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Triple Threat Triple Threat Beyond Dual Diagnosis Beyond Dual Diagnosis
• Dr. Louise Stanger Ed.D. LCSW, CIP
• Director All About Interventions
• Member NII and AIS• Faculty SDSU
Interwork Institute
Copyright © Dr. Louise Stanger Copyright © Dr. Louise Stanger
Getting To Know You Getting To Know You
• Hello! Tell your neighbor about yourself
• What brings you here today ?
• What do you want to get out of our time together?
Copyright © Dr. Louise Stanger Copyright © Dr. Louise Stanger
Objectives Objectives
• Learn to Identify multiple issues- Ecological approach
• Learn how to prioritize intervention strategies
• Identify therapeutic
interventions
Copyright © Dr. Louise Stanger Copyright © Dr. Louise Stanger
Objectives Objectives
• Understand while one disorder may be acting out another one is off in a different direction
• Discuss triangulation of data
• Picking the right treatment center
Copyright © Dr. Louise Stanger Copyright © Dr. Louise Stanger
Which Came First ?Which Came First ?
Substance Abuse
Mental Health
Other –Legal, Physical, Family History
Copyright © Dr. Louise Stanger Copyright © Dr. Louise Stanger
Importance of Family Mapping Importance of Family Mapping
Copyright © Dr. Louise Stanger Copyright © Dr. Louise Stanger
Doing a Correct Assessment Doing a Correct Assessment for Co-Occurring for Co-Occurring
• Family History with Triangulation of Data
• Establish period of abstinence (4-6 weeks)
• Establish SA as Primary or Secondary which came first
• Obtain Longitudinal History
Copyright © Dr. Louise Stanger Copyright © Dr. Louise Stanger
PortraiturePortraiture
• Qualitative evidenced based research method
• Assumes we are co-collaborators
• Use snowball sample which means we interview many people to gain data
Copyright © Dr. Louise Stanger Copyright © Dr. Louise Stanger
Unique Factors for Triple Threat Unique Factors for Triple Threat Interventions Interventions
• Often do not end up in a group meeting• Can take more then one gathering- can go on
for hours or days even months • Require an active facilitator • Can be volatile, may involve courts• May involve law enforcement• May involve medical facilities• Must support family or accountability team• MUST KNOW TREATMENT CENTERS
Copyright © Dr. Louise Stanger Copyright © Dr. Louise Stanger
Importance of Knowing Importance of Knowing Mental Health Disorders Mental Health Disorders
Copyright © Dr. Louise Stanger Copyright © Dr. Louise Stanger
InterventionsInterventionsPersonality Disorders +Personality Disorders +
• Avoid Power Struggles
• Be Direct• Support Family –
Strong Boundaries• Compliment
Narcissists• Confront Boarderline• MI,CBT, SFT,
DBT ,PAUSE
Copyright © Dr. Louise Stanger Copyright © Dr. Louise Stanger
SA-Bipolar and Other SA-Bipolar and Other
• Mania• Hypo-Mania• Depressive Episode
--------------------------------• Join with client• Nonthreatening• Over empathize• Instill hope go flat as
client escalates• Educate
Copyright © Dr. Louise Stanger Copyright © Dr. Louise Stanger
Obsessive Compulsive Disorder-Obsessive Compulsive Disorder-Borderline ++Borderline ++
Copyright © Dr. Louise Stanger Copyright © Dr. Louise Stanger
InterventionsInterventions
• Have Patience • Be Consistent• Be Understanding• Indulge OCD• Direct• Firm• Invitational Distract
When Stuck
Copyright © Dr. Louise Stanger Copyright © Dr. Louise Stanger
PTSD and TBIPTSD and TBI’’s and other hiddens and other hidden—WHAT?—WHAT?
