Co-Occuring Disorders C O U R T N E Y Y C A Z A , M A , L C A S , L P C , C S I 4 / 1 7 / 2 0 1 5
Schedule Introduction, Overview, Objectives Overview of co-occuring disorders, definitions, DSM- V info Specific info and issues in SA treatment 15 minute Break Treating clients with co- occuring disorders: counseling, interventions, etc Group activity Wrap up & resources
Objectives List and define various co-occuring disorders and important definitions from this topic Write a comprehensive treatment plan including when to refer and how to find a referral for a client Coordination of Care with other providers in the treatment planning process Specific strategies to apply when working with clients who have co-occuring disorders in a SA setting List of research, literature and resources to help
What do you need to know?
What are Co- Occuing Disorders? Client has a SA & psychiatric Dx About 50% of those with MH Dx also have SA problem at some time in their life About 50% of those with SA Dx will also meet criteria for a MH Dx at some point in their life Bottom Line: About half of our clients will have COD’s What has always been the general thought about treating these clients?
Treating the Primary Traditionally, the SA is primary; we treat that first, then work on MH What if…we treated them both as primary and worked to address both while clients are engaged in the treatment process??
Thinking about your Client SUB-GROUPS OF PEOPLE WITH CO-OCCURING DISORDERS PSYCH. HIGH- SUBSTANCE HIGH Serious & Persistent Mental Illness with Substance Dependence PSYCH. LOW- SUBSTANCE HIGH Psychiatrically Complicated, Substance Dependence PSYCH. HIGH- SUBSTANCE LOW Serious & Persistent Mental Illness with Substance Abuse PSYCH. LOW- SUBSTANCE LOW Mild Psychopathology with Substance Abuse
MH & SA SA increases risk of having MH Dx about 2 to 5x Treating one without the other will interfere with the recovery process MH Sx may manifest due to SA use, intoxication or withdrawal; likewise, SA may develop as a self medicating pattern for the MH Dx Parallel Model, Sequential Model, Integrated Model Need specific ways to improve treatment compliance Family involvement in treatment
Co-Occuring Disorders Depression & Bipolar (Mood Disorders) Anxiety Disorders ADHD Psychotic Disorders Personality Disorders
Mood Disorders & SA Depression is the most common MH Dx; affects about 1 in 9 people per year Depression: 50% of people with depression also have SA Hx at some time in their life Depression increases the risk of SA about 5x Substance use may ‘activate’ depression or mask the symptoms CBI have been effective with this population Mood monitoring, expression of feelings, dealing with guild & shame, powerlessness, anger, grief Connect feelings & behaviors
Mood Disorders & SA Bipolar is one of the most common Dx to see in SA 56% of bipolar Dx people have SA; A bipolar Dx increases risk of SA about 8- 10x These clients usually show up in the depression rather than mania- important to screen or coordinate care to determine true Dx Screening: Energy level, sleep, shopping, legal, rapid speech, jumping around topics, family history Trouble with medication adherence Expectations, ongoing support and Tx, structure/ routine
Anxiety & SA 2-4x increased risk of SA with anxiety disorder Use of medications, especially benzos (rebound anxiety issues) Use of behavioral interventions Substances used to self medicate anxiety; belief that they will decrease anxiety Anxiety can increase in early recovery PTSD, Phobias, OCD Various interventions
ADHD & SA For about half of those Dx’ed in childhood, Sx persist into adulthood For adults 15- 54 YO; 35% (M), 18% (F) have a Dx of SA in their lifetime Memory, attention and concentration affect someone with SA (Cravings, withdrawal, treatment) Important to have coordination of care or Psych referral for this Dx Medications for ADHD
Psychotic Disorders & SA Some psychotic Sx can be substance induced Schizophrenia affects about 1% of the population; 47% of them will meet criteria for SA in their lifetime Biological factors for both Schizophrenia and SA Treatment must include a multidisciplinary team Treatment goals are usually much slower in these clients Realistic goals & expectations for both client and clinician Safety planning
Personality Disorders & SA Former Axis II Dx’s Generally thought of to have poor prognosis & recovery Earlier onset of SA & greater severity Clinician factors: Low narcissism, high energy, high tolerance level (recognize your limitations!) Cluster A, B & C disorders Typically do not seek out treatment and have high resistance Flexibility in treatment
Issues in SA Treatment What issues have you encountered?
Issues in SA Treatment Resistance/ Denial Not engaged with proper MH care Resistance to 12- step Not medication compliant Self- medicating Proper diagnosing of MH Coordination of Care
15 Minute Break
Treatment Issues Group Therapy with COD’s Managing the group process Coordination of Care and safety planning Family Involvement Relapse Prevention
Counseling Interventions Medication Interventions Cognitive Behavioral Physical, Lifestyle, Psychological, Behavioral, Spiritual Issues in Recovery Education about MH & SA Client ‘buying in’ to treatment plan
Treatment Planning SA & MH Goals within agency boundaries Coordination with other providers (Sometimes required, always needed) Writing realistic MH goals for both the clinical and the client Medication adherence as a goal
Treatment Goals Medication compliance Updated MH assessments Coping skills for MH specific Education about MH diagnosis Specific things discussed by client (realistic, measurable)
Group Case Studies Identify the SA & MH in each case: Identify the elements of both, provide a idea about how Tx should progress Write a Tx goal for both MH & SA: Realist goal for both Counseling interventions: What will the clinician do for this client? How might this client need specialized care? Follow up & planning: What will determine success? What is need in the discharge plan? Challenges: What are the issues that may be problematic in the treatment of the client?
Resources AA, NA, COD groups Linking to long term care (LME’s, local agencies) NAMI- www.nami.org www.mhresources.org Relationships with local hospitals, Dr’s and others
Resources Dual Disorders- Dennis C Daley, Ph.D & Howard Moss, MD The Dual Disorders Recovery Book- Hazelden Dual Diagnosis: Drug Addiction and Mental Illness- Malinda Miller www.dualdiagnosis.org Dual Diagnosis Anonymous
Quotes
Questions?
References The Dual Disorders Recovery Book: A Twelve Step Program for Those of Us with Addiction and an Emotional or Psychiatric Illness. Various Authors, 1993. Hazelden. Treating Substance Abuse: Theory and Technique. Edited by: Frederick Rotgers, Jon Morgenstern, Scott T Walters. 2 nd Edition, 2003 The ACA Encyclopedia of Counseling. ACA, 2009
Contact Courtney Ycaza Courtney.ycaza@mcleodcenter.com
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