Treatment of Persons with Co-Occurring Disorders
Based on SAMHSA TIP 42 Part 7
Host: Dr. Dawn-Elise Snipes
Executive Director: AllCEUs Counselor Education
Podcast Host: Counselor Toolbox and Addiction Counselor Exam Review
~ Special Settings and Specific Populations
~ Acute Care and Other Medical Settings
~ Providing Treatment to Clients With COD in Acute Care and Other Medical Settings
~ Sustaining Programs for Clients With COD in Acute Care Settings
~ Dual Recovery Mutual Self-Help Programs
~ Dual Recovery Mutual Self-Help Approaches
~ Advocating for Dual Recovery
~ Specific Populations
~ Homeless Persons With COD
~ Criminal Justice Populations
Providing Tx in Medical Settings
~ Primary care and mental health providers are often not familiar with substance use disorders which can lead to unrealistic expectations or frustrations, which may be directed inappropriately toward the client
~ Education of Clinicians about addictions
~ Services Provided
~ Crisis counseling
~ Single session treatment or motivational enhancement
~ Short-term mental health or substance abuse treatment counseling
~ Medication assisted therapy and/or ambulatory detox
~ Psychoeducation as appropriate
Medical Settings cont…
~ facilitate linkage to more intensive services
~ Realize that chronically ill clients enter periods of stability when little intervention is required.
~ Episodic use of services by these clients means staff need to be flexible and to realize that these clients are likely to return when in crisis.
~ Critical to incorporate program evaluation activities that examine both process and outcome
~ Are we reaching the clients we wanted to target?
~ Are those clients enrolling and completing services?
~ Are those clients experiencing stability periods?
~ Why are Dual Recovery Groups needed?
~ Stigma and prejudice
~ Inappropriate advice
~ What are they
~ Double Trouble
~ Dual Recovery Anonymous
~ Dual Disorders Anonymous
~ Dual Diagnosis Anonymous
~ Support Together for Emotional/Mental Serenity and Sobriety (STEMSS) is a supported self-help model for people with co-occurring disorders
~ People who are homeless
~ For most homeless clients with COD, the impact of substance abuse and mental illness bears a direct relationship to their homeless status.
~ The ability to maintain housing is affected profoundly by substance abuse (Hurlburt et al. 1996).
~ Approximately 70 percent of participants in recent NIAAA demonstration projects identified substance abuse problems as the primary reason for their homelessness in both the first and most recent episodes
~ Supportive housing dramatically reduced use of other public systems by people who were homeless and had SMI
~ People who are homeless
~ Providing Housing
~ Housing contingent on treatment and drug free samples
~ Housing integrated with treatment (Shelter/RRs)
~ Other Services
~ Teach clients skills for maintaining housing.
~ Work closely with shelter workers and other providers of services to the homeless.
~ Address real-life issues in addition to housing, such as substance abuse treatment, legal and pending criminal justice issues, Supplemental Security Insurance/entitlement applications, issues related to children, healthcare needs, etc.
~ Criminal Justice
~ aftercare subsequent to prison-based treatment was to ease the abrupt transition
~ Recognize special service needs.
~ Give positive reinforcement for small successes and progress.
~ Clarify expectations regarding response to supervision.
~ Use flexible responses to infractions.
~ Give concrete (i.e., not abstract) directions.
~ Design highly structured activities.
~ Provide ongoing monitoring of symptoms.
~ Specialized programs for women with COD have been developed to address pregnancy and childcare issues as well as certain kinds of trauma
~ Women who enter treatment sometimes risk losing public assistance support and custody of their children
~ Before specialized programming, women only accounted for 20 percent of group attendance, yet made up 40 percent of census in a large integrated COD treatment program
~ Treatment for substance abuse in women should emphasize the importance of relationships, the link between relationships and substance abuse, and the importance of relationships with children as a motivator in treatment. ***
~ The stigma attached to females who abuse substances functions as a barrier to treatment, as does the lack of provision for children
~ Women and men have differing coping mechanisms and symptom profiles.
~ Compared to men, women with substance use disorders have more mental disorders (depression, anxiety, eating disorders, and posttraumatic stress disorder) and lower self-esteem.
~ Women with substance use disorders have more difficulty with emotional problems, and men have more trouble with functioning (e.g., work, money, legal problems)
~ Worsening symptoms of mental illness can result from
~ Hormonal changes that occur during pregnancy; lactation; medications given during pregnancy or delivery
~ ***The stresses of pregnancy, labor, and delivery; and adjusting to and bonding with a newborn
~ Women with co-occurring disorders sometimes avoid early prenatal care, have difficulty complying with healthcare providers' instructions, and are unable to plan for their babies or care for them when they arrive
~ When women*** are parenting, it can often retrigger their own childhood traumas. Balance growth and healing with coping and safety and be alert to the inevitable guilt, shame, denial, and resistance to dealing with these issues
~ Pregnancy cont…
~ Many psychopharmacological drugs as well as psychoactive substances can hurt the baby
~ Mothers should be screened before delivery for any substances for which the baby need to detox.
~ Some substances (opiates/methadone) are not safe to detox a pregnant woman from.
~ Pregnant women should be made aware of any and all wrap-around services to assist them in managing newborn issues, including food, shelter, medical clinics for innoculations, etc., as well as programs that can help with developmental or physical issues the infant may experience as a result of alcohol/drug exposure.
~ Postpartum or maternity “blues,” which affects up to 85 percent of new mothers
~ More so if the woman is now detoxing
~ Postpartum depression, which affects between 10 and 15 percent of new mothers
~ Begins up to 4 weeks postpartum
~ Egodystonic scary thoughts
~ Postpartum psychosis, which develops following about one per 500–1,000 births
~ Egosyntonic scary or illogical thoughts
~ More common if mom has had a psychotic episode in the past or has bipolar disorder
~ Identify and build on each woman's strengths.
~ Avoid confrontational approaches (or, as has been stated previously, supportive interventions are preferred to confrontational interventions for persons with COD, especially in the early stages of treatment).
~ Teach coping strategies, based on a woman's experiences, with a willingness to explore the woman's individual appraisals of stressful situations.
~ Arrange to meet the daily needs of women, such as childcare and transportation.
~ Have a strong female presence on staff.
~ Promote bonding among women.
~ Offer program components that help women reduce the stress associated with parenting, and teach parenting skills.
~ Develop programs for both women and children.
~ Provide interventions that focus on trauma and abuse.
~ Foster family reintegration and build positive ties with the extended/kinship family.
~ Build healthy support networks with shared family goals.
~ Make prevention and emotional support programs available for children.
~ Trauma Recovery and Empowerment Model (TREM) is a group approach to healing from the effects of trauma
~ Seeking Safety offers a manual-based, cognitive—behavioral therapy model consisting of 25 sessions which has been used in a number of studies with women who have substance dependence and co-occurring PTSD
~ The Addiction and Trauma Recovery Integration Model is designed to assess and intervene at the body, mind, and spiritual levels to address key issues linked to trauma and substance abuse experiences
~ Trauma Adaptive Recovery Group Education and Therapy (TARGET) aims to help clients replace their stress responses with a positive approach to personal and relational empowerment.
~ It is important to ensure that treatment is available to Clients With COD in Acute Care and Other Medical Settings
~ Dual Recovery Mutual Self-Help Programs are tailored to meet the unique needs of the person with COD
~ Specific Populations have unique issues which need to be accommodated in agency programming
~ Homeless Persons With COD
~ Criminal Justice Populations