Your Federal Quarterly Tax Payments are due April 15th Get Help Now >>

Co-Occurring Disorders, Best Practices and by kar19083

VIEWS: 152 PAGES: 91

									Co-Occurring Disorders, Best
 Practices and Adolescents
     ―Double Trouble - Early‖
              Main Points
• Section One: Co-Occurring Mental Health and
  Substance Use Disorders in Adolescents:
  Research
• Section Two: Systems Issues - Parallel
  Treatment Systems
• Section Three: Assessment of Co-Occurring
  Disorders
• Section Four: Evidence Based Treatments for
  Adolescents with Co-Occurring Disorders
• Section Five: Recommendations
         Section One:
Co-Occurring Mental Health and
  Substance Use Disorders in
  Adolescents: The Research
        INTRODUCTION

The research tells us the majority of youth
referred for substance abuse treatment
have at least one co-occurring mental
health disorder (COD), a DSM-IV-TR
mental health disorder and a substance
use disorder (SUD).
                  Research
• Adolescents with substance use disorders are at
  a six times risk of having a co-occurring
  psychiatric disorder (Dennis, 2004)
• Co-Occurring disorders are associated with
  poorer treatment outcomes, both physical and
  psychological when either disorder is not treated
  (Riggs, 2003)
• Drug abuse changes the brain chemistry of
  developing brains.
• Psychiatric symptoms often precede the SUD
     Incidence of Co-occurring
    Disorders in System of Care
            Adolescents
          (Turner, Muck, Muck et al, 2004)



•   SOC sites (N= 18, 290) 44% reported
    COD
Co-Occurring Disorders at Intake: SOC


                                                                                       38.4%
                              ADHD                             13.3%
                                                                          27.1%
       Oppositional Defiant Disorders                                   25.2%
                                                                               32.9%
      Mood Disorders and Depression                                        28.4%
                                                             13.2%
               Adjustment Disorders                   8.1%
                                                         9.9%
                  Conduct Disorders                                               34.0%
                                                        8.9%
             PTSD and Acute Stress                   6.8%
                                                4.6%
                     Impulse Control           3.5%
                                                 5.5%
        Disruptive Behavior Disorders              7.5%
                                                4.5%
                             Anxiety         2.3%                                         Mental Health Problems Only (n = 10,541)
                                              2.4%
                          Psychosis          1.8%

                   Autistic Disorders
                                            2.1%                                          Comorbid with Susbtance Use (n = 782)
                                         0.1%
                                                5.1%
      Learning and Related Disorders           4.3%
                                               3.8%
                  Mental Retardation         2.4%
                                             1.5%
                Personality Disorder            3.8%
                                                  5.6%
                             V Code            3.3%
                                                     7.6%
                               Other          2.8%


                                        0%                        20%               40%               60%             80%            100%
         Co-Occurring Disorders
              Categories
•   Co-occurring disorders in adolescents are
    usually categorized into internalizing and
    externalizing disorders. These should be the
    treatment targets for the mental health
    interventions.
     •    Internalizing –anxiety, fear, shyness, low self
          esteem, sadness, depression (6%) of COD
     •    Externalizing—non compliance, aggression,
          attention problems, destructiveness, impulsivity,
          hyperactivity, and antisocial behavior (18-35%) -
          COD
     •    Both (38-65%) COD
      Co-Occurring Disorders
           Categories

•   Disruptive disorders and mood disorders are
    associated with earlier onset of use of
    substances and increased substance use
    disorders
•   Internalizing disorders are associated with
    SUD and are an antecedent of the SUD.
•   Trauma/victimization in youth with SUD range
    from 25% for males to 75% of females
    (Kanner, 2004, Dennis, 2004)
            Average Scores of Child Behavioral and Emotional Problems* for
             children with Co-occurring substance use problems at Intake, 6
                                Months, and 12 Months
        Internalizing and Externalizing Scores:
                                                                                   100
                                                                                                    Internalizing Behaviors



                                                     Average CBCL Problem Scores
                                                                                   90
                                                                                                    Externalizing Behaviors
                                                                                   80

