1. TREATMENT TOOLS

2. SESSION 8 C
This session will identify various treatment tools and techniques that have been found useful in working with a dual diagnosis population
A review of outcomes regarding identified evidence based programs will also be included

3. SEVEN PRINCIPLES OF INTEGRATED CARE
Mental health and substance abuse treatment are integrated to meet the needs of people with co-occurring disorders
Integrated treatment specialists are trained to treat both substance use disorders and serious mental illness
Co-occurring disorders are treated in a stage-wise fashion with different services provided at different stages

4. SEVEN PRINCIPLES
Motivational interventions are used to treat consumers in all stages , but especially in the persuasion stage
Substance abuse counseling, using a cognitive- behavioral approach, is used to treat consumers in the active treatment and relapse prevention stages
Multiple formats for services are available including individual, group, self-help, and family
Medication services are integrated and coordinated with psychological services

5. BASIC CHARACTERISTICS OF INTEGRATED TREATMENT
Multi-disciplinary teams
Integrated treatment specialists
Stage-wise interventions
Access to comprehensive services
Time unlimited access to services
Outreach
Motivational interventions

6. BASIC CHARACTERISTICS
Substance abuse counseling
Group treatment for co-occurring disorders
Family interventions for co-occurring disorders
Alcohol and drug self-help groups
Pharmacological treatment
Interventions to promote health
Secondary interventions for non-responders

7. TREATMENT TOOLS Non-silo’d care Integrated treatment approach
Use of medications
Strengths based model
Trauma informed treatment
Motivational interviewing
Matching treatment interventions based upon stage of change
Cognitive behavioral therapy
Skills Building
Thought Stopping
Peer Support/12 Step Programs

8. BENEFITS OF INTEGRATED CARE
Integrated treatment is associated with the following positive outcomes:
Reduced substance use
Improvement in psychiatric symptoms and functioning
Decreased hospitalizations
Increased housing stability
Fewer arrests
Improved quality of life

9. STAGES OF CHANGE/STAGES OF TREATMENT
Pre-Contemplation
Contemplation
Preparation
Action
Maintenance
STAGES OF TRT
Engagement
Persuasion
Active Treatment
Relapse Prevention

10. ASSESSMENT RECOMMENDATIONS
Integrated assessment tool that looks at both the mental health as well as the addictions the individual client is presenting with
By doing a dual assessment, treatment will be integrated at a basic level and both mental health and addictions professionals will be able to use the data collected to implement programming

11. PRINCIPLES OF SCREENING AND ASSESSMENT
Because many consumers have substance use disorders, screen all consumers for both disorders
In addition to speaking with consumers, gather information from multiple sources
If information does not agree, ask consumers to help resolve the discrepancies in a matter-of-fact and non-threatening way
It is important to continue the assessment over time

12. INTEGRATED SCREENING AND ASSESSMENT
Comprehensive longitudinal assessment
Functional status
Mental health symptoms, treatment, and response to treatment
Substance use, treatment, and response to treatment
Interactions between mental illness, substance use, and treatment

13. CONTEXTUAL ASSESSMENT
Another important part of the integrated assessment is a detailed description of current substance use patterns, including factors that cause consumers to continue using

14. SUICIDE RISK ASSESSMENT
Previous attempts and their seriousness
Whether the attempt was intended or accidental
Relationship of the previous suicidal behavior to the psychiatric symptoms
Current psychiatric symptoms
How specific is the plan?
What method will be used?
When will it happen?
How available are the materials?

15. INTEGRATED TREATMENT PLANNING
Using a team approach to develop the treatment goals
Addressing the entire person
Identifying behavioral health as well as substance use disorder goals
Empowerment
Building on strengths and not deficits
Inclusive in nature

16. MOTIVATIONAL INTERVIEWING
Express empathy
Develop discrepancy
Avoid argumentation
Roll with resistance
Instill self-efficacy and hope

17. COGNITIVE BEHAVIORAL SKILLS
Identify negative thoughts
Categorize negative thoughts
Stop negative thoughts
Replace negative thoughts with positive thoughts

18. CATEGORIZING NEGATIVE THOUGHTS
Unrealistic Goals (Perfectionism)
Imagining Catastrophe
Overgeneralization
Expecting the Worst
Putting Self Down
Black and White Thinking

19. WAYS TO REDUCE NEGATIVE THINKING
Recall the good things in life and about yourself
Challenge and refute irrational beliefs
Avoid assuming catastrophe
Re-label the distress
Make a hopeful statement about yourself
Blame the event, not yourself
Remind yourself to stay on task
Pat yourself on the back

