INTEGRATING TREATMENT FOR CO-OCCURRING …

NAADAC'S LIFE-LONG LEARNING SERIES

INTEGRATING TREATMENT FOR CO-OCCURRING DISORDERS:

AN INTRODUCTION TO WHAT EVERY COUNSELOR NEEDS TO KNOW

PARTICIPANT'S REFERENCE GUIDE AND WORKBOOK

? SECOND EDITION ? JUNE 2018

NAADAC, the Association for Addiction Professionals

44 Canal Center Plaza, Suite 301 ? Alexandria, VA 22314 Ph. 703.741.7686 ? 800.548.0497 ? Fax: 703.741.7698 Email: naadac@ ? Web:

Published in 2018 by NAADAC, THE ASSOCIATION FOR ADDICTION PROFESSIONALS 44 Canal Center Plaza, Suite 301, Alexandria, VA 22314

This publication was prepared by NAADAC, the Association for Addiction Professionals. All material appearing in this publication, except that taken directly from the public domain, is copyrighted and may not be reproduced or copied without permission from NAADAC. For more information on obtaining additional copies of this publication, call 703.741.7686 or visit .

Printed June 2018.

NAADAC'S LIFE-LONG LEARNING SERIES

A SPECIAL THANK YOU

NAADAC, the Association for Addiction Professionals, understands the need for continuous education and strive to provide addiction-focused professionals the latest training to remain knowledgeable and pursue best practices for clients. The addiction profession is constantly changing to reflect new research and new understanding of the populations we serve. As a result, NAADAC is providing addiction professionals comprehensive education on co-occurring disorders.

This manual has been developed as a resource for addiction-focused professionals who work with clients suffering from co-occurring disorders. More and more of the clients who seek out treatment will exhibit this complex condition. The 2014 National Survey on Drug Use and Health produced by SAMHSA, estimates that 7.9 million adults had co-occurring disorders in the previous year. Further, it is estimated that less than half of adults who have a co-occurring disorders received treatment for both problems (Substance Abuse and Mental Health Services Administration, 2015).

This manual is intended to be a resource for professionals seeking to expand their knowledge of best practices in treating co-occurring disorders. The concept of co-occurring disorders will be defined, along with a chronology of identifying and assessing this and other mental health and addiction related issues. Common mental health disorders will be described and treatment strategies for co-occurring ailments will be introduced.

Many writers and consultants volunteered their time and knowledge during the development of the training materials. NAADAC would like to extend its sincerest appreciation to the numerous contributors to this project: Thomas Durham, Marty Harding, Sue Hoisington, Jim Holder, Donovan Kuehn, Rose Maire, Kaylene McElfresh, Richard Solly, Gerry Schmidt, Misti Storie, Cynthia Moreno Tuohy and Mary Woods. This project could not have been completed without the many hours of brainstorming, researching, writing, reviewing and editing so this product could be a significant contribution to the addiction profession.

NAADAC's Life-Long Learning Series Integrating Treatment for Co-occurring Disorders: What Every Addiction Counselor Needs to Know is only one of many planned educational projects geared at providing comprehensive and unbiased education to the addiction profession. NAADAC recognizes you have a choice in education providers, and we are delighted you have chosen to take part in this educational seminar and build your toolbox of treatment resources. Thank you for your dedication to the addiction profession!

Together, we can and are making a difference!

Sincerely,

Gerard J. "Gerry" Schmidt, MA, MAC, LPC, CAC President of NAADAC, the Association for Addiction Professionals

Integrating Treatment for Co-occurring Disorders: An Introduction to What Every Addiction Counselor Needs to Know

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NAADAC'S LIFE-LONG LEARNING SERIES

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Integrating Treatment for Co-occurring Disorders: An Introduction to What Every Addiction Counselor Needs to Know

NAADAC'S LIFE-LONG LEARNING SERIES

CONTENTS

EXECUTIVE SUMMARY.............................................................................................7

LEARNING OBJECTIVES.......................................................................................... 8

SECTION ONE: INTRODUCTION TO CO-OCCURRING DISORDERS.......................... 9

Myths and Facts.................................................................................................................................10 Myths About Co-occurring Disorders.......................................................................................10 Facts About Co-occurring Disorders........................................................................................ 13

Defining Co-occurring Disorders................................................................................................... 16 Common Terminology.................................................................................................................. 16 Quadrants of Care......................................................................................................................... 19 Co-occurring Disorders Interactions......................................................................................... 21

Models of Treatment for Co-occurring Disorders..................................................................... 23 Single Model of Care................................................................................................................... 23 Sequential Model of Treatment................................................................................................ 23 Parallel Model of Treatment....................................................................................................... 24 Integrated Model of Treatment................................................................................................. 24

History of Co-occurring Disorders Treatment............................................................................ 27 Historical Perspective of Co-occurring Disorders................................................................ 27 Chronology of Co-occurring Disorders Treatment.............................................................. 27

SECTION TWO: MENTAL HEALTH DISORDERS...................................................... 33

Common Mental Health Disorders............................................................................................... 34 Depressive Disorders.................................................................................................................. 34 Bipolar Disorders.......................................................................................................................... 37 Anxiety Disorders.......................................................................................................................... 41 Obsessive-compulsive and Related Disorders..................................................................... 44 Trauma and Stressor-related Disorders.................................................................................. 45 Personality Disorders.................................................................................................................. 46 Schizophrenia Spectrum and Other Psychotic Disorders.................................................. 48

Diagnoses with Diagnostic Criteria for the Four Case Studies Discussed........................52

SECTION THREE: CO-OCCURRING DISORDERS TREATMENT............................... 55

Stages of Change as an Initial Approach in Treating Co-occurring Disorders.................56

Screening and Assessing for Co-occurring Disorders............................................................ 58 Step 1: Engage the Client............................................................................................................59 Step 2: Identify and Contact Collaterals.................................................................................59 Step 3: Screen For and Detect Co-occurring Disorders.....................................................59 Step 4: Determine Quadrant and Locus of Responsibility.................................................. 61 Step 5: Determine Level of Care............................................................................................... 61

Integrating Treatment for Co-occurring Disorders: An Introduction to What Every Addiction Counselor Needs to Know

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