                                                                                   70

                                                                                   60

                                                                                   50

                                                                                   40

                                                                                   30

                                                                                   20
                                                                                         Intake   6 Months             12 Months
                                      Internalizing Behaviors                             64.6       60.4                   57.3
                                      Externalizing Behaviors                             71         67.0                    64
Internalizing: n=101; F(3,98)=1396, P<.001.
Externalizing: n=101; F(3,98)=1706, P<.001.
* Child behavioral and emotional problems were measured by the CBCL (Child Behavior Checklist). Clinical range for internalizing and externalizing scores is between 60 and 63, while
 clinical range for the eight syndrome scales is between 67 and 70.
          Gender Differences

Girls

•   Conduct disorder associated with SUD in both
    girls and boys, but girls with this combination
    had the highest CBCL scores for delinquency
•   Caregivers report more of both internalizing
    and externalizing problems among girls (83%)
    than boys (41%)
•   Girls are over represented in groups with poor
    outcomes
          Gender Differences
Girls

•   Females had higher rates of Co-Occurring
    disorders and were more likely to have
    suffered physical/sexual abuse
•   Girls report significantly higher level of drug
    dependence vs abuse, (72% vs 43%) in boys
          Gender Differences
Boys

•   Present more often with disruptive behaviors
    (ODD/CD)
•   More often in juvenile justice settings (80%)
    with COD referrals
•   In juvenile justice settings 3/4 of males and
    half of all females have COD
      Section Two:
Systems Issues - Parallel
 Treatment Systems and
    Colliding Cultures
     Systems Issues –
    Treatment Pathways
Different models in mental health and
substance abuse treatment have
resulted in the development of parallel
but not intersecting treatment systems
with different funding streams, mandates
and treatment philosophy.
             Clinical Barriers
A) Mental Health Treatment

   The fundamental approach to clinical education has
   not changed appreciably since 1910 (ICM 2000).
   Substance use disorders often are not seen as part of
   the ―care mandate.‖

    •   Medical model
    •   Emphasis on licensure
    •   Emphasis on minimal self disclosure.
    •   Treatment can not begin until abstinence is
        obtained
             Clinical Barriers
A) Mental Health Treatment cont.

     •   Reluctance to medicate individuals with a
         substance use disorder
     •   Psychological treatments offered but with no
         substance abuse treatment component
     •   Clinicians are reluctant to treat substance
         abusing individuals
     •   Clinicians often not cross trained in SUD
     •   Individuals with SUD often minimize the disorder
         and vice-versa
             Clinical Barriers
B) Substance Abuse Treatment
   Knowledge of mental health disorders is often limited
   and often out of scope of practice of the providers.
     • Based on a peer relationship model
     • Licensure not necessary (changing)
     • Treatment provider often a recovering individual
     • Willing to disclose substance abuse history
     • Individual with substance abuse history treated
        as an expert valued.
     • Often reluctance to allow any medication of any
        kind
     • Treatment often ignores mental health problems
        and focuses on substance abuse
     • Providers not cross trained in mental health
        treatments
      Section Three:
Assessment of Co-Occurring
        Disorders
Assessment and Screening for Co-
      Occurring Disorders

 The process of screening, assessment, and
 treatment planning should be an integrated
 approach that addresses the substance abuse
 and mental health disorders, each in the context of
 the other and neither should be considered
 primary.

 Expect comorbidity as it is higher than realized

 Assess for trauma/victimization
Assessment and Screening for Co-
      Occurring Disorders
 Substance use assessment should include:

  •   Onset, progression, patterns of use,
      frequency, tolerance/withdrawal, triggers.
  •   Assessment for patterns of use of multiple
      drugs
  •   Consequences of drug usage
  •   Motivation for treatment
  •   Family history regarding substance use
      including extended family
Assessment and Screening for Co-
      Occurring Disorders
 The assessment process ideally would include:

  •   A brief screening assessment for substance
      use disorders as part of the standard mental
      health assessment at entry and throughout
      treatment
  •   A full substance abuse disorder assessment
      for adolescents with more complicated/ Co-
      morbid disorders and identified SUD
     Assessment Instruments

Screening Instruments:

