Co-Occurring Disorders: Integrated Treatment Overview

1. Integrating Treatment for Co-Occurring Disorders Brought to you by:

2. Presented By

3. Today’s Presenters Cynthia Moreno Tuohy Executive Director NAADAC, The Association for Addiction Professionals Misti Storie Education and Training Consultant NAADAC, The Association for Addiction Professionals

4. Today’s Presenters Mary Woods, RNC, LADC, MSHS Chief Executive Officer Westbridge Community Services Tim Sheehan, Ph.D. Director of Institutional Effectiveness Hazelden Graduate School of Addiction Studies

5. Web Conference Objectives • Discuss the prevalence of co-occurring disorders in substance abuse treatment programs

6. Web Conference Objectives • Discuss the prevalence of co-occurring disorders in substance abuse treatment programs • Contrast co-occurring treatment with traditional addiction treatment

7. Web Conference Objectives • Discuss the prevalence of co-occurring disorders in substance abuse treatment programs • Contrast co-occurring treatment with traditional addiction treatment • Give a rationale for integrated treatment

8. Web Conference Objectives • Discuss the prevalence of co-occurring disorders in substance abuse treatment programs • Contrast co-occurring treatment with traditional addiction treatment • Give a rationale for integrated treatment • List instruments helpful for screening

9. Web Conference Objectives • Discuss the prevalence of co-occurring disorders in substance abuse treatment programs • Contrast co-occurring treatment with traditional addiction treatment • Give a rationale for integrated treatment • List instruments helpful for screening • Describe evidence-based therapies helpful in treating co-occurring disorders

10. Web Conference Objectives • Discuss the prevalence of co-occurring disorders in substance abuse treatment programs • Contrast co-occurring treatment with traditional addiction treatment • Give a rationale for integrated treatment • List instruments helpful for screening • Describe evidence-based therapies helpful in treating co-occurring disorders • Access new training programs available through NAADAC and Hazelden

11. Part One: Introduction to Co-occurring Disorders

12. Scope of Practice An Addiction Professional’s scope of practice varies with education, training and state requirements. With over 300 people on line today, each practitioner should keep his or her scope of practice in mind as we conduct this presentation.

13. DEFINING CO-OCCURRING DISORDERS • 50 to 75% of all clients who are receiving treatment for a substance use disorder also have another diagnosable mental health disorder. • Further, of all psychiatric clients with a mental health disorder, 25 to 50% of them also currently have or had a substance use disorder at some point in their lives.

14. Defining Co-occurring Disorders • Co-morbidity of Substance Use and Psychiatric Disorders Among a sample of about 10,000 adults: • 13.5% had an alcohol use disorder. Of those, 36.6% also had a psychiatric disorder. • 6.1% had a drug use disorder. Of those, 53.1% also had a psychiatric disorder. • 22.5% had a psychiatric disorder. Of those, 28.9% also had an alcohol or drug use disorder. Source: Regier et al. 1990

15. Defining Co-occurring Disorders • Psychiatric Disorders in Addiction Treatment • Two studies of Prevalence rates in addiction treatment settings had similar findings. Persons with substance use disorders are also like to have mood and anxiety disorders. Source: Cacciola et al, 2001; Ross, Glaser and Germanson 1988

16. Defining Co-occurring Disorders Addiction Treatment Provider Estimates by Psychiatric Disorder

17. Defining Co-occurring Disorders • Mental health disorder (MHD): • significant and chronic disturbances with “feelings, thinking, functioning and/or relationships that are not due to drug or alcohol use and are not the result of a medical illness”22 • Social phobia • Borderline personality disorder • Posttraumatic stress disorder • Bipolar disorder • Major depressive disorder • Schizophrenia • Obsessive-compulsive disorder

18. Defining Co-occurring Disorders • Substance use disorder (SUD): • a behavioral pattern of continual psychoactive substance use that can be diagnosed as either substance abuse or substance dependence

19. Defining Co-occurring Disorders • Co-occurring disorders (COD): • the simultaneous existence of “one or more disorders relating to the use of alcohol and/or other drugs of abuse as well as one or more mental [health] disorders.”18

20. Severity of Co-occurring Disorders • Co-occurring mental health disorders are often placed on a continuum of severity. • Non-severe: early in the continuum and can include mood disorders, anxiety disorders, adjustment disorders and personality disorders. • Severe: include schizophrenia, bipolar disorder, schizoaffective disorder and major depressive disorder.

21. Severity of Co-occurring Disorders • The classification of “severe and non-severe” is based on a specific diagnosis and by state criteria for Medicaid qualification but can vary significantly based on severity of the disability and the duration of the disorder.

22. Quadrants of Care

23. Part Two: What is Co-occurring Treatment and How is It Different fromTraditional Addiction Treatment?

24. Models of Treatment • Clients with co-occurring disorders have historically received substance abuse treatment services in isolation from mental health treatment services. • As more research on co-occurring disorders began to be conducted, the many limitations this approach places on the client and his or her success in treatment began to surface.

