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

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Comorbidity Guidelines

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

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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

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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

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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

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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

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Managing Suicidality

• Dos and Donts

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Managing Symptoms of Depression

• Dos and Donts

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CBT and Symptoms of Depression

• Cognitive restructuring
• Pleasure and mastery events scheduling
• Goal setting
• Problem solving

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Cognitive Restructuring
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Anxiety, Panic or Agitation

• Dos and Donts

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Managing Symptoms of anxiety, panic or agitation

• Progressive muscle relaxation
• Controlled or abdominal breathing
• Calming response
• Visualisation and imagery
• Grounding

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Managing Symptoms of Trauma

• Dos and Donts

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Managing Grief and Loss

• Dos and Donts

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Phases of Aggression(Source NSW Department of
Health 2007)
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Managing Aggression

• Listen actively
• Acknowledge the problem/situation
• Separate from others
• Sit down
• Indicate possible options
• Encourage client to try these options

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Managing Aggression

• Dos and Donts

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Managing Symptoms of Psychosis

• Dos and Donts

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Managing Personality Disorder Symptoms

• Dos and Donts

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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

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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

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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

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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

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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

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Models of Care

• Sequential treatment
• Parallel treatment
• Integrated treatment
• Stepped care

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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

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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

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Other Treatment Approaches

• Psychosocial groups
• Self-help groups
• Mindfulness training
• Contingency management.

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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

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Commonly Prescribed Medications

• Antidepressants
• Mood stabilising medications
• Anti-anxiety Medications
• Antipsychotic Medications

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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

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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

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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

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