 •   Adolescent Alcohol Involvement Scale
 •   Adolescent Drug Involvement Scale
 •   Problem Oriented Screening Instrument for
     Teenagers (POSIT)
 •   GAIN – Short Version—Sample attached.
      Assessment Instruments

Substance Use Disorder Interviews:
     • Adolescent Diagnostic Interview (ADI)
     • Diagnostic Interview for Children and
        Adolescents (DICA)

Comprehensive Assessment Instruments:
    • Comprehensive Adolescent Severity
       Inventory (CASI)
    • The American Drug and Alcohol Survey
       (ADAS classroom use)
    • Personal Experience Inventory (PEI)
    Assessment Instruments

General Checklists:

•   Achenbach YSR
•   Revised Behavior Problem Checklist.
•   Youth Outcome Questionnaire YOQ
•   Youth Outcome Questionnaire Self Report
      YOQ SR
        Section Four:
Evidence Based Treatments for
 Adolescents with Co-Occurring
          Disorders
  Evidenced Based Treatment
• ―…the integration of the best research
  evidence with clinical expertise and patient
  (consumer) values‖

• Based on the definition used in “Crossing
  the Quality Chasm: A New Health System
  for the 21st Century” (2001), by the
  Institute of Medicine
               Treatment

• New techniques and treatment modalities
  based on evidenced based research
  methodology are successful with Co-
  Occurring Disorders.
    Evidenced Based Treatments
    National Registry for Evidenced Based
    Programs and Practices—SAMSHA

1   Treatment for Co-occurring Disorders
2   Mental Health Treatments successful with Co-
    occurring disorders
3   Treatments for Substance Use Disorders
4   Preventative Practices
5   Brief Manualized Treatments
  Evidence-Based Treatments
   for Co-Occurring Disorders
Family Behavior Therapy
Multisystemic Therapy
Dialectical Behavior Therapy
Seeking Safety
TREM
TARGET
Integrated Community Treatment
Family Treatment
Family Behavior Therapy (FBT)

 Outpatient behavioral treatment aimed at
  reducing drug and alcohol use in adults
  and youth along with common co-
  occurring problem behaviors such as
  depression, family discord, school and
  work attendance, and conducts problems
  in youth.
Family Behavior Therapy (FBT)
         Populations

•   Adolescents ages 13 to 17
•   Young adults ages 18 to 25
•   Adults ages 26 to 55
•   Male and Female
•   Races: White, Black or African American,
    Hispanic or Latino, Race/ethnicity
    unspecified.
Family Behavior Therapy (FBT)
         Outcomes
•   Decreases illicit drug use
•   Decreases frequency of alcohol use
•   Improves quality of Family relationships
•   Reduces symptoms of Depression
•   Reduces symptoms of Conduct Disorder
•   Improves School / Employment
    attendance
Family Behavior Therapy (FBT)
   References & More Info
• SAMHSA’s National Registry of Evidence-
  based Programs and Practices (NREPP)
• Bradley Donohue, Ph.D. Associate
  Professor
• University of Nevada, Las Vegas
• E-mail: bradley.donohue@unlv.edu
• Web site:
  http://www.unlv.edu/centers/achievement
  Multisystemic Therapy (MST)