Copyright © Dr. Louise Stanger Copyright © Dr. Louise Stanger
Traumatic Brain Injury Traumatic Brain Injury
Copyright © Dr. Louise Stanger Copyright © Dr. Louise Stanger
Intervention with Trauma HistoryIntervention with Trauma History
• Be upfront and honest
• No surprises
• Understanding-Attunement-Empathetic
• Educate all about PTSD, TBI etc
• Match client to interventionists or therapist
• Match treatment facility
Copyright © Dr. Louise Stanger Copyright © Dr. Louise Stanger
During InterventionDuring Intervention
• If perpetrator is family member assume others maybe victims
• Have perpetraor leave intervention or not be present –this is where individual prescreening interviews is so important
• Do not let abuse become focus of intervention, focus on getting help
• Manage anger• Track all members and ground when necessary
Copyright © Dr. Louise Stanger Copyright © Dr. Louise Stanger
Psychotic-SA and Legal Psychotic-SA and Legal
• Schizophrenia
• Delusional
• Drug Induced Psychosis
• Paranoia
• Marijuana –Budder
• Methamphetamines
• Alcohol
• Ecstasy
• Hallucinogenic
Copyright © Dr. Louise Stanger Copyright © Dr. Louise Stanger
Intervention strategiesIntervention strategies
• Low stimulation
• May not use group setting
• Monotone voice
• May enter delusional system (need to be skilled to decide to or not)
• May involve commitment through that is very hard
Copyright © Dr. Louise Stanger Copyright © Dr. Louise Stanger
Legal CasesLegal Cases
• Make sure to partner with a knowledgeable attorney
• Use legal as a motivator for long term change
• Do not use treatment as an escape plan
• Form a straegic partnership
• Role of Admissions Team, Court Liason< Case Managers impt.
Copyright © Dr. Louise Stanger Copyright © Dr. Louise Stanger
Case StudiesCase Studies20 somethings -FTL20 somethings -FTL
Copyright © Dr. Louise Stanger Copyright © Dr. Louise Stanger
Intervention StrategiesIntervention Strategies
• Time and More Time
• Create a Firm Fence
• Use the Legal System to Help
• Do not be afraid to invite team members that are saboteurs to leave
• Patience-Perseverance-Determination
• Flexibility in Approaches
Copyright © Dr. Louise Stanger Copyright © Dr. Louise Stanger
Professionals Professionals Drs. ,Lawyers, Nurses, Teachers Drs. ,Lawyers, Nurses, Teachers Pilots , Fireman , Police Officers Pilots , Fireman , Police Officers
Copyright © Dr. Louise Stanger Copyright © Dr. Louise Stanger
Intervention Strategies Intervention Strategies
• Require a different sort of Team
• Employers, Business agents, Personal Assistants, Fellow Performers, Administrative Assistants , Hair Dressers, Stylists
• Treatment Center Confidentiality
• Follow up Care
• At What Price
Copyright © Dr. Louise Stanger Copyright © Dr. Louise Stanger
Older Adults Older Adults
• Physical Difficulties• Loss of Spouse or Partner• Retirement or Loss of Job• Loss of Friends• Isolation• Change of Environments• Family Systems• Spirtuality
• Have you ever checked out the check out line at CVS, RITE AID Etc.
Copyright © Dr. Louise Stanger Copyright © Dr. Louise Stanger
Intervention StrategiesIntervention Strategies
• Family Participation-Oh Dad or mom are just too old to change
• Putting Together the right Team-All the Drs, clinicians, treatment centers
• Clinicians knowing about normal , non pathological depression following the death of a spouse and about aging
• Clinicians knowing about the difference between divorce and widowers and widows
• Can be effective with team and with one on one
Copyright © Dr. Louise Stanger Copyright © Dr. Louise Stanger
Physical Limitations Physical Limitations
Copyright © Dr. Louise Stanger Copyright © Dr. Louise Stanger
Evidenced Based ModalitiesEvidenced Based Modalities
• Motivational Interviewing
• 12 Step Facilitation
• CBT
• DBT
• Solution Focused (SFT)
• Acceptance and Attunement
• Being honest and transparent
Copyright © Dr. Louise Stanger Copyright © Dr. Louise Stanger
ResourcesResources
• DSM V
• NAMI
• The Art and Science of Portraiture, Lawrence-Lightfoot and Davis
• Talking to Strangers, Weiss
• Stop Walking on Egg Shells Workbook , Kruger
• Aging and Addiction, Colleran & Jay
Copyright © Dr. Louise Stanger Copyright © Dr. Louise Stanger
ResourcesResources
• Get Your Loved One Sober, Meyers and Wolfe
• The Object of My Affection is My Reflection, Coping with Narcissists, Lerner
• Interviewing for Solutions, Dejong & Berg
• Is it Love or is it Addiction, Schaeffer
• The Clinicians Guide to 12 Step, Parker & Guest
Copyright © Dr. Louise Stanger Copyright © Dr. Louise Stanger
ResourcesResources
• The Psychology of Wealth, Richards, PHD
• Roadmap to Resilience; A Guide for Military, Trauma Victims and Their Families, Meichenbaun PHD.
• Crucial Conversations , Patterson, Grenny, McMillian,Switzler
• Thanks to Jeffrey Merrick Esq. and Heather Hayes
Copyright © Dr. Louise Stanger Copyright © Dr. Louise Stanger
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