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Introduction to Co-Occurring Disorders

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					Introduction to
 Co-Occurring
   Disorders

                  1
         Learning Objectives
• Understand the goals of the training program
• Understand how to find information regarding
  co-occurring disorders (CODs) in TIP 42 and
  other sources
• Gain a beginning familiarity with COD
  terminology


                                            2
Take a Quick
Pre-Test




               3
Overall Goals of the Competency
        Training Program
• Acquaint participants with the basic principles of
  integrated treatment
• Educate clinicians re: how to provide the best care
  to clients with CODs within the context of their
  agencies
• Provide instruction on the basic competencies of co-
  occurring-capable care
• Teach “best practices” that have been found to be
  effective in working with clients who have CODs

                                                        4
Overall Goals of the Competency
    Training Program (cont.)
• Provide basic mental health orientation to substance
  use clinicians
• Provide basic addiction treatment orientation to
  mental health clinicians
• Equip clinicians with useful tools that can be used in
  their day-to-day work with clients who have CODs
• Provide feedback over the course of the program to
  clinicians as they put their new learning into practice



                                                        5
 SAMHSA’s Definition of CODs

The term refers to co-occurring substance
use (abuse or dependence) and mental
disorders. Clients said to have co-occurring
disorders have one or more mental disorders
as well as one or more disorders relating to
the use of alcohol and/or other drugs.
                     (COCE Overview Paper #1)


                                                6
 TIP 42: Substance Abuse Treatment for
  Persons With Co-Occurring Disorders

Reasons for its release:
• Availability of data
• Treatment innovations for
  other populations with CODs
• Changes in treatment
  delivery
• Advances in treatment
• Recent developments

                                     7
         Prevalence of CODs
• In 2002, 4 million adults met the criteria for both
  serious mental illness (SMI) and substance
  dependence and abuse.

• An estimated 10 million Americans of all ages
  and in both institutional and non-institutional
  settings have CODs in any given year.




                                                        8
                       Prevalence Among
                       Adult Populations
25%
                                                                                                          Serious Mental
                                                                                                          Illness with
20%                                                                                                       Substance Abuse
                                                                                                          Serious Mental
                                                                                                          Illness without
15%
                                                                                                          Substance Abuse
                                                                                                          Substance Abuse
10%                                                                                                       with Serious Mental
                                                                                                          Illness
                                                                                                          Substance Abuse
5%                                                                                                        without Serious
                                                                                                          Mental Illness

0%    Office of Applied Studies. Results from the 2002 National Survey on Drug Use and Health: National
      Findings . NHSDA Series H-22, DHHS Publication No. (SMA) 03-3836.


                                                                                                                                9
     Research Data Indicates

• CODs are pervasive and should be the clinical
  expectation.
• The prevalence of people with CODs and
  programs for people with CODs have increased.
• People with CODs are more likely to be
  hospitalized, and the rate may be increasing.
• Rates of mental disorders increase as the
  number of substance use disorders increase.

                                                  10
        Treatment Implications
Characteristics of individuals with CODs:
• A more rapid progression from initial use to
  substance dependence
• Poor adherence to medication and less
  treatment compliance
• Higher risk of suicide and self-harm
• Lower level of social functioning
• Shorter time spent in remission
• Poorer treatment outcomes
                                                 11
  Working with COD Individuals
Co-occurring clients may:
• have difficulty understanding and remembering
  information
• be unable to recognize consequences of
  behaviors
• have poor judgment and poor planning skills
• be disorganized and have a limited attention
  span



                                                  12
Working with COD Individuals (cont.)
 Co-occurring clients may:
 • have a poor response to confrontation
 • use substances to cope with loneliness, social
   anxiety, sleep problems
 • use substances to cope with symptoms of
   mental illness and/or side-effects of medication
 • use substances to deal with stress



                                                      13
             Changes in
          Treatment Delivery
• 1995: Only 37% of substance abuse treatment
  programs offer COD programming

• 1997–Present: Almost 50% of substance abuse
  treatment programs offer COD programming

• Present: Many states, including DC, have
  moved toward minimum competency in CODs
  for mental health and addiction treatment
  agencies

                                                14
Advances in Treatment of CODs
• “No wrong door” policy (page 42)
• Mutual self-help for people with COD
• Integrated care as a priority for people with
  severe and persistent mental illness (page 45,
  Figure 3-3)
• Development of effective approaches, models,
  and strategies
• Pharmacological advances

                                                   15
What is a Serious Mental Illness?

The person has at least one 12 month
disorder, other than a substance use
disorder, that meets DSM IV criteria and has
“serious impairment” (equivalent to a GAF of
less than 60).
       Definition developed by SAMHSA for 2002 Report Serious Mental
             Illness and its Co-occurrence with Substance Use Disorders




                                                                     16
       Program Designations
• Mental Health- or Addiction-Only Treatment
• Capable & Enhanced
   Mental Health Programs that offer mental health
    services to individuals who also have a co-occurring
    substance use disorders
   Addiction Treatment Programs that offer substance
    use disorder treatment to individuals who also have a
    co-occurring mental health disorder.
                                   CCISC Model




                                                       17
The Continuum




                Source: Tip 42,Page 44



                                     18
     Treatment Innovations for
         COD Subgroups
• Homeless populations (page 197)
• Criminal Justice populations (page 200)
• Women (page 203)




                                            19
Post-Test and Recap
of Introduction to
Co-Occurring Disorders




                         20
Meet Your Classmates
  (Group Exercise)




                       21

				
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