Evidence-Based Practices:
Shaping Mental Health Services Toward Recovery
Co-Occurring Disorders:
Integrated Dual Disorders Treatment
Integrated Dual Disorders Treatment Workbook
Introduction
WHAT IS THIS WORKBOOK ABOUT?
This workbook aims to help clinicians learn about substances of abuse and to develop the basic skills needed to help people with substance abuse and mental illness (dual disorders) recover from both disorders. In this book, "recovery" means that the client is learning to master both illnesses in order to pursue personally meaningful life goals.
This book assumes that because dual disorders are so common, all clinicians need to learn basic skills to foster recovery. We also assume that clinicians, like others, learn in different ways. Some read textbooks, some prefer training videotapes, some rely on supervision, and some like practical, vignette-oriented workbooks like this one. We recommend that you give this book a try and see if it works for you.
WHAT DOES THE WORKBOOK COVER?
This workbook covers the basic information needed to treat persons with dual disorders. Many mental health clinicians have already received training and supervision on treatment of mental illness, but they need to acquire basic skills to address co-occurring substance abuse. This workbook will help clinicians learn substance abuse treatment skills. For this purpose, we assume that every clinician needs four basic skills: (1) a working knowledge of common substances of abuse and how they affect mental illnesses, (2) an ability to assess substance abuse, (3) the skills to provide motivational counseling for clients who are not ready to acknowledge substance abuse and pursue recovery, and (4) the skills to provide integrated substance abuse counseling for clients who are motivated to address their problems with substance use.
Treatment for people with dual disorders is more effective if the same clinician or clinical team helps the client with both substance abuse and mental illness. That way the client gets one consistent, integrated message about treatment and recovery. This workbook will help you learn the skills to provide effective integrated dual disorder treatment.
HOW SHOULD YOU USE THE WORKBOOK?
Use this workbook in any way that fits your learning style! Supervisors may want to use the book to teach skills to clinicians, or to review the basic skills for themselves and to teach them without using the book. Some clinicians like to read the entire book at once, but most prefer to read one chapter at a time and discuss it with their treatment team members or colleagues. The book is designed so that each chapter begins with a vignette that describes a person who has problems typical of many people who have dual disorders, and then continues with a discussion of the chapter topic. One way to use the book is to read the vignette and discuss it before you read discussion in the rest of the chapter. The discussion comes from experts in the field who have been providing integrated dual disorders treatments for years, so you can examine your own ideas in relation to theirs. There is of course no one "correct" way to do clinical work, but hopefully you will find the comments by experts helpful in developing your own thinking.
HOW IS THE WORKBOOK ORGANIZED?
Each chapter has an introduction to the concepts, a vignette, and comments from experts about some of the issues raised by the case, and recommendations for further reading. Chapter 1 provides definitions of common terms used when talking about substance use disorders. Chapters 2-5 address the effects of substances of abuse and how they impact a person with mental illness. Chapter 6 reviews the stages of treatment. Chapters 7-15 discuss different types of clinical skills. Chapters 7-12 cover skills for stage-wise treatment of dual disorders. The final three chapters, 13-15, cover special topics of family treatment, group treatment, and self-help involvement, which may not be basic skills but are topics that every clinician will want to know something about. Chapter 16 covers infectious diseases that are common and serious in persons with dual disorders.
In each chapter, the case vignette presents common problems but also some interesting twists, such as an elderly client, a person who is homeless, or a person from a minority background. These are offered to stimulate you to think about the many special issues that arise in the context of doing this work.
Many terms can be used to describe people giving or receiving treatment. For this workbook, we chose to use the word "client" to describe persons working with treatment providers. We use case manager, clinician, and counselor to describe the people providing services. We interchange pronouns, using he or she to describe clients and clinicians at different times. We use "family" to describe a relative or spouse.
We hope you enjoy this workbook. Please let us know what you like, dislike, and how you used it by contacting the main author at the address in front of the workbook. Thanks.
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