Co-occurring Alcohol and Other Drug and Mental Health Conditions in Alcohol and other Drug Treatment Settings - PowerPoint PPT Presentation

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Co-occurring Alcohol and Other Drug and Mental Health Conditions in Alcohol and other Drug Treatment Settings

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Co-occurring Alcohol and Other Drug and Mental Health Conditions in Alcohol and other Drug Treatment Settings Session 4: Management and Treatment – PowerPoint PPT presentation

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Title: Co-occurring Alcohol and Other Drug and Mental Health Conditions in Alcohol and other Drug Treatment Settings


1
Co-occurring Alcohol and Other Drug and Mental
Health Conditions in Alcohol and other Drug
Treatment Settings
  • Session 4 Management and Treatment

2
Comorbidity Guidelines
  • Refer to
  • Chapters 7 and 8
  • Appendix C Case Studies
  • Appendices D, Q to Ee

3
Management vs Treatment
  • Management of symptoms of mental illness to allow
    AOD treatment to continue with minimal disruption
    to retain clients in treatment
  • Treatment refers to evidence-based practice for
    working with comorbidity
  • Suggested treatments may be beyond scope of some
    AOD workers awareness only

4
Managing Comorbidity
  • Comorbid mental health symptoms can be managed
    and controlled whilst the client undergoes AOD
    treatment
  • Consider whole person (from psychological,
    physical and socio-demographic perspectives) when
    managing symptoms of comorbid mental conditions

4
5
Managing Comorbidity
  • Suicide risk should be monitored throughout
    treatment
  • Motivational enhancement, simple CBT-based
    strategies, relaxation and grounding techniques
    can be useful in managing AOD use as well as
    mental health conditions

5
6
Managing Comorbidity
  • Symptoms of trauma, grief, loss can be managed
    through anxiety management strategies and open
    discussion with client
  • When dealing with more challenging clients
    ensure safe environment, set clear boundaries and
    place strong emphasis on engagement and rapport
    building

6
7
Managing Suicidality
  • Dos and Donts

7
8
Managing Symptoms of Depression
  • Dos and Donts

8
9
CBT and Symptoms of Depression
  • Cognitive restructuring
  • Pleasure and mastery events scheduling
  • Goal setting
  • Problem solving

9
10
Cognitive Restructuring
11
Anxiety, Panic or Agitation
  • Dos and Donts

11
12
Managing Symptoms of anxiety, panic or agitation
  • Progressive muscle relaxation
  • Controlled or abdominal breathing
  • Calming response
  • Visualisation and imagery
  • Grounding

12
13
Managing Symptoms of Trauma
  • Dos and Donts

13
14
Managing Grief and Loss
  • Dos and Donts

14
15
Phases of Aggression (Source NSW Department of
Health 2007)
15
16
Managing Aggression
  • Listen actively
  • Acknowledge the problem/situation
  • Separate from others
  • Sit down
  • Indicate possible options
  • Encourage client to try these options

16
17
Managing Aggression
  • Dos and Donts

17
18
Managing Symptoms of Psychosis
  • Dos and Donts

18
19
Managing Personality Disorder Symptoms
  • Dos and Donts

19
20
Managing Cognitive Impairment
  • Techniques for problem-solving, planning,
    sequencing or decision-making difficulties
  • Be clear and explicit in direction
  • Encourage rehearsal of sequences
  • Encourage routines
  • Teach step-by-step decision-making and
    problem-solving
  • Use timetables and other aids to help client plan

20
21
Managing Cognitive Impairment
  • Techniques for slow information processing
  • Summarise and repeat important points have
    client relay these back to you
  • Encourage questions
  • Go slowly
  • Techniques for poor attention/concentration
  • Stress important points, repeat if necessary
  • Minimise distractions

21
22
Managing Cognitive Impairment
  • Techniques for poor memory
  • Use memory aids, routines and written
    instructions
  • Make sessions at routine times
  • Limit amount of information covered, repeat key
    points, and go slowly
  • Remind the client of appointments and key points

22
23
Treatment of Comorbidity
  • Good treatment requires a good therapeutic
    alliance which includes client choice (including
    not to be involved in treatment)
  • Some interventions have been designed for
    treatment of specific comorbidities however,
    interventions have not been well researched
  • In absence of research on comorbid disorders,
    recommended to use most effective treatments for
    each disorder

23
24
Treatment of Comorbidity
  • Both psychosocial and pharmacological
    interventions have been found to have some
    benefit in treatment of comorbidities
  • When pharmacotherapy is used, this should be
    accompanied by supportive psychosocial
    interventions

24
25
Models of Care
  • Sequential treatment
  • Parallel treatment
  • Integrated treatment
  • Stepped care

25
26
Motivational Interviewing with Co-occurring
Disorders
  • Increasing research base for applying MI with
    clients with co-existing disorders
  • Spirit of MI can be useful for engaging clients
    to address both MH and AOD concerns
  • Principles and strategies for using MI detailed
    in Appendix D of Comorbidity Guidelines

26
27
Cognitive Behavioural Techniques
  • Evidence-based treatment approach used in both
    AOD and MH settings
  • Particularly useful for managing symptoms of
    anxiety and depression
  • Underpinnings of Relapse Prevention in both AOD
    and MH contexts
  • See Appendix Q of Comorbidity Guidelines for an
    overview of techniques for using

27
28
Other Treatment Approaches
  • Psychosocial groups
  • Self-help groups
  • Mindfulness training
  • Contingency management.

28
29
Medications
  • Medications form part of evidence-based practice
    in treatment of mental health concerns.
  • Stabilising on appropriate medications and
    continued use whilst in AOD treatment can be
    essential to successful outcome for both AOD and
    MH

29
30
Commonly Prescribed Medications
  • Antidepressants
  • Mood stabilising medications
  • Anti-anxiety Medications
  • Antipsychotic Medications

30
31
Medication Adherence
  • Making regimes as simple as possible
  • Giving clear instructions
  • Associating medication with predictable daily
    events such as meal times
  • Using pill dispensing containers with daily
    organisers
  • Using alarms

31
32
Medication Adherence
  • Acknowledge any reluctance to take medications
    and allow client to express these concerns
  • Motivational interviewing, contingency management
    and CBT have been shown to be particularly useful
    in improving medication compliance
  • Facilitate discussion with medication prescriber
    if necessary

32
33
In sum
  • Range of approaches for managing symptoms of
    mental illness within AOD treatment settings
  • Treatment of co-existing disorders can occur
    within AOD settings
  • Further training in specific treatment approaches
    is recommended
  • Refer to Chapters 7 and 8 and Appendices in
    Guidelines for further information

33
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