Integrated Dual Diagnosis Treatment

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Integrated Dual Diagnosis Treatment

• CLINICAL ELEMENTS

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Integrated Treatment

• Core Components
• Integration of Services
• Comprehensiveness
• Assertiveness
• Reduction of Negative consequences
• Long-Term Perspective
• Motivation-Based Treatment
• Multiple Psychotherapeutic Modalities

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CORE COMPONENTS
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Integration of Services

• When providing IDDT, one wants to provide
  services for both mental illness and substance
  abuse simultaneously
• These services should be provided by the same
  clinician(s) or team within the same organization
• Helps to avoid gaps of service delivery
• Helps to ensure that both types of disorders are
  treated effectively

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Comprehensiveness

• IDDT attempts to provide services directed not
  only at the problems of substance abuse and
  mental illness, but also the broad array of other
  areas of functioning that are frequently impaired
  in the lives of the dually diagnosed client
• Housing -Vocational Functioning
• Family/Social relationships
• Ability to manage psychiatric illness

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Assertiveness

• This addresses the location of service provision
  and how a client is engaged in treatment
• Effective treatment programs for the dually
  diagnosed client does not wait for often
  reluctant clients seeking treatment on their own
• Effective treatment programs use assertive
  outreach and legal mechanisms to involve the
  client in treatment

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Reduction of Negative Consequences

• This is the philosophical dimension of integrated
  treatment
• Due to the damaging impact dual disorders have on
  the lives of clients, the first and foremost goal
  of the clinician is to reduce harmful effects
• Do this without judging or imposing your personal
  values on the client regarding the causes or the
  moral responsibility for the consequences

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Long-Term Perspective

• This addresses the need for time-unlimited
  services

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Motivation-Based Treatment

• This orients the clinician as to specific
  interventions to use depending of the clients
  desire to change their behavior
• This avoids unnecessary and potentially
  destructive conflict between the client and
  clinician
• This helps to maximize treatment gains through
  collaborative work

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Multiple Psychotherapeutic Modalities

• Provide psychological treatment services for the
  dually diagnosed client in as many formats as are
  needed (and several usually are)
• Individual
• Group
• Family Therapy Modalities

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STAGES
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Motivation

• IDDT is a STAGE BASED approach to treatment
• In order to most effectively treat the dually
  disordered client, interventions must by
  MOTIVATION BASED
• Adapted to clients motivation for change
• Stages of treatment is CENTRAL, it provides a
  framework for assessing the clients
• Motivational states -Setting goals
• Selecting interventions appropriate to achieving
  those goals

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Stages of Treatment

• 4 stages
• Engagement
• Persuasion
• Active Treatment
• Relapse Prevention

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Stages of Treatment vs. Stages of Change

• Stages of Treatment Stages of Change
• Engagement Precontemplation
• Persuasion Contemplation
• Preparation
• Active Treatment Action
• Relapse Prevention Maintenance

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Stages of Treatment

• IDDT uses Stages of Treatment because it is
  specific to changes that occur over the course of
  treatment for clients who experience dual
  disorders

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Stages of Treatment

• Engagement
• Definition
• The client does not have regular contact with
  their dual diagnosis clinician
• Goal
• Establish a working alliance with the client

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Engagement Interventions

• Outreach
• Practical assistance (food, clothing, housing,
  benefits, transportation, medical care)
• Crisis intervention
• Stabilization of psychiatric symptoms (medication
  management)
• Help in avoiding legal penalties
• Help with arranging visitation with family or
  family meetings
• Support and assistance to social networks

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Stages of Treatment

• Persuasion
• Definition
• The client has regular contact with the
  clinician, but doesnt want to work on reducing
  their substance use/abuse
• Goal
• To develop the clients awareness that substance
  use is a problem and increase their motivation to
  chabnge

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Persuasion Interventions

• Motivational Interviewing
• Peer Groups (persuasion groups)
• Social skills training (for non-substance related
  situations)
• Individual and family education
• Psychological preparation for lifestyle changes
  necessary to achieve remission
• Sampling constructive social and recreational
  activities
• Safe damp housing

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Stages of Treatment

• Active Treatment
• Definition
• The client is motivated to reduce their substance
  use, as indicated by a reduction for at least 1
  month, but less than 6 months
• Goal
• To help the client further reduce their substance
  use and, if possible, attain abstinence

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Active Treatment Interventions

• Social skills training to address
  substance-related situations
• Peer groups (active treatment groups)
• Self-help groups (12 step, RR, DRA)
• Individual Cognitive-Behavioral counseling
• Psycho-education
• Stress management and coping skills
• Family and individual problem solving

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Stages of Treatment

• Relapse Prevention
• Definition
• The client has not experienced problems related
  to substance use for at least 6 months (or is
  abstinent)
• Goal
• To maintain awareness that relapse can happen and
  to extend recovery to other areas (social
  relationships, work)

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Relapse Prevention Interventions

• Expanding involvement in supported or independent
  employment
• Groups (active treatment or relapse prevention,
  12-step, DRA, RR)
• Social skills training
• Family problem solving
• Lifestyle improvements (smoking cessation, diet,
  exercise, stress management techniques)
• Independent housing

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IDDT

• As seen, IDDT is COMPREHENSIVE
• It is also FLEXABLE
• You do need
• To use a stage based approach to treatment
• To use Cognitive Behavioral treatment
• To select what you have a capacity to do based on
  how you prioritize FIDELITY components of the
  model and what you as an agency or institution
  are able to do

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SPECIFIC TOOLS

• Differential Diagnosis
• Payoff Matrix
• Formulation

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Learning Curve of the Staff

• There was in our case initial resistance
• Use of the Payoff Matrix offered face validity,
  with it staff members were more willing to try
  and use various tools of IDDT
• It is important to practice, practice, practice
  the tools
• In order to make IDDT work, you need consistent
  and appropriate supervision/consultation to help
  to improve staffs ability to use the tools and
  to acquire the skills required to effectively
  implement IDDT

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Benefits of Using the Tools

• Appropriate treatment for dually diagnosed
  clients
• IDDT helps to meet the client where they are in
  their specific stage of recovery
• IDDT helps to improve outcomes for treatment
• This helps to motivate the clienty to continue to
  engage in treatment

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Benefits of Using the Tools (contd)

• Using IDDT helps make staff feel more successful
  and improves their motivation to work with this
  population previously seen as unrewarding
• The IDDT tools have broad applicability and
  generalizability beyond the dually diagnosed
  population
• Using IDDT helps to instill hope
• Hope for the clients, hope for the staff