Co-Occuring Disorders C O U R T N E Y Y C A Z A , M A , L C A S , - - PowerPoint PPT Presentation

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

Co-Occuring Disorders

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

• f 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. 2nd Edition, 2003

 The ACA Encyclopedia of Counseling. ACA, 2009

Contact

 Courtney Ycaza  Courtney.ycaza@mcleodcenter.com