Integrated Treatment for Co-Occurring Disorders

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1 Integrated Treatment for Co-Occurring Disorders An Evidence-Based Practice Tiffany Parkhouse, MA Cindy Peterson, MS Community Solutions, Inc Training and Resource Center

2 Workshop Objectives Provide understanding of Evidence Based Practices for Co-Occurring Disorders (COD). Develop an understanding of coping skills training i approaches for working with COD. Develop strategies for cognitive restructuring with COD clients. 2

3 What Are Evidence-Based Practices? Services that have consistently demonstrated their effectiveness in helping people with mental illnesses achieve their desired goals Effectiveness was established by different people who conducted rigorous studies and obtained similar outcomes 3

4 Examples of Evidence-Based Practices Integrated Treatment for Co-Occurring Disorders Supported Employment Assertive Community Treatment Family Psychoeducation Illness Management and Recovery 4

5 Why Implement Evidence-Based Practices? According to the President s New Freedom Commission on Mental Health: State-of-the-art treatments, based on decades of research, are not being transferred from research to community settings 5

6 Why Implement Evidence-Based Practices? (continued) According to the President s New Freedom Commission on Mental Health: If effective treatments were more efficiently delivered through our mental health services system... millions of Americans would be more successful in school, at work, and in their communities Michael Hogan, Chairman 6

7 Activity Substance Use PROS CONS 7

8 Treatment is in a Stage-Wise Fashion Pre-contemplation TASK: Engagement Assertive outreach, practical help (housing, entitlements, other), and an introduction to individual, family, group, and self-help treatment formats Contemplation and Preparation TASK: Persuasion/Motivation Enhancement Education, goal setting, and building awareness of problem through motivational counseling Action TASK: Active treatment Counseling and treatment based on cognitive-behavioral techniques, skills training, and support from families and self-help groups Maintenance TASK: Relapse prevention Continued counseling and treatment based on relapse prevention techniques, skill building, and ongoing support to promote recovery 8

9 What Is Integrated Treatment for Co-Occurring Disorders? Integrated Treatment is a research-proven model of treatment for people with serious mental illnesses and co-occurring occurring substance use disorders d Consumers receive combined treatment for mental illnesses and substance use disorders from the same practitioner or treatment team. They receive one consistent message about treatment and recovery 9

10 Practice Principles for Integrated Treatment for Co-Occurring Disorders Mental health and Co-occurring occurring disorders substance abuse are treated in a stage-wise treatment are integrated fashion with different to meet the needs of services provided at people with co-occurring occurring different stages disorders Motivational interventions Integrated treatment are used to treat specialists are trained to consumers in all stages, treat both substance use but especially in the and serious mental persuasion stage illnesses 10

11 Practice Principles for Integrated Treatment for Co-Occurring Disorders Substance abuse Multiple formats for counseling, using a services are available, cognitive-behavioral including individual, approach, is used to treat group, self-help, and consumers in the active family treatment and relapse prevention stages Medication services are integrated and coordinated with psychosocial services 11

12 Treatment is Integrated Mental health and substance abuse treatment are evaluated and addressed Same team Same location Same time Treatment targets the individual needs of people with co-occurring occurring disorders and is integrated on organizational i and clinical i l levels l 12

13 Integrated Treatment Recovery Model Hope is critical Services and treatment goals are consumer- driven Unconditional respect and compassion for consumers is essential Integrated treatment specialists are responsible for engaging consumers and supporting their recovery 13

14 Integrated Treatment Recovery Model (continued) Focus on consumers goals and functioning, not on adhering to treatment Consumer choice, shared decision making, and consumer/family education are important 14

15 Integrated Treatment Recovery Model (continued) Integrated treatment is associated with the following positive outcomes: Reduced substance use Improvement in psychiatric symptoms and functioning; Decreased hospitalization Increased housing stability Fewer arrests and Improved quality of life -(Drake et al.,2001) 15