 A family and community-based treatment
  for adolescents presenting serious
  antisocial behavior and who are at
  imminent risk of out-of-home placement.
    Multisystemic Therapy (MST)
             Populations
•   Children ages 6-12
•   Adolescents ages 13-17
•   Male and Female
•   Races: American Indian/Alaska Native,
    Asian American, Black or African
    American, Hispanic or Latino,
    Race/ethnicity unspecified, White
  Multisystemic Therapy (MST)
            Outcomes
• Alcohol and drug use frequency reduced
  and higher rates of abstinence
• Increased perceived family functioning-
  cohesion
• Decrease peer aggression
 Multisystemic Therapy (MST)
   References & More Info
• SAMHSA’s National Registry of Evidence-
  based Programs and Practices (NREPP)
• Scott W. Henggeler, Ph.D.
• Dept of Psychiatry and Behavioral
  Sciences
• Medical University of South Carolina
• E-mail: henggesw@musc.edu
 Dialectical Behavioral Therapy
              (DBT)
• A cognitive-behavioral treatment approach with
  two key characteristics: a behavioral, problem-
  solving focus blended with acceptance-based
  strategies, and an emphasis on dialectical
  processes.
• ―Dialectical‖ refers to the issues involved in
  treating patients with multiple disorders and to
  the type of thought processes and behavioral
  styles used in the treatment strategies.
    Dialectical Behavioral Therapy
          (DBT) Populations
•   Young adults ages 18-25
•   Adults ages 26-55
•   Older adults ages 55+
•   Male and Female
•   Race: American Indian/Alaska Native,
    Asian American, Black or African
    American, Hispanic or Latino,
    Race/ethnicity unspecified, White.
 Dialectical Behavioral Therapy
        (DBT) Outcomes
• Decrease suicide attempts
• Decrease nonsuicidal self-injury
  (parasuicidal history)
• Increase psychosocial adjustment
• Increase treatment retention
• Reduces drug use
• Reduces symptoms of eating disorders
 Dialectical Behavioral Therapy
 (DBT) References & More Info

• SAMHSA’s National Registry of Evidence-
  based Programs and Practices (NREPP)
• Marsha M. Linehan, Ph.D., ABPP
• Professor and Director of Behavioral Research
  and Therapy Clinics
• Dept of Psychology University of Washington.
• E-mail: linehan@u.washington.edu
• Web site: http://www.brtc.psych.washington.edu/
             Seeking Safety
• A present-focused treatment for clients with a
  history of trauma and substance abuse. The
  treatment was designed for flexible use: group
  or individual format, male and female clients,
  and a variety of settings. (i.e., outpatient,
  inpatient residential).
• Treatment and intervention focuses on coping
  skills and psychoeducation and has five key
  principles.
              Seeking Safety
                Population
•   Adolescents ages 13-17
•   Young adults ages 18-25
•   Adults ages 26-55
•   Male and Female
•   Races: American Indian/Alaska Native,
    Asian American, Black or African
    American, Hispanic or Latino,
    Race/ethnicity unspecified, White.
             Seeking Safety
                Outcomes
•   Reduces Substance abuse
•   Improved trauma-related symptoms
•   Improved psychopathology
•   Increased treatment retention
              Seeking Safety
      References & More Info
• SAMHSA’s National Registry of Evidence-
  based Programs and Practices (NREPP)
• Lisa M. Najavits, Ph.D.
• Director, Treatment Innovations
• Professor of Psychiatry, Boston University
  School of Medicine
• Lecturer, Harvard Medical School
• E-mail: Lnajavits@hms.harvard.edu
• URL: http://www.seekingsaftey.org
   Trauma Recovery and
 Empowerment Model (TREM)
 TREM is a fully manualized group-based
  intervention designed to facilitate trauma
  recovery among women with histories of
  exposure to sexual and physical abuse.
      Trauma Recovery and
    Empowerment Model (TREM)
           Population

•   Young adults ages 18-25
•   Adults ages 26-55
•   Female
•   Race: American Indian/Alaska Native,
    Black or African American, Hispanic or
    Latino, Race/ethnicity unspecified, White
   Trauma Recovery and
 Empowerment Model (TREM)
              Outcomes
• Reduces severity of problems related
  to substance abuse
• Reduces psychological
  problems/symptoms
• Reduces trauma symptoms
   Trauma Recovery and
 Empowerment Model (TREM)
      References & More Info
• SAMHSA’s National Registry of Evidence-
  based Programs and Practices (NREPP)
• Roger D. Fallot, Ph.D.
• Director of Research and Evaluation
• Community Connections
• E-mail: rfallot@ccdc1.org
• Web site: http://www.ccdc1.org
    Trauma Affect Regulation:
     Guide for Education and
       Therapy (TARGET)

 Is a strengths-based approach to
  education and therapy for survivors of
  physical, sexual, psychological, and
  emotional trauma.
      Trauma Affect Regulation:
       Guide for Education and
    Therapy (TARGET) Population

