What if managing both substance use and mental health issues could be made less overwhelming? Tune in as we uncover the secrets to effective treatment interventions for co-occurring disorders, also known as dual diagnoses. We promise you'll gain valuable insights into why a comprehensive approach is crucial and how key techniques—like building a robust therapeutic alliance and using motivational interviewing—can make a significant difference. Visual analogies help simplify the complexity of dual diagnoses, while we also spotlight the importance of unconditional positive regard. Plus, discover how contingency management can guide clients towards positive behavior changes through rewards.
As we conclude this thought-provoking discussion, we take a moment to honor the dedication it takes to dive into such intricate topics. Reflect on your hard work and allow yourself a moment of gratitude and encouragement. Whether you're a regular listener or tuning in for the first time, we want to remind you that perseverance leads to understanding and success—it's always within reach. So take a bow for your commitment and join us in celebrating the small victories on this journey. Thank you for being part of this conversation, and remember, your efforts are truly appreciated.
If you need to study for your national licensing exam, try the free samplers at: LicensureExams
This podcast is not associated with the NBCC, AMFTRB, ASW, ANCC, NASP, NAADAC, CCMC, NCPG, CRCC, or any state or governmental agency responsible for licensure.
What if managing both substance use and mental health issues could be made less overwhelming? Tune in as we uncover the secrets to effective treatment interventions for co-occurring disorders, also known as dual diagnoses. We promise you'll gain valuable insights into why a comprehensive approach is crucial and how key techniques—like building a robust therapeutic alliance and using motivational interviewing—can make a significant difference. Visual analogies help simplify the complexity of dual diagnoses, while we also spotlight the importance of unconditional positive regard. Plus, discover how contingency management can guide clients towards positive behavior changes through rewards.
As we conclude this thought-provoking discussion, we take a moment to honor the dedication it takes to dive into such intricate topics. Reflect on your hard work and allow yourself a moment of gratitude and encouragement. Whether you're a regular listener or tuning in for the first time, we want to remind you that perseverance leads to understanding and success—it's always within reach. So take a bow for your commitment and join us in celebrating the small victories on this journey. Thank you for being part of this conversation, and remember, your efforts are truly appreciated.
If you need to study for your national licensing exam, try the free samplers at: LicensureExams
This podcast is not associated with the NBCC, AMFTRB, ASW, ANCC, NASP, NAADAC, CCMC, NCPG, CRCC, or any state or governmental agency responsible for licensure.
Stacy:
Hello and welcome to our Licensure Exams podcast. I'm Stacey Frost and I'm here with my co-host, dr Linton Hutchinson.
Linton:
Hey there everyone. A big shout out to all our amazing therapists in New York. We saw a surge of New York listeners last week, so it looks like a bunch of you are gearing up to take your licensure exam. So good luck to all of you and remember it's in there.
Stacy:
Yep exam. So good luck to all of you and remember it's in there, yeah, in this episode of our demystifying disorders series, we'll be taking a look at treatment interventions for co-occurring disorders, which are also called dual diagnoses, and this term is used when the client has both a substance use disorder and a mental health concern.
Linton:
That's right. The treatment approach for co-occurring disorders is a wee bit different than the methodology you would use when treating someone who only has a substance use disorder or only has a mental health concern. When someone is struggling with co-occurring disorders, it's like trying to solve a puzzle with multiple layers. You can't just focus on one piece and expect the whole picture to come together. It's like trying to solve a puzzle with multiple layers. You can't just focus on one piece and expect the whole picture to come together. It's a complex situation that requires a comprehensive approach, tackling both conditions at the same time.
Stacy:
Now, if I know you, like I think you do, linton, you've probably got a great visual analogy for this one, don't you?
