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 • • • • 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 • • • • • • 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??