 Timothy Bautch, MA, LPC, CSAC, ICS Connections Counseling Madison, WI Dual Diagnosis/Co-occurring Disorders Although this term is not always precise and distinctive, for the purpose of this presentation, dual diagnosis and co-occurring disorder (COD) refers to an individual who endorses symptoms consistent with both a substance use disorder and a mental health disorder. Some mental health problems may not fully meet strict definition of a Dx. However, many of the relevant principles may apply to the Tx of COD. According to SAMSHA s Website: Approximately 8.9 million adults have COD Only 7.4% of these individuals receive treatment for both 1

2 Researchers Have Established Three Consistent Findings Regarding COD Tx: Co-occurrence is common (about 50% crossover) Dual diagnosis is associated with a variety of negative outcomes, including high rates of relapse Parallel but separate mental health and substance abuse treatment systems deliver ineffective care Drake et al Best practice involves Services Integration Integrate screening for mental health and AODA Sx Provide integrated assessment Integrated treatment planning Integrated or coordinated treatment Provide continuing care Some Similarities between Substance Use and Mental Health Disorders No fault illnesses Stigmatized illnesses Brain disorders Disease and recovery models exist Chronic illnesses Recovery is possible McKillip,

3 Interaction between MH and AODA Sx: The Weave Often substance use is used as an unhealthy coping skill to cope with MH Sx. This coping skill worked for a while: most people do the best with what they have. After a while, the skills either stop working, work for a shorter amount of time, or the consequences begin to outweigh the benefits. The consequences may amplify and/or bring about MH Sx, thus tightening the weave. With increased MH Sx, vulnerability to use increases. Interaction between MH and AODA Sx Sometimes MH Sx are masked due to frequent substance use. When a person tries to stop using, MH Sx may increase, or they may experience Sx they hadn t recognized before. Sometimes withdrawal Sx can produce transient MH Sx Educate and encourage patience and support: it will get easier. Integrated Treatment Planning Collaborative process One treatment plan and set of goals One relapse prevention plan For each goal: Clear and measurable description Short term/long term/criteria for discharge? Client strengths Method/objectives Recommended services 3

4 Integrated or Coordinated Treatment Consistent approach, philosophy, and set of recommendations Should include, as applicable, individual therapy, group therapy, family therapy, medication management Focus on preventing anxiety, rather than breaking through denial No consensus exists on specific approaches to individual, group, or family therapy Drake et al Key Techniques and Guidelines for Working With Clients Who Have COD Provide motivational enhancement consistent with specific stage of change Maintain a recovery perspective Monitor psychiatric Sx Design contingency management techniques to address specific target behaviors Use cognitive-behavioral techniques Use relapse prevention techniques Use repetition and skills-building Increase structure and support Facilitate client participation in mutual self-help groups SAMSHA Tip 42 Motivational Interventions Help client to identify goals Recognize ambivalence Recognize that not managing one s illness interferes with attaining those goals Miller, Rollnick

5 Possible Group Formats Psychoeducational Process Skill acquisition Experiential Self-help Psychoeducational Groups Didactic in nature Often focus on understanding the link between AODA and MH Sx Psychoeducational Group Topics May Include: Similarities between AODA and MH Sx Effects of use of MH Sx Effects of MH Sx on vulnerability to relapse Neurochemistry of addiction Foundation and Process of Recovery Learning new coping skills for stress and emotional discomfort Developing a recovery plan McKillip,

6 Process Groups Looser format. Group leader is a facilitator. Majority of the group involves checkin/processing. Every member is encouraged to check-in Discussions among members is encouraged Often helpful to ask for a topic to guide the discussion Topic Ideas For Process Groups Anger relationships triggers to use Boredom Depression What is recovery to me? Friends Having fun sober Support Boundaries Stress/Anxiety Complacency What to do after relapse Skill Acquisition Groups Focus on teaching and practicing skills in session CBT, DBT, Biofeedback, Meditation 6

7 Experiential Groups Focus on expressing self through experience, followed by process Art therapy, group trust activities, team building, ropes courses, equine-assisted therapy, psychodrama Facilitators should be trained and experience the activity first-hand before leading it. Considerations/Questions When Developing and Running a Co-occurring Group Screening. Inclusion/exclusion criteria? Homogeneity? Ability to assess for suicidality. Response plan? Group rules Sobriety vs. harm reduction References Drake, Robert, Essock, Susan, et al: Implementing Dual Diagnosis Services for Clients With Severe Mental Illness. Psychiatric Services 52: McKillip, Rhonda: The Basics: A Curriculum for Co-Occurring Psychiatric and Substance Disorders. McKillip and Associates Miller W. Rollnick S: Motivational Interviewing: Preparing People to Change Addictive Behavior. New York, Guilford Minkoff, Kenneth: Best Practices: Developing standards of Care for Individuals With Co-occurring Psychiatric and Substance Use Disorders. Psychiatric Services SAMSHA TIP 42: Substance Abuse Treatment For Persons With Co-Occurring Disorders