Treatment of Persons with Co-Occurring Disorders
Based on SAMHSA TIP 42 Parts 1&2
Host: Dr. Dawn-Elise Snipes
Executive Director: AllCEUs Counselor Education
Podcast Host: Counselor Toolbox and Addiction Counselor Exam Review
Objectives
~ Define Co-Occurring Disorders
~ Review the relevance of co-occurring disorders research to clinical practice
~ Familiarize with the following terms: Substance Use Disorders, Mental Disorders, Compulsive Behaviors/Behavioral Addictions, Treatment Programs, Systems
~ Co-Occurring Disorders means that the person has a substance use or addictive disorders AND a concurrent mental health issue that is not attributable to the effects of intoxication or withdrawal
~ What challenges do clients with co-d present in treatment settings? To clinicians?
~ Co-Occurring Disorders
~ Create multiple treatment issues
~ Impact treatment due to varying course of both disorders
~ Models and strategies for addressing co-d
Prevalence
~ An estimated 10 million Americans have COD in any given year
~ Using only DSM criteria
~ Not including nicotine addiction or eating disorders
~ COD are the expectation, not the exception
~ People with COD are more likely to be hospitalized
~ Rates of mental health issues increase as the rate or substance use disorders increases
Principles of COD Treatment
~ No Wrong Door
~ Mutual Self-Help
~ Integrated care
~ Individualized approaches including
~ Psychotherapy
~ Medication Assisted Therapy
~ Peer Support
~ Community Based Resources
Mood Disorders
~ Anxiety
~ Social
~ Generalized
~ Depression
~ Persistent Depressive Disorder
~ Major Depression
~ Bipolar Disorder
~ Mania or Hypomania plus Depression or PDD
Other Non-Personality Disorders
~ ADD/ADHD
~ Autism Spectrum Disorders
~ PTSD
~ Schizophrenia
~ Alcohol Induced Dementia (Wernicke-Korsakoff’s Syndrome)
~ Obsessive Compulsive Disorder
~ Issues w/Dementia
~ Age-Related Dementia
~ Alzheimer’s Disease
~ Parkinson’s Disease
Personality Disorders
~ Cluster A
~ Odd or Eccentric Behavior
~ Paranoid, schizoid, schizotypal
~ Cluster B
~ Dramatic, Emotional or Erratic Behavior
~ Antisocial, borderline, histrionic, narcissistic
~ Cluster C
~ Anxious, fearful behavior
~ Avoidant, dependent, obsessive-compulsive
Addictive Disorders
~ In the DSM V
~ Substances
~ Gambling
~ Internet Gaming Disorder (of interest)
~ NOT in the DSM
~ Sex addiction
~ Pornography addiction
~ Shopping addiction
~ Eating disorders and food related issues are not considered addictions
Criteria for Addiction
~ Use for longer than intended
~ Spending more money than intended
~ Failed efforts to quit or cut down
~ Giving up important activities
~ Development of a tolerance
~ Physiological or psychological withdrawal
~ Negative consequences in one or more areas of life related to the addiction
ASAM Levels of Care
Quadrants of Care
Recovery Oriented System of Care
~ Comprehensive Continuous Integrated System of Care
~ What types of services would be needed here?
~ Substance Use
~ Mental Health
~ Medical
~ Pain Management
~ Parenting
~ Financial
~ Occupational/Educational
~ Case management
Summary
~ Co-Occurring Disorders Treatment means providing concurrent services to meet the mental health as well as addiction needs of individuals
~ Co-Occurring Disorders treatment recognizes the reciprocal impact of each disorder on the other
~ Overlooking the MH or SAB in diagnosis or treatment sets a person up for relapse