Linton:
If I can remember what it is. But yes, dear yes. Imagine your client is on a journey and they are carrying two heavy bags. One is filled with mental health challenges and the other one with substance abuse issues. The treatment you provide is like a guide that helps the client learn how to manage and juggle the weight of both bags, at the same time teaching them the skills and the strategies to cope with the psychiatric symptoms without relying on substance use, which would end up making their load even that much heavier. By having your client address both issues hand in hand, they can start to find a balance and work towards a healthier, more stable state of wellbeing. It's challenging, but with the right support and tools provided by you, your client can make progress and find a way forward.
Stacy:
That's right, and it's really important to understand that there's no one-size-fits-all treatment plan for clients with co-occurring disorders. Every client is going to have a different set of needs. Typically, though, individual therapy is recommended for the mental health issues and group therapy is often recommended for the substance use issues. Once your client has been stabilized, treatment may be in an outpatient or an inpatient setting, and families may be involved at the client's discretion. For example, they might be invited to counseling and provided with psychoeducation.
Linton:
So Stacey. What are some of the evidence-based interventions recommended for treating co-occurring disorders? Exam makers go ape for anything that is evidence-based.
Stacy:
You mean like your love for extra wasabi on your dragon rolls from Publix?
Linton:
Nice try, Stacey. Are you sure Publix isn't sponsoring us?
Stacy:
Ah, Linton, dream on, dream on. I don't think getting free sushi for life is in our future.
Linton:
Oh God, wouldn't that be neat. I'd really like that.
Stacy:
I would too, yeah really so.
Linton:
What are some of the evidence-based interventions? Stace.
Stacy:
Okay, so first, a strong therapeutic alliance. This is one of the most important tasks when you're starting work with a client who has any kind of mental health concern, and it's especially important when you're working with co-occurring disorders, because clients who are struggling with addiction often feel judged and shamed and they might have experienced negative reactions from loved ones and peers because of their substance use and, as a result, they expect therapists to probably also have that judgmental mindset.
Linton:
Yeah, I can see that.
Stacy:
So it's extremely important yeah, it's extremely important for therapists, when working with dual diagnosis clients, to demonstrate unconditional positive regard. Judgment about a client's addictive behavior is going to quickly deteriorate trust and rupture that therapeutic relationship. So leave your biases and your preconceived notions about what your client is going through at the door.
Linton:
Right. Well, you know, when it comes to helping any client that has co-occurring disorders, motivational interviewing is another really powerful, evidence-based intervention. It's like having a heart-to-heart conversation with someone who's standing at a crossroads, unsure of which path to take. Imagine you've been diagnosed with a mental health condition and a substance use disorder. You might feel torn. Part of you wants to make a change, but another part is still resistant. That's where motivational interviewing comes in.
Linton:
If you don't know already, motivational interview is a method that helps clients navigate that ambivalent feelings about making any kind of change. It's not about trying to force them to do something they're not ready, for example. Instead, it's about creating a safe space for them to explore their goals and what they truly want for themselves. Okay, through using motivational interviewing, through this process, clients can start to clarify their priorities and start to basically find the motivation within themselves to engage in the change process all the resistance that they have and it helps them to take those first steps towards managing their illness and providing and improving their well-being. Motivational interviewing can be a real, effective tool in empowering them to take charge of their own recovery, and that's actually what you want.
Stacy:
Exactly. Contingency management is another approach to consider, and it's a behavioral approach based on the concept of operant conditioning. Remember learning about BF Skinner's experiments with rats? That is what we're talking about here. Contingency management provides rewards and incentives for desired behavior, like abstinence from drugs. Now, Linton, this reminds me of a story.
Linton:
What Didn't?
Stacy:
your parents put you in a Skinner box in the 50s.
Linton:
Have you been talking to my sister?
Stacy:
Yes, we've had some very interesting conversations. I'll bet.
Linton:
But no, they never did that. They did put me in a straitjacket to keep me in a crib, but I still remember it to this day. I can remember right now trying to free my tiny little hands and feet as a baby. But it's a world apart from a Skinner box, stacey.
Stacy:
Somehow I get the feeling it may have had the same effect.
