20/03/2018 by The Way Recovery
What does Co-Occurring Disorders mean?
Co-occurring disorders refers to co-occurring substance use (abuse or dependence) and mental disorders. Clients said to have co-occurring disorders have one or more disorders relating to the use of alcohol and/or other drugs of abuse as well as one or more mental disorders. A diagnosis of co-occurring disorders (COD) occurs when at least one disorder of each type can be established independent of the other and is not simply a cluster of symptoms resulting from the one disorder.
Co-occurring disorders refers to co-occurring substance use (abuse or dependence) and mental disorders. Clients said to have co-occurring disorders have one or more disorders relating to the use of alcohol and/or other drugs of abuse as well as one or more mental disorders. A diagnosis of co-occurring disorders (COD) occurs when at least one disorder of each type can be established independent of the other and is not simply a cluster of symptoms resulting from the one disorder. Many may think of the typical person with COD as having a severe mental disorder combined with a severe substance use disorder, such as schizophrenia combined with alcohol dependence or a person with alcohol dependence combined with a depressive disorder or an anxiety disorder. Efforts to provide treatment that will meet the unique needs of people with COD have gained momentum over the past 2 decades in both substance abuse treatment and mental health services settings.
In the late 1970s, practitioners began to recognize that the presence of substance abuse in combination with mental disorders had profound and troubling implications for treatment outcomes. This growing awareness has culminated in today’s emphasis on the need to recognize and address the interrelationship of these disorders through new approaches and appropriate adaptations of traditional treatment. In the decades from the 1970s to the present, substance abuse treatment programs typically reported that 50 to 75 percent of their clients had COD, while corresponding mental-health settings cited proportions of 20 to 50 percent. During the same period of time, a body of knowledge has evolved that clarifies the treatment challenges presented by the combination of substance use and mental disorders and illuminates the likelihood of poorer outcomes for such clients in the absence of targeted treatment efforts.
A variety of screening and assessment tools are available for primary care practitioners. These screening and assessment tools can help determine if the need for further assessment is necessary, provide background on a client’s substance use and mental health disorders and the severity, and estimate how effective they respond to interventions.
The Quadrants of Care, developed by the National Association of State Alcohol and Drug Abuse Directors (NASADAD) and the National Association of State Mental Health Program Directors (NASMHPD), is a useful classification of service coordination by severity in the context of substance abuse and mental health settings. The NASADAD–NASMHPD four-quadrant framework provides a structure for fostering consultation, collaboration, and integration among drug abuse and mental health treatment systems and providers to deliver appropriate care to every client with COD.
The use of proper medication is an essential program element, helping clients to stabilize and control their symptoms, thereby increasing their receptivity to other treatment. Pharmacological advances over the past few decades have produced more effective psychiatric medications with fewer side effects. With the support of better medication regimens, many people with serious mental disorders who once would have been institutionalized, or who would have been too unstable for substance abuse treatment, have been able to participate in treatment, make progress, and lead more productive lives.
There are several well developed and successful strategies from the substance abuse field that are being adapted for COD.
Motivational Interviewing - Is a client-centred, directive method for enhancing intrinsic motivation to change that has proven effective in helping clients clarify goals and commit to change. MI has been modified to meet the special circumstances of clients with COD, with promising results from initial studies to improve client engagement in treatment.
Contingency Management - CM maintains that the form or frequency of behaviour can be altered through the introduction of a planned and organized system of positive and negative consequences.
Cognitive Behavioural Therapy - Is a general therapeutic approach that seeks to modify negative or self-defeating thoughts and behaviours and is aimed at achieving change in both. CBT uses the client’s cognitive distortions as the basis for prescribing activities to promote change. Distortions in thinking are likely to be more severe with people with COD who are, by definition, in need of increased coping skills. CBT has proven useful in developing these coping skills in a variety of clients with COD.
Relapse Prevention - The goal of RP is to develop the client’s ability to recognize cues and to intervene in the relapse process, so lapses occur less frequently and with less severity. Relapse Prevention Therapy, has been specifically adapted to provide integrated treatment of COD, with promising results from some initial studies.
The Modified Therapeutic Community - Is a promising residential model from the substance abuse field for those with substance use and serious mental disorders. The MTC adapts the principles and methods of the therapeutic community to the circumstances of the client, making three key alterations: increased flexibility, more individualized treatment, and reduced intensity. The latter point refers especially to the conversion of the traditional encounter group to a conflict resolution group, which is highly structured, guided, of very low emotional intensity, and geared toward achieving self-understanding and behaviour change
Co-occurring disorders should be treated not by a single person but by a team of treatment professionals, all of whom are not only specialists in their own fields. This team should work closely together to create the treatment plan and then to continually assess the progress of the individual to ensure that all the therapies and treatments chosen are not only helping the individual to move forward and accomplish recovery goals but also that none of the treatments are potentially holding up progress in other areas.
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