CLINICAL CONSULTATION
The prevalence of substance abuse among persons with severe mental illness challenges all service providers to view co-occurring disorders as the rule, rather than the exception.
The New Hampshire-Dartmouth Integrated Dual Disorder Treatment (IDDT) model acknowledges that all service providers must develop a working knowledge of mental health therapy, substance abuse counseling, and basic psychopharmacology to assess and treat persons with dual disorders. These clinical skills enable SAMI providers to respond immediately with effective interventions or to respond after conferring with other members of their treatment teams. IDDT stresses that mental illness and substance abuse addictions have biological, psychological, and social factors that contribute to their causes and, as a result, must be treated with interventions that emphasize an integrated biopsychosocial approach.
To support this basic understanding and application of clinical skills, the Ohio SAMI CCOE provides ongoing clinical consultations directly to service agencies and treatment teams during and after the implementation of their SAMI programs. Clinical consultations may also include collaboration with regional and national experts. Consultations may take place in-person and/or through teleconferencing and videoconferencing. The CCOE encourages providers to learn how to
- assess consumers for the presence and severity of mental illness and substance abuse
- understand basic psychopharmacology
- recognize the signs and symptoms of a relapse to substance abuse and/or psychiatric episode
- intervene to prevent or respond effectively to symptoms and relapse
- coordinate integrated services through continuous communication with service professionals from other disciplines
- translate the specialized language (jargon) of medical and social service professionals into a language that consumers and caregivers can understand
Clinical Tools:
RECOVERY
The SAMI CCOE builds its clinical consultation services on the concept of recovery.
Recovery is a process by which persons with dual disorders develop and maintain mental health, sobriety, and independent living skills. It is also a process by which persons with dual disorders recovertheir living skills if a relapse of psychiatric symptoms or a relapse to substance abuse occurs. Consumers learn recovery skills in the context of their daily lives with the help of caregivers and professional service providers.
The IDDT model stresses that there is not one optimum level of independent living skills for all consumers to achieve. Each person develops a different capacity for self-awareness, self-monitoring, and independence. In addition, the IDDT model cites evidence from research that the presence of substance abuse drastically interferes with a mental health consumer’s ability to reach his or her maximum potential for independent living. Therefore, service providers who use the IDDT model work with consumers to eliminate the use of alcohol and other drugs and to remain abstinent.
BIOLOGY
The IDDT model teaches that mental illness and substance abuse
are disorders of the brain that inhibit individuals from living as independently as people
who do not have these disorders. Medical researchers have found a relationship between
brain chemistry and severe mental illness, as well as brain chemistry and substance abuse.
However, the researchers indicate that abnormal brain chemistry alone is not the cause of these disorders,
because the relationships between an individual’s brain chemistry, genetics, and
physical and social environments are very complex and not yet completely understood.
Psychotropic medications are
chemicals that alter brain chemistry. Medical researchers have developed these medications
in an effort to reduce the symptoms of mental illness, which may include extreme
depression, anxiety, paranoia, hallucinations, and manic behavior. Psychotropic
medications, like all medications, may create side effects, including sedation, insomnia,
changes in appetite, and abnormal movements. Because medications affect everyone
differently, finding the right medication and the right dosage takes time and consistent
interaction between consumers, service professionals, psychiatrists, and caregivers.
Alcohol and other drugs are also
chemicals that alter brain chemistry. Alcohol and other drugs may produce symptoms that
appear to be symptoms of mental illness or side effects of medication. Symptoms of
intoxication or withdrawal may include extreme depression, anxiety, paranoia,
hallucinations, and manic behavior. In addition, if consumers mix alcohol and other drugs
with psychotropic medications, they may experience unwanted and life-threatening effects.
To make sense of this complicated and confusing clinical situation, allservice providers need a specialized knowledge of both disorders and basic psychopharmacology.
The ultimate goals for persons with dual disorders are abstinence from the use of alcohol other drugs and compliance with psychiatric treatment. Achieving sobriety takes time, and there may be many unforeseen obstacles. For instance, a physician may inadvertently prescribe opiate-based pain medications or recommend over-the-counter cold remedies that contain alcohol and/or stimulants. In either case, the addictive substances in the medicines may cause persons with dual disorders to experience a relapse of their substance abuse disorder. Consumers, caregivers, physicians, and other service providers must be aware of all substances that may interfere with recovery.
PSYCHOLOGY
Mental health consumers who achieve the highest level of
independent living skills are typically those who achieve a high level of awareness.
Self-awareness enables consumers to self-monitor their symptoms and to self-monitor their
urge to use alcohol and other drugs. Self-awareness also enables consumers to manage their
emotions and their own reactions to their disorders and the stigma that often accompanies
the disorders. Awareness enables consumers to accept their illnesses, understand their
needs, develop relevant personal goals, better utilize community resources, and cultivate
reciprocating social relationships.
Through its clinical consultations, the SAMI CCOE trains service professionals in the use of mental health counseling techniques and substance abuse counseling techniques. These clinical skills are intended to help mental health consumers increase their self-awareness and to develop healthier coping skills.
SOCIAL INTERACTION
Most communities throughout the United States expect individuals
to have the capacity to cultivate predictable and trusting relationships with other people
and, thus, be able to earn money from steady employment. Communities also expect
individuals to have the capacity to manage their income and use it to acquire goods and
services, like food, clothing, shelter, medicine, transportation, and education, among
others.
Dual disorders often impede a person’s ability to develop and/or utilize effective
social skills and life-management skills. As a result, many people with dual disorders end
up underemployed, unemployed, without healthcare, and alone. Through its clinical
consultation services, the SAMI CCOE educates service providers about the ways in which
dual disorders inhibit effective social interactions and life-management skills.
The SAMI CCOE educates providers about the importance of including primary caregivers of persons with dual disorders in clinically based social interventions. Inclusion is
important for a number of reasons. Caregivers are typically family members, neighbors, or
friends who have been providing ongoing financial and emotional support to consumers. As a
result, they can help service providers develop comprehensive assessments and treatment
plans by providing important information about the history and current status of
consumers. By providing continuous support to consumers, caregivers often experience a lot
of financial and emotional burden. Clinically based social interventions like multiple
family group therapy may help caregivers find new ways to fulfill unmet needs. Research
has shown that the involvement of caregivers significantly increases a person’s
chances of managing symptoms, improving social interactions and coping skills, and
recovering from dual disorders.
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"Recovery is a personal process of overcoming the negative impact of a psychiatric disability despite its continued presence."
– Ohio Department of Mental Health
RECOMMENDED RESOURCE
Implementing IDDT: A step-by-step guide to stages of organizational change (booklet) | get resource |
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