20. BEHAVIORAL TECHNIQUES
Behavioral techniques to reduce or stop using substances include helping consumers:
Improve conversation skills
Learn assertiveness and relaxation skills
Replace substance use activities with other pleasant and useful activities
Manage mood problems

21. MAT Medication Assisted Therapy
Coordinating care so that the client received the care he/she needs
Effective use of anti-psychotic, anti-anxiety, and/or other drugs that will help sustain recovery
Educate about medication compliance
Use of peer educators regarding the utilization of medication and monitoring of compliance

22. STRENGTHS BASED MODELS
Building self-efficacy
Focusing on strengths and what the client CAN accomplish (rather than their deficits)
Positive reinforcements
Token economy
Allowing client to feel empowered

23. TRAUMA INFORMED TREATMENT
Understanding the importance of addressing any trauma in the client’s life
The prevalence of trauma in a co-occurring client
Utilization of trauma elements in therapy
Teaching stress management and coping techniques

24. COGNITIVE BEHAVIORAL THERAPY
Integrating thought processes with behavioral change
Altering behavior through conscious will
Consistent feedback and positive reinforcement
Treating the whole person

25. SKILLS BUILDING Stress management Development of coping skills
Communication skills
Job skill development
Basic living skills
Medication management
Development of relapse prevention strategies

26. PEER SUPPORT/12 STEP PROGRAM
NAMI
Self Help Groups
Mentoring
Peer Support

27. FOUR PHASES OF PARALLEL PROCESS RECOVERY
Acute stabilization- detoxification of substances and treatment of psychotic symptoms
Engagement- establishment of treatment relationship
Prolongs stabilization- maintaining complete abstinence from the drug(s)
Rehabilitation- continued participation in the program and self growth

28. IMPORTANT CATEGORIES OF MENTAL ILLNESS
Psychotic disorders
Mood disorders
Personality disorders
Anxiety disorders

29. PSYCHOTIC DISORDERS
Disturbances in thinking, perception, communication, and behavior
Usually first observed during adolescence or early adulthood
Chronic, variable course
Most common is schizophrenia

30. PSYCHOSIS
Refers to the degree of severity of symptoms, not to a specific psychiatric disorder
Thinking is so impaired that it interferes with ability to meet the ordinary demand of life
Two types of psychotic symptoms
Delusion- false belief that an individual holds in spite of logical proof to the contrary-interferes with social adjustment
Hallucination- a false perception; a sensation of sight, hearing, smell, or taste that has no real world stimulus to cause it

31. OTHER PSYCHOTIC SYMPTOMS
Disturbance of affect of emotions
Bizarre behaviors
Paranoid behaviors
Cognitive disturbances
Thought disorder

32. MOOD DISORDERS
Disturbances of a person’s mood, which are not due to alcohol or drugs, physical illness, or other mental illness
Two extreme abnormalities of mood- depression and mania- exist on either end of the continuum of the two basic normal moods of sad and happy

33. MOOD DISORDERS
Bipolar disorders-are shown by distinct manic episodes that occur with or without the presence of history of depression
Depressive disorders involve depression symptoms only

34. DEPRESSION SYMPTOMS
May appear in emotional, cognitive, motivational, and physical ways including dejected mood, negative feelings toward self, withdrawal, crying, lack of energy, sleep and appetite disturbances

35. MANIC SYMPTOMS
A distinct period of abnormally and persistently elevated, expansive, or irritated mood that is severe enough to cause marked impairment in occupational, social, or interpersonal functioning

36. ANXIETY DISORDERS
Anxiety- sensations of nervousness, tension, apprehension, and fear that come from the anticipation of danger, which may be internal or external
Panic attack- distinct period of intense fear or discomfort that developed abruptly, usually peaking within a few minutes or less
Phobias- the focus of anxiety is a person, thing, or situation that is dreaded, feared, and probably avoided

37. ANXIETY DISORDERS
Obsessive-compulsive disorders- obsessions or compulsive rituals or both
Post-traumatic stress disorder (PTSD)- persistent re-experiencing of a psychologically traumatic stress when the person experienced intense fear, helplessness, or horror; may experience recurrent and intrusive images and thoughts of the stressor

38. ANXIETY SYMPTOMS
Most common psychiatric symptoms seen in individuals with substance use disorders
Substance induced or withdrawal-related anxiety symptoms usually resolve within a few days or weeks. Most resolve with substance abuse treatment
Coexisting anxiety disorders may range from mildly to seriously debilitating