•   Young adult ages 18-25
•   Adults ages 26-55
•   Male and Female
•   Race: Black or African American, Hispanic
    or Latino, Race/ethnicity unspecified,
    White
   Trauma Affect Regulation:
    Guide for Education and
 Therapy (TARGET) Outcomes
• Decreased severity of PTSD symptoms
• Decreased PTSD diagnosis pre to posttreatment
• Reduced negative beliefs related to PTSD and
  attitudes toward PTSD symptoms
• Reduced severity of anxiety and depression
  symptoms
• Improved self-efficacy related to sobriety
• Increased emotional regulation
• Improved health-related functioning
  Trauma Affect Regulation:
   Guide for Education and
Therapy (TARGET) References
         & More Info
• SAMHSA’s National Registry of Evidence-
  based Programs and Practices (NREPP)
• Julian D. Ford, Ph.D.
• Associate Professor
• Dept of Psychiatry, MC1410
• University of Connecticut Health Center
• E-mail: ford@psychiatry.uchc.edu
   Evidenced Based Practices


• Integrated Co-Occurring Treatment Model
  (ICT)
• Family Integrated Transitions (FIT)
 Evidence-Based Mental Health
Programs that have had Success
with Substance Abuse Treatment
   Evidenced Based Mental Health
Treatment that has success with COD
•   MST*
•   Adolescent Transitions Program
•   Strengthening Families Program
•   Brief Strategic Family Therapy (Promising)
•   Multidimensional Family Therapy (Effective)
•   Functional Family therapy (effective)
•   ART
•   Dialectical Behavior Therapy*
•   Anger Management for substance abuse and
    mental health clients
•   Multidimensional Treatment Foster Care
       Adolescent Transitions
             Program

• Promising Practice
• Outcomes
  – Reduces Negative Parent/Child Interaction
  – Decreases Antisocial Behavior at School
  – Reduces Smoking at 1 Year Follow Up
  Evidence-Based Practices
       Parent Training
Adolescent Transitions Program
•   School-based Universal, Selected, Indicated
•   Twelve Group and Four Family Meetings
•   Social Learning Theory – Skill Devel
•   Est cost to Implement $2,000 - $5,000
•   Thomas Dishion PhD, Kate Kavanaugh PhD –
    University of Oregon
Evidence-based Mental Health Treatments
Strengthening Families Program
 • Effective Practice
 • Targets high-risk children 6-12 yrs / parents
 • Created for children of parents with AOD
 • Improves Parenting Skills, Child Social
   Behavior, and Family Relationships
 • Decreases Parent/Child Substance Use, Child
   Behavior Problems, Parent/Child Depression
 • Up to 2-year longitudinal
   Evidence-based Practices Treatments
Strengthening Families Program
• Adapted: African American, Asian/Pacific
  Islander, Hispanic, Native American, Rural
  Families
• Adapted to 10-14 year olds ( V.Molgaard)
• Three Part Curriculum – Parenting Skills, Child
  Skills, Family Life Skills – 14 sessions
• Separate Parent and Child Groups
• Combined Parent and Child Group
• Training - $2,700-$3,700+
• Karol Kumpfer PhD – University of Utah
          Evidence-based Practices
 Brief Strategic Family Therapy


• Targets child/adolescents 8-17 years exhibiting,
  or at risk of behavior problems including
  substance abuse
• Promising Practice
• Improve Child’s Behavior by Improving Family
  Interactions
Evidence-based Practices - Family Therapy
 Brief Strategic Family Therapy

• Severe Conduct Disorder and Substance Abuse
  = 24-30 Sessions
• Implementation : Three Day Training, Two Day
  Booster, Monthly Phone/Video Consult (1 yr) --
  $18,000
• Jose Szapocznik PhD - Spanish Family
  Guidance Center, Center for Family Studies,
  University of Miami
Evidence-based Practices - Family Therapy
Multidimensional Family Therapy

