Substance Use Disorder Treatment For People With Co Occurring Disorders Treatment Improvement Protocol Tip 42 Updated March 2020

This Treatment Improvement Protocol (TIP) update is intended to provide addiction counselors and other providers, supervisors, and administrators with the latest science in the screening, assessment, diagnosis, and management of co-occurring disorders (CODs). For purposes of this TIP, CODs refer to co-occurring substance use disorders (SUDs) and mental disorders. Clients with CODs have one or more disorders relating to the use of alcohol or other substances with misuse potential as well as one or more mental disorders. A diagnosis of CODs 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 CODs as having a serious mental illness (SMI) combined with a severe SUD, such as schizophrenia combined with alcohol use disorder (AUD).

This TIP, Substance Abuse Treatment for Persons With Co-Occurring Disorders, revises TIP 9, Assessment and Treatment of Patients With Coexisting Mental Illness and Alcohol and Other Drug Abuse. The revised TIP provides information about new developments in the rapidly growing field of co-occurring substance use and mental disorders and captures the state-ofthe- art in the treatment of people with co-occurring disorders. The TIP focuses on what the substance abuse treatment clinician needs to know and provides that information in an accessible manner. The TIP synthesizes knowledge and grounds it in the practical realities of clinical cases and real situations so the reader will come away with increased knowledge, encouragement, and resourcefulness in working with clients with co-occurring disorders.

Treatment Improvement Protocols (TIPs), developed by the Center for Substance Abuse Treatment (CSAT), part of the Substance Abuse and Mental Health Services Administration (SAMHSA) within the U.S. Department of Health and Human Services (DHHS), are best-practice guidelines for the treatment of substance use disorders. CSAT draws on the experience and knowledge of clinical, research, and administrative experts to produce the TIPs, which are distributed to a growing number of facilities and individuals across the country. This TIP revises TIP 9, "Assessment and Treatment of Patients with Coexisting Mental Illness and Alcohol and Other Drug Abuse." The main purpose of this TIP is to provide addiction counselors and other practitioners with this state-of-the-art information on the rapidly advancing field of co-occurring substance use and mental disorders. Following a discussion of the evolving field of co-occurring disorders, this document addresses the developments that led to this TIP. It then describes the scope of this TIP (both what is included and what is excluded by design), its intended audience, and the basic approach that has guided the selection of strategies, techniques, and models highlighted in the text. The organization of the TIP is laid out for readers, with the components of each chapter and appendix described in an effort to help users of the TIP quickly locate subject of immediate interest. Chapters in this TIP include: (1) Introduction; (2) Definitions, Terms, and Classification Systems for Co-Occurring Disorders; (3) Keys to Successful Programming; (4) Assessment; (5) Strategies for Working With Clients With Co-Occurring Disorders; (6) Traditional Settings and Models; (7) Special Settings and Specific Populations; (8) A Brief Overview of Specific Mental Disorders and Cross-Cutting Issues; and (9) Substance-Induced Disorders. Appended are: (1) Bibliography; (2) Acronyms; (3) Glossary of Terms; (4) Specific Mental Disorders: Additional Guidance for the Counselor; (5) Emerging Models; (6) Common Medications for Disorders; (7) Screening and Assessment Instruments; (8) Sample Screening Instruments; (9) Selected Sources of Training; (10) Dual Recovery Mutual Self-Help Programs and Other Resources for Consumers and Providers; (11) Confidentiality; (12) Resource Panel; (13) Cultural Competency and Diversity Network Participants; and (14) Field Reviewers. An index is also included. (Contains 53 figures and approximately 750 references.) [This publication was produced by The CDM Group, Inc. for the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (DHHS).].

This book includes a compilation of papers published in 2020 and 2021 focused on dual disorders, which are found in significant and growing numbers in both substance addiction and mental health clinics. These contributions assume a broad perspective ranging from exposure to genetic and neurobiological elements to factors such as personality and quality of life. In all cases, these papers aimed to be transferred to and to benefit clinical practice.

This handbook reflects the reality facing mental health and substance abuse professionals in their daily practices, focusing on how to effectively manage caseloads that include individuals with vastly differing levels of functioning.

This Treatment Improvement Protocol (TIP) provides guidelines for counselors and others working in the field of co-occurring substance use and mental disorders. TIPs are best-practice guidelines for the treatment of substance use disorders that make the latest research in substance abuse treatment available to counselors and educators. The content was generated by a panel of experts in the fields of substance abuse treatment and mental health, and reviewed by independent experts. The nine chapters include selected literature reviews, synopses of many treatment approaches for co-occurring disorders, and empirical information. Terminology, assessment, treatment strategies and models, and an overview of specific mental disorders and cross-cutting issues, such as suicidality and nicotine dependency, are explored in detail. Appended are: (1) Bibliography; (2) Acronyms; (3) Glossary of Terms; (4) Specific Mental Disorders: Additional Guidance for the Counselor; (5) Emerging Models; (6) Common Medications for Disorders; (7) Screening and Assessment Instruments; (8) Sample Screening Instruments; (9) Selected Sources of Training; (10) Dual Recovery Mutual Self-Help Programs and Other Resources for Consumers and Providers; (11) Confidentiality; (12) Resource Panel; (13) Cultural Competency and Diversity Network Participants; and (14) Field Reviewers.

Case management has been variously classified as a skill group, a core function, service coordination, or a network of "friendly neighbors." Although it defies precise definition, case management generally can be described as a coordinated approach to the delivery of health, substance abuse, mental health, and social services, linking clients with appropriate services to address specific needs and achieve stated goals. The Consensus Panel that developed this TIP believes that case management lends itself to the treatment of substance abuse, particularly for clients with other disorders and conditions who require multiple services over extended periods of time and who face difficulty in gaining access to those services. This document details the factors that programs should consider as they decide to implement case management or modify their current case management activities. This summary is excerpted from the main text, in which references to the research appear.

To practice psychotherapy in a correctional setting is to encounter a range of cultural issues reflecting the various ethnic, class, gender, and physical subgroups of the prison population--as well as to navigate the culture of the prison, staff, and justice system that underpins the patients' circumstances. Drawing on the authors' extensive professional experience, Psychotherapy in Corrections offers mental health professionals a comprehensive look at the most common situations they are likely to face and provides practical advice on dealing with them. Diagnostically oriented chapters cover core issues that include self-harm and substance use disorders, as well as mood and personality disorders. Specific supportive therapy techniques for addressing these issues, as well as special situations--including the experience of women in prison, behaviors that can disrupt care, and efforts to reduce recidivism--are illustrated by clinical vignettes. In tackling the social and developmental conditions that lead individuals to interact with the correctional system, Psychotherapy in Corrections also acknowledges the effects of the COVID-19 pandemic and the movement for social justice in society. Anyone who conducts psychotherapy in a prison setting will benefit from an approach centered on treating the human in front of them, regardless of the setting or their crime.

Motivation is key to substance use behavior change. Counselors can support clients' movement toward positive changes in their substance use by identifying and enhancing motivation that already exists. Motivational approaches are based on the principles of person-centered counseling. Counselors' use of empathy, not authority and power, is key to enhancing clients' motivation to change. Clients are experts in their own recovery from SUDs. Counselors should engage them in collaborative partnerships. Ambivalence about change is normal. Resistance to change is an expression of ambivalence about change, not a client trait or characteristic. Confrontational approaches increase client resistance and discord in the counseling relationship. Motivational approaches explore ambivalence in a nonjudgmental and compassionate way.