Clinical Guide for Integrated Dual Disorder Treatment (IDDT)

1 Www .cen te rfo re bp .ca duFe at urin g Sta ge-W ise Tre atme ntAtrainingbookletfromCEN TE R FOREVIDENCE-BAS EDPRACTIC ES& its Ohi o SubstanceAbuse andMen ta l IllnessCoordinatingCen ter of Excell enceClinical Guid eIINNTTEEGGRRAATTEEDD DDUUAALLDDIISSOORRDDEERR TTRREEAATTMMEENNTTthe evidence-based practice2 Cli nic al G uide fo r IDD T | ter fore ase .ed u ver . 2012-10-22 CONSU LTI NG & TRAININGIN TEGRA TED D UA L D ISORDERTRE AT MENT F ID DT E: ANOV ERV IEW OF T HE EVID ENCE-BASE D PR ACT ICE 6- pa ge booklet, tri- fold for mat At- a-gla nce descriptions ofID DT s cor e components Us e f or education , t raining &cons en sus b uildingMEDI CAL PROF ES SIONALS &IN TEGRA TED D UA L D ISORDERTRE AT MENT F ID DT E 8- pa ge booklet At- a-gla nce descriptions of howID DT ca n en han ce medicalpra ctice Us e f or education , t raining &cons en sus b uildingID DT POSTER: S TA GES OFCH AN GE & T REAT MENT 18 ( w) x 2 4 (h) poster Tips for each sta ge of IDDTtr ea tme nt Dis pla y in your office as areminder of ID DT s cor ecomponent sIM PLE MENT ING I DDT.

2 A STE P-BY -ST EP GUI DE T O STAGE S OFORG ANIZ ATI ON AL CH ANGE 40-pag e booklet 5 s ta ges of cha nge, 8 to 10pra ctic al action st eps i n eachst age Use i n pl annin g a ndimplementation c ommitteesREA DINESS RUL ER 7 (w ) x 1. 75 (h) lami nat ed rul er 2 s ides: I mporta nce &Con fidence S cal es (z ero- to -10 ) Use t his to ol t o help peopl eev alua te the importa nce of th epers on al c ha nges they desire andthe ir c onfi den ce a bout makin gtho se cha ngesTHE SPI RIT O F MI |MO TIVA TIO NA L I NTE RV IEW IN G Audio C D 19 orig inal t ra cks, in tervi ews, t ip s Lea rn how M I en ha nces directpra ctic e wi th peo pl e w ho h av eco-o ccurr ing diso rders This booklet is part of an evolvin g consu lt ing and tra ining process from the Center for Evid en ce-BasedPractices (CEBP) at Case Wes te rn Reser ve Univers ity.

3 For more information about the Center , se e th e bac kco ve r of thi s booklet. F or more in formati on about Int egra ted Dual Disorder Tr ea tment (IDDT), theev ide nce -based practi ce, consult these res ources from our 2012-10-22ww nt er fo se. ed u|Cli ni cal Guid e for IDDTTABLE OF CONTENTS IDDT At-A-Glance | Pr oblem, So luti on , A Better ..4 Bel ie ve | You Do Make a Diffe re nc ..6 Acc ess to Qu al ity C ar e | Purpose of th is ..8 In teracti ng wi th Co nsumers | Th e Imp act of Cognitive ..10 Co-occurri ng Di sor ders | A Brie f Ove rvie w of the Continuum of Symptom Sev eri ty ..12 In teg rate d Primary ..14 Scr ee ning and Assessment | The Imp or tan ce of Continuous Ass ess ..16 Me nta l Hea lth Sc reening and Assessment ..18 Su bs tan ce Ab use Screening and.

4 19 Compre he nsi ve Assessment | Puttin g the P ieces Together ..22 Diagnos is a nd Eligi ..24 Sta gin g an d Tr eatment Planning ..28 Sta ge s of C hang e ..28 Sta ge -Wise Tr eatment ..32 Ps yc hos oci al Treatment ..33 Mo tiva tio nal In te rvi ew ing ..33 Me dica tio n Tr eatment ..34 Cl inic al Le adership ..38 Advocacy ..40 Fideli ty & O utc ..42 To bac co & Re cov ery ..44 Sou rc es & Re sou rc es ..46 ..50 Sta gin g & Sta ge -Wi se T re atment Table ..51 Our Center is participating in the national effort to help organizations integrate primary and behavioral healthcare services. Learn how Integrated services for co-occurringmental illness and substance use disorders candovetail into an Integrated primary and behavioralhealthcare solution. We encourage you to contact us for TEGR AT ED PRIMARY & BEHA VIOR ALHEAL THCA RE4 Cli nic al G uide fo r IDD T | ter fore ase.