• Targets Adolescents (11-18 years) with drug
  and behavior problems.
• Effective/Promising Practice
• Outcomes include improvements in:
  –   Rates of drug Use {42%-70% abstinent at followup}
  –   Behavior Problems
  –   School Performance
  –   Family Functioning
Evidence-based Practices - Family Therapy
Multidimensional Family Therapy
• Superior outcomes to CBT, Family Group
  Therapy, Peer Group Therapy, and Residential
  Treatment
• Superior outcomes to Residential Treatment for
  Adolescents with Co-Occuring Conditions at 1 yr
  follow up
• Howard Liddle PhD – University of Miami
        Evidence-based Practices
Functional Family Therapy (FFT)

• Targets Youth 11-18 yrs at risk/
  presenting behavior problems, substance
  abuse, conduct disorder
• Effective Practice
           Evidence-based Practices
Functional Family Therapy (FFT)
• Average duration of service is 3-4 months
• Cost effective
   – On average costs $2,100 per youth
   – 8-30 sessions of direct service
• Full time therapist will serve 12-15 families at
  one time
• Site certification and training
   – Teams of 3-8 interventionists - $25,000+
• James Alexander PhD – University of Utah
           Evidenced Based Treatment
Aggression Replacement Training
            (ART)
• Promising Practice / Proven Approach
• Assumes aggression is related to
  – Weak or absent personal, interpersonal and social-cognitive skills
    for pro-social behavior
  – Impulsive and over reliance on aggressive means to meet daily
    needs
  – More egocentric and concrete moral reasoning
• Consists of three coordinated components
  – Skillstreaming - Anger control training - Moral reasoning
         Evidenced Based Treatment
       (ART)—Skillstreaming
• Arnold Goldstein, Ph.D.
• Procedures to enhance pro-social skill levels
• Small group instruction
• 50 pro-social skills
• Modeling ―expert‖ use of the behaviors
• Guided opportunities to practice and role-play
• Provided performance feedback; praise, re-
  instruction and feedback
• Transfer training; encouraged to practice and use
  in real world situations
            Evidenced Based Treatment
    ART-Anger Control Training
• Eva Feindler, Ph.D.
• Teaches youth alternatives to aggression
• An emotion oriented component
• Involves modeling, guided practice, performance
  feedback, and homework
• Youth are taught to respond to provocations
    –   Triggers
    –   Cues
    –   Reducers
    –   Reminders
    –   Use of appropriate skillstreaming alternatives
    –   Self evaluation
     Cognitive Behavioral Therapy:
ART—Moral Reasoning Training
• Group discussion of moral dilemmas
• Group rules
• Group process
  – Introduce the problem situation
  – Cultivate mature morality
  – Remediate moral development delays
  – Consolidate mature morality
        Anger Management for
        Substance Abuse and
         Mental Health Clients
• Outcomes for Consumers with Substance Dependence,
  Many of Whom had PTSD
   – Significant reductions in self-reported anger and
     violence
   – Decreased substance use
   – Positive impacts across ethnicities and gender
• Successful with Consumers w/o substance abuse, who
  have mood and thought disorders.
• Studies for youth younger than 18 in process.
Anger Management for Substance
 Abuse and Mental Health Clients
• Patrick M. Reilly & Michael S. Shopshire PhD
  San Francisco Treatment Research Cntr
• Center for Substance Abuse Treatment,
  SAMHSA
• Promising Practice (Probably) / Proven
  Approach
• Bargain Basement Award - It’s Free!
  http://www.kap.samhsa.gov/products/manuals/p
  dfs/anger1.pdf
        Evidence-based Practices –
   Multidimensional Treatment
           Foster Care
• Effective Practice
• Targets Adolescents with Delinquency and
  their Families.
• Alternative to Group Home Placement and
  Incarceration
     Evidence-based Practices –
 Multidimensional Treatment
         Foster Care
• Patricia Chamberlain PhD – Oregon
  Social Learning Center
    Evidence Based Practices for
    Adolescents Substance Use
         Disorder Treatment
•   Motivational Interviewing (MI)—Explain
•   Adolescent Portable Therapy
•   Behavioral Therapy for Adolescents
•   Brief Strategic Family Therapy
•   Multidimensional Family Therapy *
•   Multisystemic Therapy *
•   Seeking Safety *
  Evidence-Based Preventative
  Programs for Substance Use
           Disorder
• Integrated Dual Diagnosis Treatment Model
  (IDDT)
• Seeking Safety *
• Strengthening Families*
• Dialectical Behavior Therapy (DBT)*
• Trauma Affect Regulation: (TARGET)*
• Trauma Recovery and Empowerment Model
  (TREM)*
 Manualized Brief Interventions
  Cannabis Youth Treatment
            Series
Resource for substance abuse treatment
 professionals that provide a unique perspective
 on treating adolescents for marijuana use.
 These volumes present effective, detailed,
 manual-based treatment resources for teens
 and their families.