16 Cognitive Behavioral Treatment 2 Types of CBT Techniques COGNITIVE RESTRUCTURING Cognitive Skill Building 16

17 Cognitive Restructuring Based on the premise that offenders have learned destructive attitudes and thinking habits that point them to criminal i behavior. Cognitive restructuring consists of identifying the specific attitudes and ways of thinking that point to criminality i and systematically ti replacing them with new attitudes and ways of thinking. 17

18 Aaron Beck Developed Cognitive Therapy It is not a thing that makes us unhappy, but how we view things that make us unhappy. If we change our interpretation of things, we can change how we feel and act in the future. Goal: Identify and alter cognitive distortions that maintain symptoms 18

19 Albert Ellis Developed Rational Emotive Behavioral Therapy Core principles: People are the cause/solution of their own problems Responses to our emotional problems are within our control Confront irrational beliefs and replace with rational beliefs Goal: Change the thoughts that block people from attaining goals 19

20 ABC Model A = Activating Event B = Beliefs C = Emotional & Behavioral Consequences D = Disputation Healthy & Unhealthy feelings Productive & Unproductive behavior E = Effective New Strategy t 20

21 Disputation Techniques Core irrational beliefs: Absolutes, Inflexible, Rigid & Unconditional Dispute through the following questions: Is there any evidence for this belief? What is the evidence against this belief? What is the worst thing that can happen if you give up this belief? What is the best thing that can happen? 21

22 ABC EXAMPLE A = Girlfriend breaks up with me. B = NO ONE will ever care for me. C = Feelings: Sad, worthless, angry, disappointed, depressed Actions: Withdraw from others, drink/use D = Examine the evidence: I have some friends who care about me. I ve had girlfriends before and this feeling has gone away. There is hope. Coping in this way won t help in the long run. E = I might be loveable and things can improve. 22

Cognitive Skill Building Cognitive Skills training is

the thinking and behavioral skills required to function

This skill deficit is remedied by systematic training in

23 Cognitive Skill Building Cognitive Skills training is based on the premise that offenders have never learned the thinking and behavioral skills required to function productively and responsibly in society. This skill deficit is remedied by systematic training in skills such as problem solving, negotiation, anger control and social skills. 23

24 Cognitive Skill Steps 1. Define the skill 2. Establish trainee need 3. Model the skill 4. Select a role player 5. Set up role play 6. Conduct role play 7. Provide feedback 8. Assign homework 24

25 Tips for using CBT with COD Clients Use visual aids, including illustrations and concept mapping ( a visual presentation of concepts that makes patterns evident). Practice role preparation p and rehearse for unexpected circumstances. Provide specific in vivo feedback on applying principles and techniques. Use outlines for all sessions that list specific behaviorally anchored learning objectives. Test for knowledge acquisition. Make use of memory enhancement aids, including notes, tapes, and mnemonic devices. 25

26 Evidence Based CBT Curriculums for Substance Abusing Clients Treating Alcohol Dependence (TAD) 17 Skill based topics designed d to teach coping skills. Originally tested with alcohol abusers but has been generalized to all substances. Also beneficial i in working with COD clients. Cannabis Youth Treatment t (MET/CBT) Designed originally with marijuana abusing youth but generalized to youth who use any substances. bt :1 sessions focused on motivating clients (stage based) with 10 group sessions focusing on teaching coping skills both cognitive and behavioral. 26

27 Summary Integrated Treatment for Co-Occurring Disorders is effective in the recovery process for consumers with co-occurring occurring disorders The goal of this evidence-based practice is to support consumers in their recovery process In Integrated Treatment programs, the same practitioners, working in one setting, provide mental health and substance abuse interventions in a coordinated fashion Consumers receive one consistent message about treatment and recovery 27

28 Additional Resources For more information about Integrated Treatment for Co-Occurring Disorders and other evidence-based d practices, visit it 28

Integrated Treatment for Co-Occurring Disorders. An Evidence-Based Practice

Integrated Treatment for Co-Occurring Disorders An Evidence-Based Practice What Are Evidence-Based Practices? Services that have consistently demonstrated their effectiveness in helping people with mental