Addictions and Mental Illness - Crisis and Trauma Resource

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Addictions and Mental Illness

TRAINER: SHERI COBURN, MSW, RSW

Working with Co-occurring Disorders

OUR HISTORYPA R A LLE L O R D I V E RGENT TR EATM E NT

ADDICTION

MENTAL ILLNESS

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PARALLEL TREATMENT

Mental IllnessProfessional/expert approach

Recovery is managing symptoms

Medical model/empowerment-based

Medication-based

Mental illness is primary diagnosis

AddictionsPeer approach/self-help

Recovery is establishing and maintaining sobriety

Confrontation & Support

Spiritual growth

Addiction is primary condition

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CIRCULAR CAUSALITY

Addiction Mental Illness

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BEYOND THE CHICKEN & THE EGG

Third Factor –e.g., Trauma

Mental Illness

Addictions

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SEEING THE WHOLE PICTURE

Addictions

Third Factor

Mental Illness

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INTEGRATED TREATMENT

• Started in late 80’s/early 90’s

• Focus on treating both addictions and mental illness

as DUAL PRIMARY diagnoses

• Emphasis that all interventions need to be relevant

to both the mental illness and addiction

• Interventions based on positive, strength-based,

hopeful relationship with a caregiver

• Motivation-based approaches

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COMMON THEMES:PRO B LE MS

Danger

Hopelessness, Helplessness,

Powerless

Isolation

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COMMON THEMESI N TE RVENTI ONS

Safety

Empowerment

Connection

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IMPORTANT INFORMATION

• Person outside of the

problem

• Strengths

• Resources

oFormal and informal

oSafety

• Goals/preferred direction

• Obstacles

oCurrent and history of violence/trau

oMental health concerns

oAddictions

oMedical issues

• Motivation

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GETTING TO KNOW THE PERSON

• Interests, hobbies, important people in their lives

• Pets

• Favourites…

• What would you like me to know about you?

• How would _________ describe you? What story would they share that

demonstrates that?

• Is there a question you wish I would have asked?

O UTS I D E O F TH E PRO B LE M

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EXPLORING STRENGTHS

• Resilience• Determination• Friendship• Fairness• Justice• Kindness

• Helping• Sharing• Compassion• Thoughtfulness• Self control• Patience

S H A R E A STO RY O F …

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THE CO-OCCURRING SPECTRUM

Mental Health Continuum

(vulnerability/stress)

Addiction Continuum (compulsive coping)© C R I S I S A N D T R A U M A R E S O U R C E I N S T I T U T E

THE CO-OCCURRING SPECTRUM

Mental Health Continuum

(vulnerability/stress)

Addiction Continuum (compulsive coping)

Severe Mental Illness

Low-LevelAddiction

Severe Mental Illness

Severe Addiction

Low-Level Mental Illness

Low-LevelAddiction

Low-Level Mental Illness

Severe Addiction

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BARRIERS TO ASSESSMENT & TREATMENT

• Lack of awareness on the part of the caregiver

• Lack of time or failure to allocate enough time or resources to

do a proper assessment

• Shame/fear on the part of the person coming for help

• Denial on the part of the person coming for help

• Lack of trust in the caregiver by the person coming for help

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MANAGING THE CAREGIVER’S AGENDA

• Basic self-care (eating, sleeping,

hygiene routines)

• Coping skills

• Social relationships

• Housing

• Family relationships

• Addictive behaviours

• Professional relationships

• Leisure activities

• Support networks

• Relationship with themselves

• Past issues

• Exploring family, cultural, &

language roots

• Spirituality

• Medication compliance© C R I S I S A N D T R A U M A R E S O U R C E I N S T I T U T E

THEMES WITHIN INTERVENTION

INTEGRATED TREATMENT

Motivation-Based Work

Safety and Harm

Reduction

Client-Centred

Approach

Emotional Regulatio

n

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HARM REDUCTION

• Harm reduction is not permission to use.• Harm Reduction is about:oAssessing the current levels of risk and harmoUnderstanding the underlying needs being metoWorking systematically at a realistic rate to increase

safety and reduce harm and riskoWorking systematically to meet the underlying needs in

safer, more permanent waysoHaving goals that are realistic and achievable by the

individual

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Termination

STAGES OF CHANGE

( P R O C H A S K A , N O R C R O S S A N D D I C L E M E N T E , 1 9 9 4 )

Pre-contemplation

Contemplation

Preparation

Action

Maintenance

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STAGES OF CHANGE SPIRAL

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EMOTIONAL REGULATION

• Identifying and understanding emotions

• Strategies for sitting with strong emotions

• Strategies for moving past strong emotions

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INCLUSION

• Caregiver is a therapeutic guide for the individual seeking help

• The caregiver is cognisant of not pushing their own agenda

• Approach is client-centred with a focus on highlighting healthy attachment between client and service provider

• Focus is on meeting the client’s perception of their needs vs. meeting the caregiver’s or treatment program’s objectives

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ATTACHMENT FOCUS

• The therapeutic relationship is key in working with co-occurring disorders

• Helps heal past insecure attachments

• Sets the stage for building new coping skills, learning boundaries; regulating and attuning to others

• Builds confidence in one’s ability to manage and work through distress

• Provides an example of predictable attachment outside of substance use

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COLLABORATIVEINTERVENTION STRATEGY

DISTRESS (LAPS)

Acknowledge & Validate

Goals

Support Attempts to

Realize Goals

Support Fine Tuning

of Goals

Explore New Reality

LAPS:

Listen for Distress

Acknowledge Present Distress

Prioritize the Distress

Soothing Distress

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COLLABORATIVE INTERVENTION STRATEGIES

Intervention happening on two levels:

Surface: • Individual sets goals for their life in the areas of both

addictions and their mental health

Deeper Level: • Caregiver is continually paying attention to the level of

distress being experienced by the individual seeking help• Relationship development becomes the foundation for the

ongoing success of treatment

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PROCESS OF RECOVERY

Denial of both addiction and mental illness

Acceptance of one/denial of other

Acceptance of both mental illness & addiction

Understanding connection between the two, integrating change

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SUMMARY

• An integrative vs. parallel treatment plan is imperative –it requires a collaboration between both addiction and mental health caregivers and integration of their treatment’s approaches.

• Effective intervention strategies consider motivation, safety, pacing, inclusion, and emotion regulation as integral in helping people navigate their healing.

• Collaborative interventions blend the importance of goal setting with relationship building, recognizing the relevance of healthy attachment in the recovery process.

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