1 Co-Occurring Disorders: Treating Mental Health and Substance AbuseErinn Nelson, MS, LPC, SAS-IT Lizzie Kriewald, MS, LPC, SAC

2 What You Will Learn . . . What are Co-Occurring DisordersHow this population affects our community Treatment planning and the process we take How we can plan for the future

3 What Does This Mean? Formally known as dual diagnosis or dual disorderThe presence of two or more disorders at the same time In our world: Mental health diagnosis and substance abuse diagnosis These are found in the DSM-V (Diagnostic Statistical Manual) The severity of their addiction is broken up into mild, moderate, severe (depending on the number of criteria they meet) Ask for questions? Any combination Examples: Bipolar Disorder and Alcohol use disorder or Major Depressive Disorder and Amphetamine use disorder Often self-medicating Depression = Stimulants Anxiety = Downers/Depressants

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5 Why Is This Important? According to a Substance Abuse and Mental Health Services Administration (SAMHSA) studies: 7.9 million adults in the United States have a co-occurring disorder Both mental health and substance use disorders can have biological, psychological, and social components, making co-occurring disorders difficult to diagnose. Which came first – chicken or the egg? The Criminal Justice System Many people who enter the CJ system have co-occurring disorders About 10 million adults each year enter US jails, about 700,000 of these individuals have co-occurring disorders Oftentimes is a failure to accurately assess/screen Assessments/screenings should be done by trained professionals, who can make appropriate referrals.

6 Why Is This Important? HomelessnessThis population often has a variety of issues that require services beyond behavioral health treatment, such as life skills development, employment assistance, and safe housing Of an estimated 600,000 people who are homeless on any given day, approximately 25-30% have a mental illness and as many as half of those individuals also have a substance abuse disorder Oftentimes these services are not available due to: Lack of resources in community No healthcare/insurance THEREFORE – may go undiagnosed/untreated This equals: Chronic homelessness and further deterioration of physical and behavioral health, as well as social and economic functioning. The resources we do have should focus on: Mandatory screening/assessments to diagnose co-occurring disorders Further referrals

7 Why Is This Important? Homelessness Maslow’s Hierarchy of Needs

8 Why Is This Important? Veterans1/3 of veterans seeking treatment for substance use disorders also met criteria for PTSD This only accounts for those seeking services A percentage of this population is also struggling with homelessness

9 Levels of Care Outpatient Intensive Outpatient Day TreatmentExample: Peaceful Solutions Counseling & Compass Counseling Intensive Outpatient Example: North Central Health Care & Wausau Health Services Day Treatment Example: North Central Health Care, Northwest Journey, & Horses Treat Medically Monitored Treatment Example: MMT Program at North Central Health Care & Koinonia Inpatient/hospitalization Example: St. Elizabeth’s Hospital & L.E. Phillips Involuntary Commitment 3 Party Commitments and interventions

10 Treatment Planning Always screening for both Assessing needsWe are treatment planning from day 1 Assessing needs If there is an AODA concern it is always the primary focus May resolve the MH concern after use subsides Examples (anxiety may be due to withdrawal) May not give MH diagnosis or make notes to rule things out due to substance use Short vs. Long-Term Goals All AODA clients are given short and long-term goals Do this to meet Maslow’s needs, so long-term goals can be reached successfully Usually a six-month minimum of treatment due to the numerous barriers that exist COLLABORATION Crucial for these individuals to increase their support network We include family, providers, support groups, etc. to accomplish this goal

11 The Treatment Process Sober vs. Recovery BrainWhat is the difference? Definitions? Example: A – B – C Dry Drunk Brain When start using drugs we developmentally get “stuck” Brain not fully developed until our late 20s We are training our brains to only be able to solve our problems with substances We need to make new pathways to make changes Routine, structure, and REPITITION! Backwards Bicycle https://www.youtube.com/watch?v=MFzDaBzBlL0

12 The Treatment Process Areas of Life Affected (graph)Positive Daily Self-Care Should be used to correct the damage that has happened Self-Care Plans

13 The Treatment Process Other Methods Used: Motivational InterviewingCognitive Behavioral Therapy Thought Logs Mood Charts (include substance use) Solution-Focused Independent Living Skills Budgets, Nutrition, interpersonal skills, etc. Self-Help Groups (AA/NA) Crisis Planning/Contracts Psychoeducation Include family in this process Disease concept of addiction (family may be in denial about this) Deny AODA but acknowledge MH or vice versa

14 Early Prevention EDUCATION IS KEY! What Needs to Happen:Alcohol is the primary substance of abuse for 45% of Dual Diagnosis patients The biggest increase in use for any one substance in the 2000s has been prescription painkillers. About 21% of Dual Diagnosis patients are addicted to opiates (Oxycontin, Percocet, Lortab, etc.) What Needs to Happen: Early interventions in schools Increase awareness of the problem Example – Horace Mann Program ACES Study More routine assessments With primary care physicians In criminal justice system Women's shelters Get community involved De-stigmitize MH and addiction to lessen guilt/shame

15 Long-Term Recovery Maintenance Attending support groupsSponsorship Practicing daily self-care Being aware of triggers MEDICATION MANAGEMENT Safety Plans Recovery team versus family support Lapse versus relapse Spiritual, emotional/behavioral, chemical (relapse) Attending higher levels of treatment as necessary

16 Questions or Comments?

17 References F. (2016). Integrated Treatment of Substance Abuse & Mental Illness. Retrieved May 25, 2016, from S. (2016, March 08). Co-Occuring Disorders. Retrieved May 25, 2016, from U. (2003). Co-Occurring Mental and Substance Abuse Disorders: A guide for mental health planning advisory councils. Retrieved May 25, 2016, from