What recovery means:

• Independent living

• Control of symptoms

• Active remission of substance use

• Competitive employment

• Socialization with peers who do not use

• Satisfaction with life

• Getting finances in order

I was able to obtain remission from Co-occurring Disorders when I had:

•Stable housing

•Sober and clean network

•Regular and meaningful activities

•Trust in my clinical relationships

•Insight to know that I had to work on my recovery

Module 1: Practical Knowledge of Common Substances

and Mental Illness

The Impact Alcohol and Mental illness can have on a person’s life…

Alcohol abuse can be related to negative outcomes, such as the following:

• Increased symptoms of mental illness-sadness, anxiety, mania and psychotic symptoms

• Illegal use of drugs- easier to find and in some cases cheaper

• Victimization- a by product of getting involved with negative people; believing that you are helpless and/or hopeless; putting yourself in a situation that may cause you to be violated

• Homelessness

• Incarceration

• Suicidal behaviors

• Hospitalizations

• Physical health problems

Assessing Alcohol Use

One dose can increase and exaggerate symptoms, for example: • Euphoria turns to depression and suicidal thoughts

• Poor judgment can result in high risk relationships

• Serious lack of coordination such as stumbling and falling down

Understanding long-term effects of alcohol use

Besides mental illness, other medical issues may include: • Cirrhosis of the liver and other liver problems • Dementia-wet brain (thiamine deficiency caused by drinking) • Neuropathy( pain and burning in arms and legs) • Cancer • Esophageal verses- bleeding from the esophagus • The “DTs”- physical withdrawal • Insomnia

Putting it together . . .

What are some physical warning signs of a Co-occurring Disorder?

What are some behavioral signs of substance use?

What are some behavioral signs of substance use?

Module 2: Basic Elements and Practice Principles

The basic elements and practice principles of Integrated Treatment for Co-occurring Disorders, an evidence-based treatment.

Basic Elements and Practice

Principles Typical Outcomes related to Co-occurring Disorders are: • Rapid progression from initial use to substance dependence

• Poor adherence to medication or misuse

• Decreased likelihood of treatment completion

• Greater rates of hospitalization

• Suicidal behavior tendencies • Difficulties in social functioning and isolation • Shorter time in remission of symptoms • Feelings of shame and guilt • Lifestyle of constant chaos

It is essential for clients who are impaired by a Co-occurring Disorder to get the same message to AVOID problems seen in other models, like:

• Provider conflict of treatment philosophies

• Poor provider communication with other agencies

• Scheduling and transportation problems for people in need of services

• Providers passing the client from one agency to another

What are the 7 Practice Principles?

Practice Principle 1:

In an ideal treatment setting, meeting the needs of people with Co-occurring Disorders (substance use and mental health treatment) should be integrated because:

• Most clients with Co-occurring Disorders receive from several different agencies if, they receive treatment at all

• When there are multiple treatment services we find there is confusion and different treatment philosophies held by providers that could lead to treatment and communication gaps

• The result is that clients may fall through the gaps

• Clients with Co-occurring Disorder have a better chance of recovery when they receive treatment from the same professional in an integrated fashion. (One stop shopping).

Practice Principle 2:

In an ideal treatment setting, Integrated Treatment Professionals are trained to treat both substance use and mental illnesses, and they:

• Know about typical substances that can be used by clients

• Know how typical substances can affect people who have a Co-occurring Disorder

• Understand the terminology for both mental illness and substance use

Practice Principle 3:

In an ideal treatment setting Co-occurring Disorders should be treated in stages with different services provided at each stage of recovery:

• Clients go through different stages in recovery at different times (Pre-contemplation, Contemplation, Preparation, and Action are the stages of change and are addressed in the next module) • Each stage marks the level of readiness for a specific treatment

• Treatment professionals should be aware of each stage of treatment (Engagement, Persuasion, Active treatment, and Relapse Prevention are the stages of treatment and are addressed in the next module)

Practice Principle 4:

In an ideal treatment setting, Motivational Interventions are used to treat people in all stages, especially in the persuasion stage:

• Motivational interventions include motivational interviewing, counseling and treatment

• Motivational interventions are key to treatment -they help clients to identify recovery goals

