Educating students about the co-occurring occurring disorders of mental illness and substance abuse 10-29-2007
Presenters Andrew L. Cherry, DSW, ACSW Oklahoma Endowed Professor of Mental Health University of Oklahoma, School of Social Work, Tulsa. OU OK-COSIG Project Evaluator Mary E. Dillon, MSW, Ed.D OU OK-COSIG Associate Evaluator, Tulsa. L. D. Barney, ICAADC, MSW Student, University of Oklahoma, Norman Campus. OK-COSIG Program Specialist, ODMHSAS, OKC
The COSIG Initiative The interest in developing a better infrastructure for treating people with a cooccurring disorder reached a critical mass politically with the report to Congress on Cooccurring Disorders (SAMHSA, 2002). Using the momentum generated by the report to Congress SAMHSA has been able to acquire the money to fund Co-occurring State Incentive Grant (COSIG) projects in 17 states. (See: http://coce.samhsa.gov/about/index_right.aspx?obj=7).
Failing People with a Co-occurring Disorder The evidence from the field is that people with the co-occurring disorders of Mental Health, Trauma related Mental Health Issues and Substance Abuse are NOT benefiting from traditional mental health and substance abuse treatment. The evidence that current options are ineffective comes in the form of multiple treatment failures, years of lost productivity, and higher levels of involvement in the justice system.
Rate of Incidence: Adults The need for better treatment options for people with a co-occurring disorder received critical support when the 2002 National Survey on Drug Use and Health in the United States reported that over 22% of adults (estimated to be 5.2 million people) with a serious mental illness and those who abuse alcohol or other drugs have a co-occurring problem of mental health and substance abuse.
A Paradigm Shift There is a growing consensus among professionals in the field of mental health and addiction that sequential treatment (treatment from one provider, then treatment from another) or parallel treatment (treatment by two different providers at the same time) has been a failure with people who have a cooccurring disorder.
Paradigm Shift (cont d) The proposed solution is to integrate the two treatment systems of mental health and substance abuse. However, today s social work students lack the array of skills needed to assess and treat persons with these cooccurring conditions.
SW Students are not equipped to work with people with a COD There is overwhelming evidence that the behavioral health workforce, including SW students, are not prepared in knowledge and skills to respond to the needs of people with a co-occurring disorder. While the incidence of co-occurring disorders among individuals has increased dramatically, most of the workforce lacks the array of skills needed to assess and treat persons with these co-occurring conditions.
SW Students are not equipped to work with people with a COD (Con d) For the most part, training and education programs have ignored the need to change their curricula to address the needs of people with a co-occurring disorder. Thus, we continue to prepare social work students who are under prepared from the moment they complete their education (Hoge, M. A., Morris, J. A., Daniels, A. S., Stuart, G. S., Huey, L. Y. & Adams, N. (2007). An Action Plan for Behavioral Health Workforce Development: A Framework for Discussion-Executive Summary. Rockville, MD: Substance Abuse and Mental Health Services Administration).
Presenter 2: Infusing material on cooccurring disorders in existing courses A module or material on co-occurring disorders needs to be presented in courses on alcohol/substance abuse, mental health, psychopathology, human behavior in the social environment, and practice courses. The existence of co-occurring disorders should be mentioned in all class discussions that touch on substance abuse, mental health, and disabilities.
Core Texts We need to add material on co-occurring disorders because: Core texts that provide material on substance abuse and mental health have little or no information about co-occurring disorders or on treating people with cooccurring disorders. Core texts do not reflect the paradigm shift in the treatment community.
Co-occurring vs. Dual Diagnosis Co-occurring is the preferred term because Dual Diagnosis suggests only two issues. Co-occurring allows for more than two issues. For example: A soldier with minor Traumatic Brain Injury is experiencing severe depression after being deployed in Iraq and drinking heavily to deal with the depression.
Integrated Treatment Defined In this case integrated treatment offers the best hope of successful treatment. What is integrated treatment? Integrated treatment is another name for treatment based on a systemic model.
The Rationale for the Integrated Treatment Model Extensive professional literature supports the clinical value of providing integrated services to people with a co-occurring disorder (CSAT, 2005). Studies suggest that: The number of people with a co-occurring disorder is high (Regier et al., 1990; Kessler et al., 1994; Grant et al., 2004), There is a negative impact from each untreated disorder on the recovery from the other (Rosenthal & Westreich, 1999),
An Example of a Systemic Model : Stages of Treatment ENGAGEMENT: Establish a working alliance, a collaborative relationship with the solider. PERSUASION: Help the soldier develop an awareness that substance use is a problem. Provide information and educate about co-occurring disorders, the role of medication, and increase the soldier s motivation to change.
An Example of a Systemic Model : Stages of Treatment (con d) ACTIVE TREATMENT: Support the soldier during a comprehensive assessment. Use cognitive behavior to move through the stages of change. RELAPSE PREVENTION: Help the soldier understand that relapse can happen and extend recovery to other areas (e.g., employment, education, self-help groups, peer groups, family, lifestyle improvements, independent housing, and becoming a role model for others).
Social Work s Advantage Social Workers have at least 6 advantages when working with people with a co-occurring disorder. 1. We respect an individuals' worth and dignity, encourage mutual participation, demonstrate acceptance, uphold confidentiality, and handle conflict responsibly. 2. We encourage individuals' active participation in the helping relationship and uphold their right to make their own decisions.
Social Work s Advantage (con d) 3. We assist clients in securing resources needed to enhance their social functioning. 4. We ensure that social institutions are humane and responsive to human needs. 5. We accept and appreciate diverse populations. 6. We hold ourselves accountable for ethical conduct, the quality of our work, and we participate in continuous professional development.
Different Philosophical Perspectives The gorilla in the room that our students will need to be prepared to struggle with is the different philosophical perspectives of mental health and substance abuse. These differences make a collaborative team effort difficult and can lead to inconsistent messages being sent to the person during treatment.
Why is this Important to our Students? Our students will be advantaged by having the knowledge that there is a paradigm shift taking place. They will be prepared to work with people with a co-occurring disorder if they understand that the integrated treatment model is what we know as the systemic model. They will be sought out as professionals to provide treatment for people with co-occurring disorders.