300 Special Series -Counseling People with Co-Occurring Disorders SAMHSA TIP 42 Part 6

Summary: Treatment of Persons with Co-Occurring Disorders Based on SAMHSA TIP 42 Part 6 Host: Dr. Dawn-Elise Snipes Executive Director: AllCEUs Counselor Education Podcast Host: Counselor Toolbox and Addiction Counselor Exam Review Objectives ~ Identify essential programming for clients with COD ~ Explore modifications for clients with COD ~ Identify components in successful implementation of programming Essential Programming for Clients With COD ~ Screening, Assessment, and Referral ~ Physical and Mental Health Consultation ~ Prescribing Onsite Psychiatrist ~ Medication and Medication Monitoring ~ Mental Health and Substance Use Disorders ~ Relapse Prevention ~ Psychoeducational Classes ~ Double Trouble Groups (Onsite) ~ Dual Recovery Mutual Self-Help Groups (Offsite) Design and Implementation ~ Designing Outpatient Programs for Clients With COD ~ Group work and modifications ~ Individual work and modifications ~ Recovery support ~ Case management ~ Implementing Outpatient Programs ~ Evaluating Outpatient Programs ~ Sustaining Outpatient Programs Design ~ The population of persons with COD is heterogeneous in terms of motivation for treatment, nature and severity of substance use disorder (e.g., drug of choice, abuse versus dependence, polysubstance abuse), and nature and severity of mental disorder Individual Counseling ~ Variety of approaches ~ Culturally responsive ~ Trauma informed ~ Regularly scheduled ~ Guided by the treatment plan ~ Problem: Depression ~ Goal 1: To self report a mood of 3 or above 6 out of 7 days ~ Objective 1A: Learn about the causes of depression ~ Objective 1B: Identify my symptoms of depression and what might be causing them ~ Objective 1C:… Group Work ~ Working in Groups ~ Group therapy should be augmented by individual counseling ~ Reduce the emotional intensity of interpersonal interaction in COD group sessions ~ Because many clients with COD often have difficulty staying focused ~ Treatment groups usually need stronger direction from staff ~ Group or activity running for no more than 40 minutes. ~ Because of the need for stability, the groups should run regularly and without cancellation ~ In early recovery psychoeducational groups are usually more beneficial (Relapse prevention, PAWS, CBT/DBT Tools…) Groups ~ Because many clients with COD have difficulty in social settings, group sizes may need to be smaller ~ Co-leaders are especially important in these groups, as one leader may need to leave the group with one member ~ Considerable tolerance is needed for varied (and variable) levels of participation depending on the client's level of functioning, stability of symptoms, response to medication, and mental status ~ Affirmation of accomplishments should be emphasized over disapproval or sanctions. ~ Negative behavior should be amended rapidly with a positive learning experience designed to teach the client a correct response to a situation Medication Management ~ Medication Assisted Therapy ~ Opiates ~ Alcohol ~ Nicotine ~ Management of acute and post-acute withdrawal symptoms ~ Psychopharmacology Primary Care ~ Consults or referrals to rule out mood or pain issues caused by ~ Autoimmune disorders (Fibro, Chron’s etc) ~ Liver or kidney issues ~ Diabetes ~ Sex or thyroid hormone issues (Including Low T, PMDD and hypo or hyper thyroid) ~ STDs ~ HIV ~ Musculoskeletal issues Family Education ~ Particularly in cultures that value interdependence and are community and/or family-oriented, a family and community education and support group can be helpful ~ Programs must provide this instruction in an interactive style that allows questions, not in a lecture mode. The essentials of this information include: ~ The name of the disorder ~ Its symptoms, prevalence, cause ~ How it interacts with substance abuse—that is, the implications of having both disorders ~ Treatment options and considerations in choosing the best treatment ~ The likely course of the illness ~ Programs, resources, and individuals who can be he