Common Issues & Interventions
in the Treatment of
Co-Occurring Disorders
Objectives
~ What are Co-occurring Disorders
~ Chicken and Egg Dilemma
~ Awareness and Mindfulness
~ Self-Esteem
~ Sleep
~ Nutrition
~ Depressed and/or Anxious Mood

What are Co-Occurring Disorders
~ Any physical or mental health disorder that
~ Occurs at the same time as an addiction
~ Can cause clinically significant impairment on its own
~ Creates a hurdle in the recovery process

Chicken and the Egg
~ Which to address first—Mental Health or Addiction
~ Both! (assuming motivation)
~ Addiction (Goal is progress not perfection)
~ What are your triggers for use?
~ What have you done in the past that has helped you not use?
~ What can you do to help yourself stay clean/not use now?
~ How can you do that? / How can I help?
~ Mental and/or Physical Health Issues
~ What MH/PH issues do you have that contribute to your use?
~ What can you do that helps make those things less distressing?
~ How can you do that? / How can I help?
Awareness
~ Most people in early recovery are on autopilot
~ The powerlessness to change the situation often prompts disconnection emotionally, mentally, physically and spiritually
~ Part of the definition of addiction is experiencing difficulties in multiple areas of life as a result of use which often results in guilt, resentment, depression, grief, negative self-image
~ Life is about survival  avoiding the intolerable pain

Awareness –Interventions
~ Turn off Autopilot
~ Mindfulness
~ How I feel right now
~ Meeting my needs
~ Thoughts Feelings, Urges and Behaviors that keep me unhappy
~ Thoughts Feelings, Urges and Behaviors that will help me start changing
Awareness –Interventions
~ Purposeful Action Continuum
Awareness –Interventions
~ Deal with thoughts and feelings that prevent self awareness
~ Guilt (I need to ignore my needs and make up for…)
~ Fear (If I tune in, I might get overwhelmed)
~ Apathy (What’s the point?)
~ Self-Hatred/Negative Internal Voice (Suck it up!)
Self-Esteem
~ Low Self Esteem
~ Powerless
~ Walk the middle path, identifying what you do and do not have control over
~ Learn from prior failures
~ Create a Success Mantra

Quotes About Success and Failure
~ “Failure isn't fatal, but failure to change might be” – John Wooden
~ “I have not failed. I've just found 10,000 ways that won't work.” – Thomas A. Edison
~ “Success is stumbling from failure to failure with no loss of enthusiasm.” – Winston Churchill
~ The only real mistake is the one from which we learn nothing.” – Henry Ford
~ “Success is the result of perfection, hard work, learning from failure, loyalty, and persistence.” Colin Powell

Self-Esteem
~ Low Self Esteem
~ If people do not feel worthy of recovery/happiness, they will not stay motivated for it
~ Change the Dialogue
~ Undeserving of happiness (refusal to forgive self)
~ What would it mean if you forgave yourself?
~ What are you afraid will happen?
~ What makes someone deserving of happiness?
Self-Esteem
~ Low Self Esteem
~ If people do not feel worthy of recovery/happiness, they will not stay motivated for it
~ Change the Dialogue
~ Unlovable or fallible?
~ What makes someone lovable?
~ Useless/purposeless or undirected?
~ What skills/qualities/attributes do you have?
~ How can you use those?
Sleep
~ Sleep is disrupted by
~ Addictions
~ Stress/Depression/Anxiety
~ Physical Pain
~ Poor Nutrition
~ Sufficient quality sleep improves
~ Focus/Concentration
~ Energy
~ Hormone levels
~ Appetite
~ Mood

Sleep
~ Interventions
~ 3-Step sleep routine
~ Eliminate caffeine, nicotine and alcohol before bed
~ Avoid sleep aids when possible (Medications for the treatment of sleep disorders) as they reduce deep sleep.
~ Try guided imagery or at least thinking about something non-stressful
~ Address pain, allergy and apnea issues that wake you up

Nutrition
~ More than half of the population is meeting or exceeding total grain and total protein foods recommendations
~ Grains are refined and not “whole” greatly reducing nutrient value
~ Fortified grains do not provide vitamins and minerals in the “natural” most bioavailable ratio
~ About three-fourths of the population has an eating pattern that is low in vegetables, fruits, dairy, and oils.
~ Potentially causing deficiencies in Vitamin C, calcium and magnesium

Nutrition– Water
~ Aids on digestion which makes minerals and nutrients more accessible to the body
~ Enables your body to excrete waste.
~ The brain is approximately 85% water
~ Water gives the brain the electrical energy for all brain functions, including thought and memory processes. (Dr. Corinne Allen)
~ Water delivers nutrients to the brain and removes toxins.
~ If you are 1% dehydrated  5% decrease in cognitive function.
~ 2 percent% dehydration  fuzzy short-term memory, problems with focusing

Mood
~ Depression
~ Hopelessness
~ Complete the sentence… I don’t think there is any hope that…
~ For each sentence identify why the person believes there is no hope.
~ What would have to change to give him or her hope?
~ How can you start to make that happen
~ Hope Chest…
~ Each day add a card with something that indicates things are going better
Mood
~ Depression
~ Helplessness
~ Nothing I do will change it
~ What have other people done?
~ What has worked in the past?
~ What is keeping that from working now?
~ Validate steps already taken
~ Identify next steps
~ Create successes to increase self-efficacy and empowerment.
Mood
~ Depression
~ Apathy
~ Exhaustion “Sick and tired of being sick and tired”
~ Learned helplessness
~ Identify bad events
~ Determine which parts were uncontrollable
~ Explore which parts are, in the present, controllable
Mood
~ Anxiety/Worry
~ Loss of control
~ What do you most worry about being out of control of, and why?
~ What parts of that situation are in your control?
~ When you have lost control of that before, what happened?
~ Inability to cope
~ How do you cope
~ What are some of the most difficult things you have coped with and how?
Emotional Dysregulation
~ Inability to tolerate/handle any more stress
~ Prevention
~ What stressors can you eliminate
~ Who can handle other stressors (bills, picking up kids)
~ What are the current stressors you are dealing with
~ Put each on an index card (add cards as needed)
~ Prioritize (urgency then stressfulness)
~ Address one to 3 each week

Emotional Dysregulation
~ Intervention
~ 4 things you can do when you get stressed out/angry
~ Practice the pause by…
~ Distract don’t react by…
~ Improve the moment by…
~ Turning your attention by…
~ What are 3 helpful problem solving skills
~ Create a win/win
~ Brainstorming
~ Focus on the parts in my control

Interpersonal Issues
~ What have this person’s relationships been like?
~ What does he/she think a healthy relationship look like?
~ What has caused prior relationships to end?
~ What can be learned from those relationships?
~ What does he/she most need in a best friend and why?
~ Which of those characteristics does he/she bring?
Cookie Metaphor
Medications
~ Psychotropics for depression or anxiety
~ Muscle relaxants or pain medications for pain
~ Antagonist or partial agonist medications for addiction
Summary
~ People with addictions should be expected to have mood issues
~ Addiction isn’t diagnosed until there are multiple problems (which can cause mood issues)
~ There are many common themes that can be identified and addressed in early recovery to
~ Enhance self esteem
~ Empower the client
~ Begin creating a resiliency narrative.