1. Integrated Dual Diagnosis Treatment
CLINICAL ELEMENTS

2. Integrated Treatment Core Components Integration of Services
Comprehensiveness
Assertiveness
Reduction of Negative consequences
Long-Term Perspective
Motivation-Based Treatment
Multiple Psychotherapeutic Modalities

3. CORE COMPONENTS

4. Integration of Services
When providing IDDT, one wants to provide services for both mental illness and substance abuse simultaneously
These services should be provided by the same clinician(s) or team within the same organization
Helps to avoid gaps of service delivery
Helps to ensure that both types of disorders are treated effectively

5. Comprehensiveness
IDDT attempts to provide services directed not only at the problems of substance abuse and mental illness, but also the broad array of other areas of functioning that are frequently impaired in the lives of the dually diagnosed client
Housing -Vocational Functioning
Family/Social relationships
Ability to manage psychiatric illness

6. Assertiveness
This addresses the location of service provision and how a client is engaged in treatment
Effective treatment programs for the dually diagnosed client does not wait for often reluctant clients seeking treatment on their own
Effective treatment programs use assertive outreach and legal mechanisms to involve the client in treatment

7. Reduction of Negative Consequences
This is the philosophical dimension of integrated treatment
Due to the damaging impact dual disorders have on the lives of clients, the first and foremost goal of the clinician is to reduce harmful effects
Do this without judging or imposing your personal values on the client regarding the causes or the moral responsibility for the consequences

8. Long-Term Perspective
This addresses the need for time-unlimited services

9. Motivation-Based Treatment
This orients the clinician as to specific interventions to use depending of the clients desire to change their behavior
This avoids unnecessary and potentially destructive conflict between the client and clinician
This helps to maximize treatment gains through collaborative work

10. Multiple Psychotherapeutic Modalities
Provide psychological treatment services for the dually diagnosed client in as many formats as are needed (and several usually are)
Individual
Group
Family Therapy Modalities

11. STAGES

12. Motivation IDDT is a STAGE BASED approach to treatment
In order to most effectively treat the dually disordered client, interventions must by MOTIVATION BASED
Adapted to clients motivation for change
Stages of treatment is CENTRAL, it provides a framework for assessing the clients
Motivational states -Setting goals
Selecting interventions appropriate to achieving those goals

13. Stages of Treatment 4 stages Engagement Persuasion Active Treatment
Relapse Prevention

14. Stages of Treatment vs. Stages of Change
Stages of Treatment Stages of Change
Engagement Precontemplation
Persuasion Contemplation
Preparation
Active Treatment Action
Relapse Prevention Maintenance

15. Stages of Treatment
IDDT uses Stages of Treatment because it is specific to changes that occur over the course of treatment for clients who experience dual disorders

16. Stages of Treatment Engagement Definition: Goal:
The client does not have regular contact with their dual diagnosis clinician
Goal:
Establish a working alliance with the client

17. Engagement Interventions
Outreach
Practical assistance (food, clothing, housing, benefits, transportation, medical care)
Crisis intervention
Stabilization of psychiatric symptoms (medication management)
Help in avoiding legal penalties
Help with arranging visitation with family or family meetings
Support and assistance to social networks

18. Stages of Treatment Persuasion Definition: Goal:
The client has regular contact with the clinician, but doesn’t want to work on reducing their substance use/abuse
Goal:
To develop the clients awareness that substance use is a problem and increase their motivation to chabnge

19. Persuasion Interventions
Motivational Interviewing
Peer Groups (persuasion groups)
Social skills training (for non-substance related situations)
Individual and family education
Psychological preparation for lifestyle changes necessary to achieve remission
Sampling constructive social and recreational activities
Safe “damp” housing

20. Stages of Treatment Active Treatment Definition: Goal:
The client is motivated to reduce their substance use, as indicated by a reduction for at least 1 month, but less than 6 months
Goal:
To help the client further reduce their substance use and, if possible, attain abstinence

21. Active Treatment Interventions
Social skills training to address substance-related situations
Peer groups (active treatment groups)
Self-help groups (12 step, RR, DRA)
Individual Cognitive-Behavioral counseling
Psycho-education
Stress management and coping skills
Family and individual problem solving

22. Stages of Treatment Relapse Prevention Definition: Goal:
The client has not experienced problems related to substance use for at least 6 months (or is abstinent)
Goal:
To maintain awareness that relapse can happen and to extend recovery to other areas (social relationships, work…)

23. Relapse Prevention Interventions
Expanding involvement in supported or independent employment
Groups (active treatment or relapse prevention, 12-step, DRA, RR)
Social skills training
Family problem solving
Lifestyle improvements (smoking cessation, diet, exercise, stress management techniques)
Independent housing

24. IDDT As seen, IDDT is COMPREHENSIVE It is also FLEXABLE You do need;
To use a stage based approach to treatment
To use Cognitive Behavioral treatment
To select what you have a capacity to do based on how you prioritize FIDELITY components of the model and what you as an agency or institution are able to do

25. SPECIFIC TOOLS
Differential Diagnosis
Payoff Matrix
Formulation

26. Learning Curve of the Staff
There was in our case initial resistance
Use of the Payoff Matrix offered face validity, with it staff members were more willing to try and use various tools of IDDT
It is important to practice, practice, practice the tools
In order to make IDDT work, you need consistent and appropriate supervision/consultation to help to improve staff’s ability to use the tools and to acquire the skills required to effectively implement IDDT

27. Benefits of Using the Tools
Appropriate treatment for dually diagnosed clients
IDDT helps to meet the client where they are in their specific stage of recovery
IDDT helps to improve outcomes for treatment
This helps to motivate the clienty to continue to engage in treatment

28. Benefits of Using the Tools (cont’d)
Using IDDT helps make staff feel more successful and improves their motivation to work with this population previously seen as unrewarding
The IDDT tools have broad applicability and generalizability beyond the dually diagnosed population
Using IDDT helps to instill hope
Hope for the clients, hope for the staff