Linton:
Watch it. We're talking about interventions for co-occurring disorders, not me and my childhood Houdini skills.
Stacy:
All right, all right, fair enough, linton. Back to interventions.
Linton:
All right, all right. Well, as they say, an ounce of prevention is worth a pound of cure. Work with your client to develop a relapse prevention plan that could include self-care goals, techniques to deal with urges and cravings to use drugs, and a list of people who can be contacted when your client feels the urge to use or does end up using.
Stacy:
That's a good one. Psychoeducational classes can also be helpful, and these provide information about disorders and symptoms, relapse prevention, like we're talking about HIV and AIDS prevention and other high-risk behaviors that are associated with co-occurring disorders.
Linton:
Medication may be used in certain cases to stabilize the client. Is that something that you would suggest as a therapist, Stacey?
Stacy:
Ah, here's the tricky one that flubs people up. Remember, making recommendations for medications is outside of your scope of practice, so leave that to Linton.
Linton:
The psychiatrist or the MD. You, as the therapist, may consult with the psychiatrist or prescribing physician and describe your client's symptoms. If medication is warranted, you can help the client adhere to the medication regime. Just remember, like Stacey just said, it's outside the scope of your practice to make recommendations for medications to the client. Leave that to the folks wearing the white coats.
Stacy:
Right, and the last intervention we'll touch on is geared towards strengthening the client's support network. Recovery programs try to emphasize the importance of strong, positive support systems. Support groups such as those based on the 12-step model, like Alcoholics Anonymous or Narcotics Anonymous, can also be invaluable.
Linton:
What if the client has really really severe mental concerns, stacey like schizophrenia, or bipolar 1 disorder?
Stacy:
Okay. So for clients with serious mental health conditions, coordination with a multidisciplinary team is really essential, and there's a few different options you can go with here. Assertive community treatment is an approach in which a multidisciplinary team shares caseloads and provides direct services to clients. The team's intention is to help meet basic needs like housing, stabilize the client in their community and ensure that the client receives treatment for substance abuse and mental health. Intensive Case Management is another treatment model where an individual case manager keeps a low caselo load so they can provide more intensive and consistent services for clients, and the intention is to link and coordinate services for clients.
Stacy:
And then we have residential treatment programs, and these are facilities where the client both lives in and receives treatment in the same place. Residential treatment can happen in a variety of settings short-term or long-term, like 12 months or more, halfway houses, which are transitional living spaces, and institutions that are part of the criminal justice system, and they're typically used to treat clients with substance abuse issues who are involved in the criminal justice system. All right, Linton, how about a quick summary of the interventions we've talked about as we wrap up this episode? Okay, this is what you quick summary of the interventions we've talked about as we wrap up this episode.
Linton:
Okay, this is what you should take away from everything we've talked about. Co-occurring disorders require the integrated treatment of both the substance use disorder and mental health disorder simultaneously. The goal is to help clients manage psychiatric symptoms without using substances. Again, there is a not one-size-fits-all treatment approach. Individual and group therapies are commonly used, and families may be involved. So as you prepare for your exam, you'll need to read the client's case study very carefully to determine what techniques that should be used. So important treatment elements include establishing a strong therapeutic alliance and demonstrating unconditional positive regard. Using motivational interviewing to build motivation for change, applying contingency management techniques to reinforce positive behaviors, develop a relapse prevention plan, provide psychoeducation about disorders and strengthen the client's support system. For clients with severe mental health concerns, it's important to coordinate with a multidisciplinary team, using assertive community treatment, intensive case management or residential treatment facilities.
Stacy:
Boy, that was a mouthful. Thank you, it was, you're welcome.
Linton:
Take a breath. Take a breath, boy. That was a mouthful. Thank you, it was.
Stacy:
You're welcome. Take a breath. Take a breath and take a bow.
Linton:
I will.
Stacy:
And thank you to all of our listeners out there for tuning in today and good luck studying and, as we always say, remember it's in there.
