03/11/2013
C Wilson CNCAOD
Dual Diagnosis workshop
Cate Wilson, CNC, Homeless Health Outreach Team
Dual Disorders/ dual diagnosis � Dual diagnosis or co-morbidity � Co occurrence of 2 or more disorders � Common to have multiple morbidities • 50-70% of people in mental health settings • 40-80% in AOD settings
Dual diagnosis heterogenic group � SU MH conditions independent � SU -> MH trigger the other � MH-> SU interact both ways � Stress -> MH -> SU outside factors � Physical illness -> stress: MH; SU � Complex interactions
Impact of Dual Diagnosis • Significant challenges to MHS and AOD services. • Relapse of one disorder often triggers a relapse in
the other disorder • Poorer treatment outcomes • overall higher rates of � -physical problems, -homelessness-financial
criminal activity- incarceration- family breakdown- suicide-self harm- aggression- increased MH admissions- emergency services contact
Models of care-integrated care approach
� “ a chemical substance used in the treatment, cure, prevention, or diagnosis of a disease or used to otherwise enhance physical or mental well-being”
� “Recreational drugs (street drugs) target CNS and brain chemistry. They alter perception, mood and behavior”
Drug Definitions
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Why Do People use substances? • Experimental / Rebellion • Coping mechanism for –ve emotions, stressors,
increase self esteem • Aid creativity, pleasure, energy • Work study related • Reduce boredom. • Learned behaviour • Cultural / social expectations
Risk factors for addiction
Barlow & Durand (2006 p 407)
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Psychoactive drugs � Produce harms and benefits � 2 major groups of harms � Toxicity (intoxication) immediate effect � Dependence- delayed effect long term drug use
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Drug use spectrum
Special considerations
� Even small amt of substance can have severe impact on mentally ill persons Individuals with severe mental illness may consume far smaller
� Always assess and manage all alcohol and drug use in clients with severe mental illness.
� Early intervention for AOD use � -prompt feedback, brief interventions,
psychoeducation or more intensive substance use interventions.
Causes of mental health problems • 1 in 5 will have a MI • Continuum of wellness to illness model • Mental illness vs poor work life balance • Spectrum of disorders • anxiety, depression (high prevalence) • psychosis and eating disorders (low
prevalence) • 26 % of under 26 y/o mental disorder
Stress vulnerability model
Mood disorders � Mood disorders include: � �. Adjustment Disorder with depressed mood � �. Major Depressive Disorder � �. Dysthymic Disorder � �. Bipolar Disorder � �. Substance Induced Mood Disorder � �. Postnatal Depression.
Stages of change model
Integrated motivational assessment tool
Assisting families, carers & significant others � Families support for own needs � Mutual support groups; telephone support,
educational materials � Provide information to families � Emergency plan � Others take caring role for children of users � Young carers pursue age appropriate interests
support from school counsellors, teacher, � trusted relative, kids help line, websites such as
http://www.youngcarers.net.au),
Treatment- overview • TREATMENT MATCH TO CLIENT GOALS • Substance use & mental illness needs to be
addressed • Holistic framework • Psychosocial issues addressed � -social, legal, housing and welfare matters. • Complexity of issues person may present in crisis
Treatment. • Mental health inpatient treatment (MHA) • Inpatient withdrawal management (detox) • Referral to specialised withdrawal unit- HADS Fairhaven,
Riverlands, Moonyah • Psycho-education -mental illness and substance use & how the
two inter-relate. • Community mental health case manager, & psychiatrist • AODS service (community based) in Miami and Southport-
specialised addiction service consisting of case managers and group workers, eg Back in Control & Adapt
• Opioid pharmacotherapy program public programs at Miami & Southport, private prescribers GPGC
• Private hospital Currumbin -MH/substances • Outpatient withdrawals –GP , Biala Ground floor
Treatment. • AOD counselling, public or private • Better outcomes GP mental health plan psychology &
allied health • NGO- drug arm, GCDC, Quihn, Goldbridge, • Residential rehabilitation ( AOD, MH & DD) • Harm reduction services –NSPs, QUIHN, sexual
health • Recovery focused holistic care • Youth – headspace, YHES house, GCYS • Self help groups, AA, NA, AL ANON, Dual ANON,
Smart recovery groups,
Psychotherapy /Treatment • Motivational enhancement techniques, MI, SOC,
integrated therapy • Cognitive & behavioural therapies CBT, ACT • Brief & solution focused therapies • Gestalt, insight orientated therapies • Family & systems therapy • Psychologist via GP mental health plan
� Reference: � Adapted from � QLD Health dual diagnosis guidelines 2011 � NSW Clinical Guidelines- the care and
persons with comorbid mental illness and substance use problems in an acute setting 2009