Essentials IT.2

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

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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

Essentials IT.2

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