Crisis Intervention with Individuals who have Substance Use Problems

1. Crisis Intervention with Individuals who have Substance Use Problems

2. Facts & Figures: • Lifetime prevalence of A & D diagnosis: 25%. • 11% of Americans are currently experiencing an alcohol or drug problem. • Alcohol is the nation’s #1 drug problem, involved in approximately 50% of all crimes (including traffic fatalities).

3. About half of individuals with A & D disorders have additional psychiatric diagnoses (dual diagnosis). 1/3 are misusing another drug. • A large proportion of crisis interventions and other emergency services (e.g., ER visits) are associated with substance misuse.

4. Substance Abuse: • Failure to fulfill role obligations. • Recurrent use in potentially dangerous situations. • Recurrent legal problems. • Continued use despite psychosocial problems resulting from substance use.

5. Substance Dependence: • Tolerance. • Withdrawal. • Loss of control/compulsive use. • Excessive time involvement. • Reduce involvement in other activities because of substance use. • Continued use despite obvious negative consequences.

6. Crisis as a Window of Opportunity

7. Potential Presenting Crises: • Severe intoxication, overdose, medical problems, or withdrawal symptoms. • Suicidal ideation/attempts. • Unemployment & financial losses. • Interpersonal problems (e.g., separation, date rape or partner violence). • Legal crises (e.g., DV/aggravated assault, child abuse/neglect, DUI’s, PD’s). • “Intervention”

8. Assessment Issues: • Typically referred by others and expected to undertake non-discretionary change. • Denial & Concealment: need collateral information. • Ask about what and how much was ingested. • Need for medical evaluation? • Clients may present with consequences of abuse, rather than abuse itself. • Dual diagnosis (as much as 50%).

9. Intervention Strategies: • Try to prevent intoxicated clients from driving away. • Help client make connections between substance use and current problems. • Help client find leverage & incentives for change. • Education about process of addiction. • Referral for family members. • Reframe relapse as common and an opportunity for learning.

10. Referral Options: • Self-helps groups (AA, NA, Rational Recovery). • Psychoeducation (e.g., DUI programs). • Outpatient: individual, group, or family therapy. • Intensive outpatient treatment. • Partial Hospitalization/Day Treatment • Residential treatment setting (e.g., Minnesota Model = 28 days). • Medical/Psychiatric hospitalization, which is typically reserved for clients who are dually-diagnosed or need medical detoxification. • Long-Term Behavioral Modification (e.g., Synanon).