Foundations of Addictions Counseling, 3/E David Capuzzi & Mark D. Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Chapter 9 Treatment of Comorbid Disorders Updated by Melinda Haley, Walden University

Prevalence of Comorbidity Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Dual diagnosis and “co-occurring” are no longer used. New term is comorbid. The DSM-5 also dropped the terms “abuse” and “dependence” and replaced them with the phrase “substance use disorders.”

Co-Occurring Disorders and Addictions Treatment Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved People with COD Poorer treatment outcomes, higher cost Integrative treatment has been the exception Mental health and substance abuse professionals disagree on some basic issues

Prevalence of Comorbidity Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved 25% to 30% of alcoholics experience depression and anxiety 25% of suicides by chronic alcoholics

Assessment Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Behaviors in common Compulsive use without control Continued use despite negative consequences Obsession with using or obtaining the drug or behavior SASSI, BDI, MMPI, ASI, MAST most used by addiction counselors Still infrequently used Belief they can diagnose without instrument Sense of inadequate training Fear of pathology focus

Assessment of addiction and psychiatric problems Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Which came first? Which one is primary? Which to treat first? If psychiatric symptoms decrease when person stops using, addiction is probably primary If not, psych. problem probably came first Take a history Either way, addiction is usually dealt with first through detoxification and/or medical intervention

Cultural Issues Related to Assessment Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Culturally diverse groups on the rise Cultural understanding especially important during assessment Some cultures somaticize mental symptoms and want physical solutions from the counselor May be insulted by probing personal questions Understand family roles Be aware of cultural bias in diagnoses

Treatment and Care Needs Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Specialized techniques for dealing with: Increased probability of high risk behaviors Inadequate social support systems Unstable relationships Insufficient housing Sexually transmitted diseases Unemployment status Limited concentration – simplicity, role playing, repetition “No Wrong Door Policy”

COD Treatment Models Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Addiction as disease 12-steps, abstinence as treatment Addiction as other than disease If the disease concept does not fit with a particular counselor’s worldview, then some of the alternative models may be better fit.

Alternatives to the Disease Model of Treatment Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Brief interventions targeting specific symptoms may be just as effective as long-term treatment Substance abuse on a continuum Self-efficacy model resistance, harm reduction, action, coping, recovery

Alternatives, (continued) Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Solution-focused Humanistic-existential Cognitive-behavioral, cognitive-affective, affective- behavioral interventions

Client’s Questions to Counselor About Recovery Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Often disruptive Redirect questioning “How will knowing about my recovery help you in your recovery?” “Staff have a policy to refrain from disclosing such information” “Does a doctor need to have diabetes to treat a person with diabetes?”

Multidisciplinary Treatment Team Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Beneficial Typically include: Mental health counselors Substance abuse counselors Nursing staff Case managers Psychiatric consultants On site prescribing psychiatrist

Brief Description of the Counseling Process Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Issues- and DSM-based assessment Help client Identify measurable and meaningful objectives Select specific strategies/techniques/timelines Formative evaluations During and after sessions Summative evaluation Follow-up

Assessment: the Case of Dwayne Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Referral/Outpatient Therapy Methods used Clinical interview Observation Bio-psychosocial history Mental status evaluation Psychological testing Records review

Assessment: the Case of Dwayne Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Alcohol Use Disorder, Severe Marijuana Use Disorder, Mild Conduct Disorder, Adolescent onset type Client strengths Client issues Treatment Plan/ Objectives Primary Goals Treatment Objectives Treatment Strategies Treatment Techniques

Useful Web Sites Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Addiction Treatment Forum National Institute on Drug Abuse (NIDA): Patients and Families