PowerPoint Slides for On-Demand Webinar

Terms, Conditions of Use, & Disclaimer

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the Crisis & Trauma Resource Institute.

All information provided is for educational and informational purposes only. It is not intended to provide individual counselling or advice and should not be relied upon for such purposes.

W E E N V I S I O N A W O R L D W H E R E E V E R Y O N E I S T R A U M A - I N F O R M E D .

www.ctrinstitute.com info@ctrinstitute.com 1.877.353.3205

Addictions and Mental Illness

TRAINER: SHERI COBURN, MSW, RSW

Working with Co-occurring Disorders

OUR HISTORYPA R A LLE L O R D I V E RGENT TR EATM E NT

ADDICTION

MENTAL ILLNESS

© C R I S I S A N D T R A U M A R E S O U R C E I N S T I T U T E

PARALLEL TREATMENT

Mental IllnessProfessional/expert approach

Recovery is managing symptoms

Medical model/empowerment-based

Medication-based

Mental illness is primary diagnosis

AddictionsPeer approach/self-help

Recovery is establishing and maintaining sobriety

Confrontation & Support

Spiritual growth

Addiction is primary condition

© C R I S I S A N D T R A U M A R E S O U R C E I N S T I T U T E

CIRCULAR CAUSALITY

Addiction Mental Illness

© C R I S I S A N D T R A U M A R E S O U R C E I N S T I T U T E

BEYOND THE CHICKEN & THE EGG

Third Factor –e.g., Trauma

Mental Illness

Addictions

© C R I S I S A N D T R A U M A R E S O U R C E I N S T I T U T E

SEEING THE WHOLE PICTURE

Addictions

Third Factor

Mental Illness

© C R I S I S A N D T R A U M A R E S O U R C E I N S T I T U T E

INTEGRATED TREATMENT

• Started in late 80’s/early 90’s

• Focus on treating both addictions and mental illness

as DUAL PRIMARY diagnoses

• Emphasis that all interventions need to be relevant

to both the mental illness and addiction

• Interventions based on positive, strength-based,

hopeful relationship with a caregiver

• Motivation-based approaches

© C R I S I S A N D T R A U M A R E S O U R C E I N S T I T U T E

COMMON THEMES:PRO B LE MS

Danger

Hopelessness, Helplessness,

Powerless

Isolation

© C R I S I S A N D T R A U M A R E S O U R C E I N S T I T U T E

COMMON THEMESI N TE RVENTI ONS

Safety

Empowerment

Connection

© C R I S I S A N D T R A U M A R E S O U R C E I N S T I T U T E

IMPORTANT INFORMATION

• Person outside of the

problem

• Strengths

• Resources

oFormal and informal

oSafety

• Goals/preferred direction

• Obstacles

oCurrent and history of violence/trau

oMental health concerns

oAddictions

oMedical issues

• Motivation

© C R I S I S A N D T R A U M A R E S O U R C E I N S T I T U T E

GETTING TO KNOW THE PERSON

• Interests, hobbies, important people in their lives

• Pets

• Favourites…

• What would you like me to know about you?

• How would _________ describe you? What story would they share that

demonstrates that?

• Is there a question you wish I would have asked?

O UTS I D E O F TH E PRO B LE M

© C R I S I S A N D T R A U M A R E S O U R C E I N S T I T U T E

EXPLORING STRENGTHS

• Resilience• Determination• Friendship• Fairness• Justice• Kindness

• Helping• Sharing• Compassion• Thoughtfulness• Self control• Patience

S H A R E A STO RY O F …

© C R I S I S A N D T R A U M A R E S O U R C E I N S T I T U T E

THE CO-OCCURRING SPECTRUM

Mental Health Continuum

(vulnerability/stress)

Addiction Continuum (compulsive coping)© C R I S I S A N D T R A U M A R E S O U R C E I N S T I T U T E

THE CO-OCCURRING SPECTRUM

Mental Health Continuum

(vulnerability/stress)

Addiction Continuum (compulsive coping)

Severe Mental Illness

Low-LevelAddiction

Severe Mental Illness

Severe Addiction

Low-Level Mental Illness

Low-LevelAddiction

Low-Level Mental Illness

Severe Addiction

© C R I S I S A N D T R A U M A R E S O U R C E I N S T I T U T E

BARRIERS TO ASSESSMENT & TREATMENT

• Lack of awareness on the part of the caregiver

• Lack of time or failure to allocate enough time or resources to

do a proper assessment

• Shame/fear on the part of the person coming for help

• Denial on the part of the person coming for help

• Lack of trust in the caregiver by the person coming for help

© C R I S I S A N D T R A U M A R E S O U R C E I N S T I T U T E

MANAGING THE CAREGIVER’S AGENDA

• Basic self-care (eating, sleeping,

hygiene routines)