25. Models of Treatment • A twenty-eight year-old-woman named Anita entered an addiction treatment center where she was assessed as having alcohol dependence. Six months earlier, Anita had been diagnosed with major depressive disorder and was prescribed medication by her family doctor. At the treatment facility, it was recommended that Anita be re-assessed and treated, if necessary, at a mental health clinic, located nearby in town. What model of treatment does this scenario represent? • single model of treatment • sequential model of treatment • parallel model of treatment • integrated model of treatment

26. Models of Treatment • Single model of care - It was believed that once the “primary disorder" was treated effectively, the client’s substance use problem would resolve itself because drugs and/or alcohol were no longer needed to cope. • Sequential model of treatment - acknowledges the presence of co-occurring disorders but treats them one at a time. • Parallel model of treatment - mental health disorders are treated at the same time as co-occurring substance use disorders, only by separate treatment professionals and often at separate treatment facilities.

27. Integrated Model of Treatment Integrated model of treatment • an approach to treating co-occurring disorders that utilizes one competent treatment team at the same facility to recognize and address all mental health and substance use disorders at the same time.

28. Integrated Model of Treatment • The integrated model of treatment can best be defined by following seven components: • Integration

29. Integrated Model of Treatment • The integrated model of treatment can best be defined by following seven components: • Integration • Comprehensiveness

30. Integrated Model of Treatment • The integrated model of treatment can best be defined by following seven components: • Integration • Comprehensiveness • Assertiveness

31. Integrated Model of Treatment • The integrated model of treatment can best be defined by following seven components: • Integration • Comprehensiveness • Assertiveness • Reduction of negative consequences

32. Integrated Model of Treatment • The integrated model of treatment can best be defined by following seven components: • Integration • Comprehensiveness • Assertiveness • Reduction of negative consequences • Long-term perspective

33. Integrated Model of Treatment • The integrated model of treatment can best be defined by following seven components: • Integration • Comprehensiveness • Assertiveness • Reduction of negative consequences • Long-term perspective • Motivation-based treatment

34. Integrated Model of Treatment • The integrated model of treatment can best be defined by following seven components: • Integration • Comprehensiveness • Assertiveness • Reduction of negative consequences • Long-term perspective • Motivation-based treatment • Multiple psychotherapeutic modalities

35. Benefits of an Integrated Model of Care • Benefits of an Integrated Model of Care • Reduced need for coordination

36. Benefits of an Integrated Model of Care • Benefits of an Integrated Model of Care • Reduced need for coordination • Reduced frustration for clients

37. Benefits of an Integrated Model of Care • Benefits of an Integrated Model of Care • Reduced need for coordination • Reduced frustration for clients • Shared decision-making responsibilities

38. Benefits of an Integrated Model of Care • Benefits of an Integrated Model of Care • Reduced need for coordination • Reduced frustration for clients • Shared decision-making responsibilities • Families and significant others are included

39. Benefits of an Integrated Model of Care • Benefits of an Integrated Model of Care • Reduced need for coordination • Reduced frustration for clients • Shared decision-making responsibilities • Families and significant others are included • Transparent practices help everyone involved share responsibility

40. Benefits of an Integrated Model of Care • Benefits of an Integrated Model of Care • Reduced need for coordination • Reduced frustration for clients • Shared decision-making responsibilities • Families and significant others are included • Transparent practices help everyone involved share responsibility • Clients are empowered to treat their own illness and manage their own recovery

41. Benefits of an Integrated Model of Care • Benefits of an Integrated Model of Care • Reduced need for coordination • Reduced frustration for clients • Shared decision-making responsibilities • Families and significant others are included • Transparent practices help everyone involved share responsibility • Clients are empowered to treat their own illness and manage their own recovery • The client and his/her family has more choice in treatment, more ability for self-management, and a higher satisfaction with care

42. One disorder does not necessarily present as “primary.” There isn’t necessarily a causal relationship between co-occurring disorders. These are co-occurring brain diseases that need to be treated simultaneously. Co-occurring Disorders Interactions An integrated model of care assumes that:

43. SCREENING AND ASSESSMENT Screening: The first phase of evaluation where the potential client is interviewed to determine if he or she is appropriate for that specific treatment facility and to determine the possible presence or absence of a substance use or mental health problem.

44. SCREENING AND ASSESSMENT Assessment: The second phase of evaluation where a systematic interview is necessary to verify the potential presence of a mental health or substance use disorder detected during the screening process.

45. SCREENING AND ASSESSMENT Complexities of Screening and Assessment • Intoxication • Withdrawal • Substance-induced disorders • Motivational factors • Feelings, symptoms, and disorders

46. Co-occurring Disorders Interactions Substances and Negative Emotions

47. SCREENING AND ASSESSMENT • The choice of screening measures depends on: • The skill of the screening professional • The cost of the screening materials • How simple the scale is to interpret and use across disciplines • Psychometric qualities • The relevance of screening to prevalent disorders • Movement from very sensitive (generic) measures to more specific measures

48. SCREENING AND ASSESSMENT • Integrated Assessment Process – 12 Steps • Engage the Client

49. SCREENING AND ASSESSMENT • Integrated Assessment Process – 12 Steps • Engage the Client • Identify and Contact Collaterals

50. SCREENING AND ASSESSMENT • Integrated Assessment Process – 12 Steps • Engage the Client • Identify and Contact Collaterals • Screen for and Detect Co-occurring Disorders