Introduction to IDDT and Harm Reduction Treatment Susan Doig, LCSW, CADC Chief Clinical Officer Trilogy, Inc What are Dual Disorders? • Mental Illness and Substance Use disorders occurring together in one person Risk Factors • 50% of persons with serious mental illness also have substance abuse issues • Being dually diagnosed is associated with high rates of the following: – Relapse – Hospitalization – Violence – Incarceration – Homelessness – Serious Infection (HIV, hepatitis) *as noted from “Implementing Dual Diagnosis Services for clients with severe Mental Illness” Drake, et al. 2001 Traditional Treatment • • • • Non-integrated approach Treats each disorder separately Requires navigation of two separate systems Office based Traditional Treatment • 12 step approaches have not had positive results with dually disordered individuals • Cognitive impairment can detract from understanding information • Confrontational approaches used in SA treatment are not well tolerated • Frustration and dropout may result from requirements of abstinence What is Dual Disorders Tx? • An integrated, multidisciplinary approach – Assertive outreach – Engagement (motivational interviewing) – Skill building – Building community supports – Relapse prevention What is Dual Disorders Tx? • Provides wide array of services other than just counseling such as: housing, medication training, supported employment, etc. • No wrong door • Non-linear: people do not move smoothly from one stage to the next. • Drake et. al. 2001 Effectiveness of Dual Disorders Tx • It’s an Evidenced Based Practice (EPB) • Increases abstinence and helps people to cut down use • Better health outcomes • Helps to improve outcomes for treatment which helps to motivate the client to set additional goals Effectiveness of Dual Disorders Tx • Many people attain stable remission of substance use disorders over time • Recovery encompasses other areas of adjustment • Health, work, housing, relationships HARM REDUCTION • Harm reduction: anything that reduces the risk of injury whether or not the individual is able to abstain from the risky behavior. --- David Ostrow, M.D., Ph.D. Challenges in working with people in re-entry • • • • • • Gaps in health care coverage Homelessness/housing upon release Access to medications Continuity with providers Increase service use and cost Non-integrated systems of care Court and provider collaboration • Court order treatment can increase motivation to participate in tx • Relapse can be difficult to manage • Effective Communication is key • Planned release • QUESTIONS??