Triple Threat: Beyond Mental Health and Substance Abuse Issues

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?


Objectives Objectives

• Learn to Identify multiple issues- Ecological approach

• Learn how to prioritize intervention strategies

• Identify therapeutic

interventions


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


Which Came First ?Which Came First ?

Substance Abuse

Mental Health

Other –Legal, Physical, Family History


Importance of Family Mapping Importance of Family Mapping


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


PortraiturePortraiture

• Qualitative evidenced based research method

• Assumes we are co-collaborators

• Use snowball sample which means we interview many people to gain data


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


Importance of Knowing Importance of Knowing Mental Health Disorders Mental Health Disorders


InterventionsInterventionsPersonality Disorders +Personality Disorders +

• Avoid Power Struggles

• Be Direct• Support Family –

Strong Boundaries• Compliment

Narcissists• Confront Boarderline• MI,CBT, SFT,

DBT ,PAUSE


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


Obsessive Compulsive Disorder-Obsessive Compulsive Disorder-Borderline ++Borderline ++


InterventionsInterventions

• Have Patience • Be Consistent• Be Understanding• Indulge OCD• Direct• Firm• Invitational Distract

When Stuck


PTSD and TBIPTSD and TBI’’s and other hiddens and other hidden—WHAT?—WHAT?


Traumatic Brain Injury Traumatic Brain Injury


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


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


Psychotic-SA and Legal Psychotic-SA and Legal

• Schizophrenia

• Delusional

• Drug Induced Psychosis

• Paranoia

• Marijuana –Budder

• Methamphetamines

• Alcohol

• Ecstasy

• Hallucinogenic


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


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.


Case StudiesCase Studies20 somethings -FTL20 somethings -FTL


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


Professionals Professionals Drs. ,Lawyers, Nurses, Teachers Drs. ,Lawyers, Nurses, Teachers Pilots , Fireman , Police Officers Pilots , Fireman , Police Officers


Public FiguresPublic Figures


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


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.


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


Physical Limitations Physical Limitations


It Takes a Village It Takes a Village


Evidenced Based ModalitiesEvidenced Based Modalities

• Motivational Interviewing

• 12 Step Facilitation

• CBT

• DBT

• Solution Focused (SFT)

• Acceptance and Attunement

• Being honest and transparent


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


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


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


Health & Medicine

Triple Threat: Beyond Mental Health and Substance Abuse Issues