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Issues, Settings & Models of Care for Persons with Co-occurring Disorders. Arthur J. Cox, Sr., DSW, LCSW “2005 National Forum on Clinical Skill Building for Co-occurring Disorders September 22-23, 2005 Orlando, FL. Arthur J. Cox, Sr., DSW, LCSW. President/CEO

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Issues settings models of care for persons with co occurring disorders

Issues, Settings & Models of Care for Persons with Co-occurring Disorders

Arthur J. Cox, Sr., DSW, LCSW

“2005 National Forum on Clinical

Skill Building for Co-occurring

Disorders

September 22-23, 2005 Orlando, FL


Arthur j cox sr dsw lcsw
Arthur J. Cox, Sr., DSW, LCSW

  • President/CEO

  • The Mid-Florida Center for Mental Health and Substance Abuse Services, Inc.

  • P. O. Box 33

  • Avon Park, FL 33826

  • (863) 452-6818

  • Fax (863) 452-6617

  • E-mail: [email protected]

  • Website: www.midfloridacenter.com


Cod resources
COD Resources

  • SAMHSA’s Co-Occurring Center for Excellence atwww.coce.samhsa.gov

  • Co-Occurring Dialogues Discussion List: Membership is free and unrestricted and can be done by sending an e-mail to [email protected]

  • Co-Occurring State Incentive Grants (COSIG) and Policy Academies: see SAMHSA website for information at www..samhsa.gov

  • Reports (see COCE website)


Mfc a fully integrated treatment organizations for co occurring disorders
MFC:A Fully Integrated TreatmentOrganizations for Co-occurring Disorders

  • One program that provides treatment for both disorders.

  • Client’s mental and substance related disorders are treated by the same clinicians.

  • Clinicians are continuously cross-trained to treat multiple disorders.

  • Focus is on preventing anxiety rather than breaking through denial.

  • Agency offers stagewise & motivational counseling.

  • 12 Step support groups attendance are required or available.

  • Psychiatric evaluations and psychpharmacotherapies are available


Coce core products and services
COCE Core Products and Services

  • The COCE Web Site www.coce.samhsa.gov

  • Overview papers, technical reports, and other products

  • Technical Assistance

    Direct requests to:

    Email: [email protected]

    Phone: 301-951-3369

  • Meetings and conferences

  • Pilot evaluation of the Performance Partnership Grant (PPG) measure


Overview of co occurring disorders
Overview of Co-occurring Disorders

  • Prevalence & Trends

  • Heterogeneity & Special Populations

  • Shift towards Integrated Assessment and Treatment

  • Effective approaches, Models & Strategies

  • Training Needs

  • Recent Development at Federal, state and community levels


Use

  • drink / use to be social and on social occasions (sometimes referred to as social or recreational use)

  • occasionally drink or use for the intoxicating effects

  • drink / use occasionally, for example a couple of times a month to a couple of times per year

  • typically drink 1 - 2 drinks per drinking occasion, sometimes more; may leave drinks unfinished

  • drink or use to intoxication only occasionally; episodes of intoxication do not interfere with life functioning

  • have never experienced life problems as a result of drinking or using


Abuse
ABUSE

  • drink or use for the effect of feeling drunk or high

  • frequently drink to intoxication and use to the point of significant impairment

  • have experienced at least one life problem associated with the use of drugs or alcohol

  • continue to use despite life problems associated with using

  • are starting to experience increased tolerance to alcohol and drugs of abuse

  • often drink or use alone in order to avoid hassles from family or friends

  • drink or use on weekends in order to avoid disruptions to work or school schedules

  • engage in illegal activity related to use; arrests / legal problems resulting from use

  • See TIP 42, PP 22-23, Burton, Cox & Fleisher-Bond, 2001


Dependence
DEPENDENCE

  • drink or use because of a compulsion, (i.e. “have to”)

  • drink or use constantly, often daily

  • almost always drink to intoxication and use to the point of significant impairment

  • drink or use to avoid withdrawal

  • have experienced numerous problems in several areas of life functioning and continue to use despite these problems