• Coping skills

• Social relationships

• Housing

• Family relationships

• Addictive behaviours

• Professional relationships

• Leisure activities

• Support networks

• Relationship with themselves

• Past issues

• Exploring family, cultural, &

language roots

• Spirituality

• Medication compliance© C R I S I S A N D T R A U M A R E S O U R C E I N S T I T U T E

THEMES WITHIN INTERVENTION

INTEGRATED TREATMENT

Motivation-Based Work

Safety and Harm

Reduction

Client-Centred

Approach

Emotional Regulatio

n

© C R I S I S A N D T R A U M A R E S O U R C E I N S T I T U T E

HARM REDUCTION

• Harm reduction is not permission to use.• Harm Reduction is about:oAssessing the current levels of risk and harmoUnderstanding the underlying needs being metoWorking systematically at a realistic rate to increase

safety and reduce harm and riskoWorking systematically to meet the underlying needs in

safer, more permanent waysoHaving goals that are realistic and achievable by the

individual

© C R I S I S A N D T R A U M A R E S O U R C E I N S T I T U T E

Termination

STAGES OF CHANGE

( P R O C H A S K A , N O R C R O S S A N D D I C L E M E N T E , 1 9 9 4 )

Pre-contemplation

Contemplation

Preparation

Action

Maintenance

19© C R I S I S A N D T R A U M A R E S O U R C E I N S T I T U T E

STAGES OF CHANGE SPIRAL

© C R I S I S A N D T R A U M A R E S O U R C E I N S T I T U T E

EMOTIONAL REGULATION

• Identifying and understanding emotions

• Strategies for sitting with strong emotions

• Strategies for moving past strong emotions

© C R I S I S A N D T R A U M A R E S O U R C E I N S T I T U T E

INCLUSION

• Caregiver is a therapeutic guide for the individual seeking help

• The caregiver is cognisant of not pushing their own agenda

• Approach is client-centred with a focus on highlighting healthy attachment between client and service provider

• Focus is on meeting the client’s perception of their needs vs. meeting the caregiver’s or treatment program’s objectives

© C R I S I S A N D T R A U M A R E S O U R C E I N S T I T U T E

ATTACHMENT FOCUS

• The therapeutic relationship is key in working with co-occurring disorders

• Helps heal past insecure attachments

• Sets the stage for building new coping skills, learning boundaries; regulating and attuning to others

• Builds confidence in one’s ability to manage and work through distress

• Provides an example of predictable attachment outside of substance use

© C R I S I S A N D T R A U M A R E S O U R C E I N S T I T U T E

COLLABORATIVEINTERVENTION STRATEGY

DISTRESS (LAPS)

Acknowledge & Validate

Goals

Support Attempts to

Realize Goals

Support Fine Tuning

of Goals

Explore New Reality

LAPS:

Listen for Distress

Acknowledge Present Distress

Prioritize the Distress

Soothing Distress

© C R I S I S A N D T R A U M A R E S O U R C E I N S T I T U T E

COLLABORATIVE INTERVENTION STRATEGIES

Intervention happening on two levels:

Surface: • Individual sets goals for their life in the areas of both

addictions and their mental health

Deeper Level: • Caregiver is continually paying attention to the level of

distress being experienced by the individual seeking help• Relationship development becomes the foundation for the

ongoing success of treatment

© C R I S I S A N D T R A U M A R E S O U R C E I N S T I T U T E

PROCESS OF RECOVERY

Denial of both addiction and mental illness

Acceptance of one/denial of other

Acceptance of both mental illness & addiction

Understanding connection between the two, integrating change

© C R I S I S A N D T R A U M A R E S O U R C E I N S T I T U T E

SUMMARY

• An integrative vs. parallel treatment plan is imperative –it requires a collaboration between both addiction and mental health caregivers and integration of their treatment’s approaches.

• Effective intervention strategies consider motivation, safety, pacing, inclusion, and emotion regulation as integral in helping people navigate their healing.

• Collaborative interventions blend the importance of goal setting with relationship building, recognizing the relevance of healthy attachment in the recovery process.

© C R I S I S A N D T R A U M A R E S O U R C E I N S T I T U T E

* Follow us on LinkedIn and Facebook to receive notices

ADDITIONAL EVENTS & RESOURCES

• Other Public Workshops

• On-Location Training

• Live and On-Demand Webinars

• Blog Articles

• Free Monthly Webinar

© C R I S I S & T R A U M A R E S O U R C E I N S T I T U T E