1. Essentials for Teen and AdultSubstance Use: Mastery of CBT,
MI,and Integrated Treatment INTEGRATED TREATMENT
2. OBSTACLES SOLUTIONS Clinicians expectations Cast a wide net
History of sanctions, Openly discuss clinicians legal leading to
client secrecy responsibilities, clients legal Legal concerns,
control over clients Finances custody, steps for regaining custody
of children control Clients inability to provide Gather as much
information as accurate information possible
3. To identify clients with substance use problems Cast a wide
net Ask directly about substance use Explore past use of substances
before current use Use lab tests to screen for substance use
Explore interactions between substance use and the course of mental
illness Use instruments which invite self-disclosure DALI
4. Characteristic Correlate Characteristic Correlate with SA
with SADemographic Present Gender Male Antisocial personality
disorder in adulthood Age Young Poor education Low Marital status
Not married Medication and psychosocialHistory treatment compliance
Family history of SUD Present High Conduct disorder in Present
Violent/disruptive behaviorchildhood Depression High premorbid
social Good Suicidality Highfunctioning High trauma and PTSD
Present Legal system involvement Homelessness Present
5. Classify the nature of the substance use problem Determine
substance use diagnoses per DSM for abuse Any problems related to
drug or alcohol use (social, legal, school, or employment,
physical, psychiatric, use in dangerous situations) . . ..if yes, .
. . . Determine substance use diagnoses per DSM for dependence Use
of more than intended Interference with other activities Continued
use despite knowledge of problems Marked tolerance, Withdrawal
symptoms
6. Classify the nature of the substance use problem Use Alcohol
Use scale, Drug Use scale (Handouts) Rate worst period of use Tap
multiple sources Base ratings on team consensus If SUD detected,
then do functional assessment (Handout) to determine areas of
impairment Handouts: Alcohol Use Scale Revised Drug Use Scale-
Revised
7. Set goals with client that address substance abuse , mental
illness in concurrent treatment Address pressing needs Evaluate
client motivation to address SA Identify treatment goals and target
behaviors Assess clients adjustment, focusing on role of substance
use Handouts = Functional Assessment , Functional Analysis Select
interventions to achieve goals Choose measures to monitor outcomes
Update treatment plans at least every 6 mo.
8. SKILLS and STRATEGIES
9. Definition: Client has irregular contact with dual-
diagnosis clinician or case manager Goal: To establish a working
alliance, increase the clients communication about substance use or
mental illness Understandings The Client-Counselor Relationship
will later serve as basis for modifying substance use behavior
Client must develop the motivation, skills and supports to lead
healthier lifestyle
10. STRUCTURING EXPLORING CASE MGMT STRATEGY STRATEGY Outreach
Create structure OARS skills Practical Open the session Open
questions assistance Ask how the client is Affirmations Reflective
Crisis intervention Set the agenda Set limits listening Social
networks Pace the session Summaries Medication Close the session
with a Empathy/shared management wrap up or summary understanding
Guided Legal help exploration and Family meetings discussion Close
monitoring
11. Richard Wife 11
12. STRUCTURING STRATEGEY Create Structure Listen for setting
of session time limits: we have about 50 minutes. . Listen for
agenda-setting: Mostly, Ill be listening. EXPLORATION STRATEGY,
Motivational (OARS skills) Open questions: Listen for: What is
happening that brings you here?and Is there anything that does help
you feel better when youre going through that? Affirmations: Listen
for: Together you were very strong, didnt need any help. Express
empathy: Listen for: umm, Im sorry.There is a lot of worrying going
on. Summaries: Listen for:couple of nights youre not sleeping,
couple of drinks. . . .
13. CASE MGMT STRATEGIES CHANGE STRATEGY (MOTIVATIONAL SKILLS)
Practical assistance. Reinforce honest communication Provide
information: about substance use: Listen for: . .we have people
that we Listen for: That helps. call case managers who will look at
things related to food or heat that Develop discrepancy: are really
causing problems for our Listen for: It helps in some ways,
clients. but in other ways, its not h Provide practical help and
support helping enough, so here you are. Listen for information
concerning case management, food, heating Support self-efficacy :
help, entitlements, resources, Listen for: It takes a lot of
paperwork. strength to come here. . .to even find out what were
about. . .
14. 1. In the Engagement stage of Integrated Treatment, the
best course of action is to use Motivational skills - True -False2.
Motivational Skills include which 3 of the following: Open
questions Affirmations CBT Reflective Listening Functional
analysis
15. 3. Simple reflective listening often attains good results
with dually-diagnosed clients True -False4. Integrated treatment
practice assumes that medication compliance is often problematic
with dually diagnosed clients True -False5. It is appropriate for a
counselor using Integrated Treatment to help the dually diagnosed
client obtain access to a range of resources to assist him or her
manage problems such as legal issues, transportation and medical
issues. True -False