• Motivational interventions encourage clients to abstain from use as they become motivated to reach their goals. Treatment specialists should use listening and counseling skills to help clients who are demoralized or are not ready to pursue abstinence

Practice Principle 5:

In an ideal treatment setting, Treatment Specialists use a Cognitive-Behavioral approach (a mental health counseling method that helps clients be aware of inaccurate and negative thought patterns by reframing the negative to positive statements) in the active treatment and prevention stages:

• Treatment professionals with skills in cognitive-behavior therapy can help clients identify unpleasant emotions and symptoms that may lead to relapse • Treatment professionals with skills in cognitive-behavior therapy can help clients stop the thought patterns that may lead clients to using • Treatment professionals with skills in cognitive-behavior therapy can also help clients identify triggers and help change their reactions • Treatment professionals with skills in cognitive-behavior therapy can help clients learn to identify and manage negative thoughts • Treatment professionals with skills in cognitive-behavior therapy can introduce clients to coping techniques like journaling, relaxation, and mindfulness

Practice Principle 6:

In an ideal treatment setting, multiple types of services are available such as – individual and/or group therapy, self-help, and family support:

• Clients benefit from multiple options at different stages of recovery

• Some families can be an excellent source of support for clients especially families who educate themselves about the recovery process • Group therapy can help clients feel less alone

• Peer groups (like DTR, AA, NA, etc) are especially helpful in developing a positive social network

Principle 7:

In an ideal treatment setting, psychiatric medication services are integrated and coordinated with services:

• Medication providers should work closely in multidisciplinary treatment teams for seamless services for clients

• Psychiatric medications may be prescribed despite active substance use -potentially addictive medications should be avoided

One consistent message:

“you need help with your mental illness AND your substance use.”

Since the mid 1990s, studies support the effectiveness of Integrated Treatment. In contrast to traditional treatment we see positive outcomes such as:

•Reduction in substance use

•Improvement in psychiatric symptoms

•Less hospitalizations

•Improved quality of life for the people we serve

Putting it together . . .

In your experience, list one traditional service delivery system that has been inadequate:

What would your “system of care” look like if Integrated Treatment services were offered?

Module 3: Stages of Treatment and Core Processes

The different stages of change and types of treatment that are helpful at each stage.

Stages of Treatment and Core Processes

Attempting to make changes that involve failure can cause low self-esteem. Every time you make a plan and are unable to achieve success, it only reinforces negative thoughts and poor self-image.

Most people relapse when trying to change behavior. Perhaps you can understand and see why change comes in steps…

The Stages of Change

The Stages of Treatment

The Stages of Change The Stages of Treatment Pre-contemplation Engagement Contemplation Persuasion Preparation Persuasion Action Active Treatment

Peer Support Specialists are trained clients who have achieved a high level of personal recovery and who are working in the Mental Health and/or Addictions System. They are able to reach and support other clients struggling with their own recovery through identification. Peer Support services are an integral part of the recovery process based on “I’ve been where you are and recovery is possible” connections with clients.

Putting it together . . .

What are some things you could do to engage a client during the engagement stage of treatment?

During the persuasion stage of treatment what might be some possible exploratory questions that you could ask a client?

What would be some possible components of a relapse prevention plan?

Module 4: Motivational Interviewing

Motivational interviewing is a client-centered counseling style for eliciting

behavior change by helping clients to explore and resolve ambivalence.

Motivational Interviewing uses some special techniques to identify clients’ motivation and goals. The helping professional expresses empathy, develops discrepancy, avoids arguments, rolls with resistance, instills self-efficacy and offers hope.

Technique 1: Express Empathy

Technique 2: Develop Discrepancy

Technique 3: Avoid Argumentation

Technique 4: Roll with Resistance

Technique 5: Instill Self-Efficacy and Hope

True empathy is expressed by allowing clients the grace and space to be where they are at each moment in his or her treatment journey.

Putting it together .

. . What makes motivational interviewing so different?

Do you have a client who would benefit from motivational interviewing? If so, how?

In Conclusion…

“Treatment in a parallel and separate mental health system

and a separate substance abuse treatment system…

is remarkably ineffective” ≈

Drake and colleagues