  • suffer from the disease of addiction, marked by loss of control

  • have marked tolerance to alcohol and drugs of abuse

  • may experience withdrawal when use is discontinued

  • TIP 42, P.23, Burton, Cox, & Fleisher-Bond, 2001, P. 23


Defining loss of control
Defining Loss of Control

  • using more than intended or over a longer period of time than intended

  • unsuccessful efforts to reduce, control or discontinue use, (i.e. being unable to keep promises to self and others to quit, relapsing following treatment interventions)

  • excessive time spent getting substances, using them and/or recovering from their effects

  • continuing to use despite the presence of intense physical and/or psychological problems created or worsened by use (APA, 1994), TIP 42, PP 21-23.


Physiological dependence
Physiological Dependence

  • increased tolerance: requiring more and more of a substance in order to get the desired effect, (i.e. “I used to catch a buzz on one or two beers, now I can drink a six pack and not really feel it.”); decrease in the desired effect when the same amount of a substance is taken (APA, 1994)

  • withdrawal: experiencing physical symptoms of the withdrawal syndrome for the specific substance taken upon discontinuing use; the symptoms cause impairment in functioning; continuing to use a substance in order to avoid withdrawal (APA, 1994)


Mental disorders
Mental Disorders

. Disorders are defined by:

  • sets of symptoms that,

  • occur over time, and

  • lead to an inability to function the way a person wants to or is required to.

  • Further, they do not occur exclusively during the course of substance use, and

  • are not better accounted for by medical conditions


Classifying mental disorders
Classifying Mental Disorders

  • Psychotic Disorders: schizophrenia, all types; other psychotic disorders

  • Mood Disorders: depressive disorders, all types; bipolar disorders, all types

  • Anxiety Disorders: phobias, PTSD, generalized anxiety disorder, panic disorder

  • Behavioral Disorders: personality disorders, all types (clusters A, B, and C)

  • TIP 42, PP23-26, Burton, Cox, Fleisher-Bond 2001, PP 35-42


Quadrants of care
QUADRANTS OF CARE

  • Category I –Mental & substance related disorders are both less severe –primary health.

  • Category II – 50% of behavioral health clients – mental disorders – cmhc

  • Category III – Majority of COD – SA/MH/Jails

  • Category IV – Chronic MI/SA - ???

  • Figure 2-1 Tip 42, p29


Components of integrated treatment basic competencies
Components of Integrated Treatment: Basic Competencies*

What Substance Abuse Professionals

Need to Know

  • the nature of mental disorders and their development

  • symptomatology of mental disorders and other functional disorders

  • psychosocial difficulties resulting from mental disorders

  • the necessity of psychotherapeutic medications in the treatment of mental illness

  • effective psychiatric treatment interventions

  • substance abuse treatment interventions that may prove detrimental to persons with mental disorders


Components of integrated treatment
Components of Integrated Treatment

What Mental Health Professionals

Need to Know

  • the nature of addictive disorders and their treatment

  • symptoms and hallmarks of addictive disorders

  • psychosocial difficulties that arise from chronic substance use

  • psychotherapeutic agents that may prove detrimental to persons with substance-related disorders

  • effective substance abuse treatment interventions

  • mental health treatment interventions that may prove detrimental to persons with substance-related disorders


What professionals from both fields need to know
What Professionals from Both Fields Need to Know

  • the nature of substance abuse and mental illness as they co-occur

  • strategies for meeting the special treatment needs of persons with co-occurring disorders

  • basic competencies for assessing other functional disorders that impact the clinical picture

  • strategies for offering treatment interventions for other functional disorders

  • strategies for assessment and differential diagnosis; assessing for ‘multiple disorders’

  • common myths and misconceptions about co-occurring disorders

  • methods for blending treatment interventions and developing competent programming

  • comprehensive understanding of relapse when disorders co-occur

  • how best to assess / treat special populations (women, youth the elderly, alternative lifestyle, HIV/AIDS, persons of color)


Questions
Questions

  • Questions and Comments from attendees


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