These brief treatments can be transposed easily to
  the mental health setting
        Cannabis Youth Treatment
            (CYT) Series

• Motivational Enhancement Therapy and Cognitive
  Behavioral Therapy for Adolescent Cannabis
  Users: 5 Sessions, Vol. 1. Sampl, S., & Kadden, R.
  – Uses both motivational enhancement therapy and
    cognitive behavioral therapy
       Cannabis Youth Treatment
           (CYT) Series
• Motivational Enhancement Therapy and
  Cognitive Behavioral Therapy Supplement: 7
  Sessions of Cognitive Behavioral Therapy for
  Adolescent Cannabis Users, Vol.2. Webb, C.,
  Scudder, M., Kaminer, Y., & Kadden, R.
  – Uses cognitive behavioral therapy and Motivational
    Enhancment –7 sessions
• Family Support Network for Adolescent
  Cannabis Users, Vol.3. Hamilton, N.L., Brantley,
  L.B., Tims, F. M., Angelovich, N., &McDougall,
  B.
  – Provides additional support for families
       Cannabis Youth Treatment
           (CYT) Series
• The Adolescent Community Reinforcement
  Approach for Adolescent Cannabis Users, Vol.4.
  Godley, S. H., Meyers, R. J., Smith, J. E.,
  Karvinen, T., Titus, J. C., Godley, M. D., Dent,
  G., Passetti, L., & Kelberg, P.
  – Outlines 12 individual sessions for adolescents and
    their parents or caregivers
• Multidimensional Family Therapy for Adolescent
  Cannabis Users, Vol.5. Liddle, H. A.
  – Integrates family therapy and primary substance
    abuse treatment
     Cannabis Youth Treatment
          (CYT) Series
     References & More Info
• SAMHSA, Substance Abuse Mental
  Health Services Administration.
• www.samhsa.gov
• CYT—Website
  Section Five:
Recommendations
      Recommendations

It is clear that there are enormous mental
health needs for adolescents with Co-
Occurring Disorders.
          Recommendations
Assessment:

  –   Comprehensive biopsychosocial
      assessment
  –   Assess Mental Health Issues using standard
      mental health intake process/evaluation
  –   Assess for SUD using a brief screening tool
      for substance use disorders in ALL
      adolescents entering system
         Recommendations
Assessment:

  – Follow up with a comprehensive substance
    use disorder assessment for adolescents
    who have a co-morbid substance abuse
    disorder
  – Assess for trauma/victimization
  – Assess readiness for change
             Recommendations
Treatment:

•   Implement science based psychotherapies for
    co-occurring disorders into routine practice

•   Target most common co-morbidities ,i.e.
    Depression, ADHD, PTSD, CD

•   Target most common substances abused;
    marijuana alcohol/cigarettes
           Recommendations
Treatment:

• Conceptualize SUD as a process; waxes/wanes,
  relapse expectable. Unrealistic to expect total
  remission in all cases.

• Medication has a place in treating co-morbid
  disorders, particularly the internalizing disorders
                 Recommended
                   Programs
•   Assessment format that includes standardized
    SUD instruments, screening and more
    comprehensive when indicated
     •   GAIN
     •   Sassi
•   Preventive Program
     •   Strengthening Families
•   Family program
     •   Multisystemic Therapy
     •   Or Family ----free on e
•   Trauma treatment paradigm
     •   Seeking Safety
          Recommendations
• Substance abuse treatment protocol
  – Motivational Enhancement and Cognitive
    Behavioral Therapy (5 or 7 sessions)
  – Motivational Interviewing.
• Individual Treatment
• Social Skills Treatment
  – ART
• Placement
  – MTFC

								
To top