5 Ed u ver . 2012-10-22 TWO DISORDERSR esearch shows the over 50 percent of people inthe United States who have been diagnosed w itha severe mental il lne ss will also have adia gn os able co-occurring substance u se Disorder (al co hol or oth er drugs) during their lifetimes(s ee Regier in Sources on page 46).SEP AR ATE SERV ICESHi sto ri cal ly, people with co-occurr ing dis or dershave been exc lud ed from mental healthtreat ment be ca use of their substance use ke wi se, they hav e been excluded fr omsubstan ce a buse tre atment because of their severement al hea lth symptoms. As a result, theyfreq uen tl y h ave not gotten the help they AT IV E LIFE OUTCOMESIndi vi duals w ith co-occurring disorders are morelik ely to ex perience the following: Recurring ps ychiatr ic episodes Co ntinued abus e of and dependen ce upon alcoholand other drugs Ho spitalizat ion and em erg en cy room vis it s Rela tio nship dif ficulties Vio lence Suicide Arr est and inca rce ra tion Unemplo yment Ho me les sne ss Poverty Inf ec tio us dise as es, s uch as HIV, hepatitis, andsexually t ra nsmitt ed diseases Co mpl icat ions res ulting from chr onic illn essessuch as diabetes and cancerIN TEG RA TED T REATMENTTh e In te gra ted Dua l D is or der Tre at ment ( ID DT)mod el co mbines s ubs ta nce a buse serv ic es wi thmental h ea lth se rvi ces an d helps peop le a dd ressboth d isor der s a t t he s ame ti me in the s ameser vic e or ga niz ati on by the same te am oftr eatm ent pr ov id ers.

6 IDDT is mult idis ciplin aryan d co mbin es p harma col ogica l, ps ycholog ica l,edu ca tio na l, a nd soci al in terv ent ion s t o a dd re ssth e ne ed s of consu mers an d t heir fa mil ymembers. I DD T a ls o pr omo tes c onsume r a ndfam ily i nvol ve ment in serv ice d el iver y, st ablehou si ng as a n eces sa ry condit ion f or recove ry, andempl oymen t a s a n e xp ect at ion f or tm en t i s i ndividua lize d t o a ddress the uniqueci rc umsta nce s of e ach pers on s li en t c ompone nt sIDDT is bui lt upon the fol lo win g core t reat mentchara cter ist ic s (c ompon en ts ): Mul ti dis cipl in ary T eam Co -oc curr in g Trea tment S pecialist s Sta ge- Wise In terv en tion s Ac ces s t o C omprehensive Services (e. g., r esi dential ,employment, et c.) Time- Un limit ed Servi ces Asser tiv e O ut reac h Mo ti vation al In terv en ti on s Substance- Abus e Coun sel ing Gro up Tr ea tment Fa mi ly Psyc hoe ducation Participa tion i n Alc oho l & Drug Sel f- Hel p G ro ups Pha rma col og ical Tr eat me nt In terv ent io ns t o P romo te Health Sec on da ry Interventio ns for Treat ment o f Non-Res pon ders Evi den ce- Ba se d Pr ac ti ce | EB PTh e U.

7 S . Substance Abuse a nd Menta l Heal thSe rvi ce s A dminist ra ti on (SAMHSA) endorse s t heIn teg rated D ual D iso rder Treatme nt (I DDT )mod el as a n e vi den ce-base d p ra cti MSOLUTI ONThe Integrate d Dual Disor der Tr eatment (IDDT) model was developed byRo be rt E. Dr ake , M. D., and hi s colle agues at t he Dartmouth Psychiatri cRe se arch Cen ter of Dar tmou th Me dica l Sc hool (see Sources on pag e 4 6).AT -A-G LANC E5ver. 2012-10-22ww nt er fo se. ed u|Cli ni cal Guid e for IDDTA BE TTER L IFEIM PR OVE D OUT COMESDe cr eas e Dur atio n, f re quency, and intensity ofsympto ms of mental illn es s and sub st anceus e diso rde rs Ho spitaliza tion Ar rest a nd incarcer at ion Dupl icat ion of s ervices Treatment drop-out Ut iliz ation of hig h-cost ser vicesA W ORD AB OUT WORDSMe di cal p ro fessio nal s o fte n re fer to p eople who have a sev ere me ntal il lnessand /o r substance use d isord er as pati ents.

