Introduction to IDDT and Harm Reduction Trreatment, Susan Doig

Transcription

Introduction to IDDT and Harm Reduction Trreatment, Susan Doig
Introduction to IDDT and Harm Reduction
Treatment
Susan Doig, LCSW, CADC
Chief Clinical Officer
Trilogy, Inc
What are Dual Disorders?
• Mental Illness and Substance Use disorders
occurring together in one person
Risk Factors
• 50% of persons with serious mental illness also have
substance abuse issues
• Being dually diagnosed is associated with high rates of the
following:
– Relapse
– Hospitalization
– Violence
– Incarceration
– Homelessness
– Serious Infection (HIV, hepatitis)
*as noted from “Implementing Dual Diagnosis Services for clients with severe
Mental Illness” Drake, et al. 2001
Traditional Treatment
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Non-integrated approach
Treats each disorder separately
Requires navigation of two separate systems
Office based
Traditional Treatment
• 12 step approaches have not had positive
results with dually disordered individuals
• Cognitive impairment can detract from
understanding information
• Confrontational approaches used in SA
treatment are not well tolerated
• Frustration and dropout may result from
requirements of abstinence
What is Dual Disorders Tx?
• An integrated, multidisciplinary approach
– Assertive outreach
– Engagement (motivational interviewing)
– Skill building
– Building community supports
– Relapse prevention
What is Dual Disorders Tx?
• Provides wide array of services other than just
counseling such as: housing, medication
training, supported employment, etc.
• No wrong door
• Non-linear: people do not move smoothly
from one stage to the next.
•
Drake et. al. 2001
Effectiveness of Dual Disorders Tx
• It’s an Evidenced Based Practice (EPB)
• Increases abstinence and helps people to cut
down use
• Better health outcomes
• Helps to improve outcomes for treatment
which helps to motivate the client to set
additional goals
Effectiveness of Dual Disorders Tx
• Many people attain stable remission of
substance use disorders over time
• Recovery encompasses other areas of
adjustment
• Health, work, housing, relationships
HARM REDUCTION
• Harm reduction: anything that reduces the
risk of injury whether or not the individual is
able to abstain from the risky behavior.
--- David Ostrow, M.D., Ph.D.
Challenges in working with people in
re-entry
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Gaps in health care coverage
Homelessness/housing upon release
Access to medications
Continuity with providers
Increase service use and cost
Non-integrated systems of care
Court and provider collaboration
• Court order treatment can increase
motivation to participate in tx
• Relapse can be difficult to manage
• Effective Communication is key
• Planned release
• QUESTIONS??