8 Be havioral health care profe ssionalsoft en ref er to them as cl ie nt sor co nsumers. Many individuals and advocacyorg an izatio ns are not c omfo rtab le w ith any of these term s and w ould rather usethe ph rase pe ople withor peo ple whohave a health condition or th is b oo kl et, we wi ll us e th e w ord patient from tim e to time , bec ause this i s st ill th e l anguage that many me dical professionals use e ve ryday. Ye t, we a re al so usi ng th is b oo kle t to introduce r eade rs to the purpose of themulti disci pl inary I DD T te am. T hes e te ams are comp rise d of profe ssi onals whote nd t o use th e wor ds cli ent and co nsumer, so we will use this language as wel nally , we agree wi th th e co nsume r adv ocacy move men t w hic h ask s t hatpe ople wh o r ec eive se rvi ces b e tal ke d about and treate d as i ndivi dual s, not asdiag no ses.

9 All peopl e have ho pes, fear s, dreams, life-experie nc es , and a personalnar rat ive to tel l. W e al l ne ed s om eo ne to listen, to acknowle dge , t o re spect, toac cep t, t o enc oura ge .Incr eas e Abs ti ne nc e fr om use of al cohol an d o ther drugs Conti nuity of care Improved relatio nshi ps Cons umer q ua li ty-o f-l ife Sta ble hous ing Inde pendent li vi ngLI VI NG IN TH E COMMUNITYMos t pe ople with severe mental illness r ec eive trea tment in theleas t re st ric tive envir onment as possi bl e n ot in a hos pit al butin t he co mm un ity, where many social and econom ic s itua tionsand c irc um sta nces influence and affect their symptoms , hea lth,and w ell -being. These situations and ci rcumstan ces mayin clude t he fol lo win g: Access to sa fe, a ffordable, and st ab le housing Access to sa fe and nutritious food Access to competit ive employ me nt an d stab le income Medical ca re an d insurance Rela tio ns hip s wit h p ee rs/ friends Rela tio ns hip s wit h f am ily m embersCA TAL YST F OR C HA NGETrea tme nt pr ovi de rs who use the IDDT model donot forc e c han ges t o occur.

10 Consu me rs must do thedi ff ic ult wor k of change. In fact, re cov er y wouldnot oc cu r without each person s re ad in es s,wi ll in gn es s, and abil ity t o change . Ye t, it is likelytha t m any of th ese su cces s s tori es woul d not beoc currin g i f t hese s erv ice provi ders we re not giv ingcon su mers th e l evel of at ten tive ness t ha t I DDTprom ote s and suppor ts. You s ee, t he s trengt h of IDDT i s tha t i t as semblessom e ve ry u sefu l c on cept s a nd interventi ons into En gage with provide rs a nd id en tify pers onalgoal s Tal k h onestly about th eir use a nd a bus e o falc oho l, t obacco, an d a nd o ther dru gs Red uce a nd ev en tu all y elimin ate theirsu bst anc e u se Un der stan d a nd m an ag e the sym pto ms o fthei r mental Disorder s Att ain compet it iv e jobs in their lo calcommunit ies Remain o ut of the hos pit al Remain o ut of jail Att ain an d ma in ta in safe and s table ho us ing Att end su pport gr ou ps andps ychoed uca tional g rou ps Es ta bl is h s upportiv e soci al net works Im pr ov e the ir physic al hea lth and atte nt ionto persona l hygiene an d appeara nce In crea se t heir ec ono mic in dependenceYOU DO MAKE A DIF FERE NC EThere a re a growing nu mber of me di cal an d behavioral heal thc are p rof ess ion al saround t he cou ntr y who ar e bearing witne ss to pe rsonal transformati ons of pe op lewit h c o-occu rr ing