Concurrent Disorders
Situation when an individual suffers from at least one substance-related/addictive disorder as well as at least one other mental disorder.
dual diagnosis
The term “dual diagnosis” is avoided when referring to the concurrent substance-related/addictive disorders and other mental disorders
trimorbidity
used for co-occurrence of posttraumatic stress disorder, traumatic brain injury, and a substance-related/addictive disorder
how many pts seeking help for addiction also suffer from a mental disorder
approx. 50%
how many persons with mental illness also suffer from a substance-related/addictive disorder
15-20%
populations with the highest rates of SUD
- persons suffering from psychotic disorders
- The high prevalence rates of mental disorders among incarcerated individuals, when compared with the general population, has been well established
- Lesbian, gay, and bisexual individuals have been found to experience poorer mental health and higher rates of substance misuse.
true or false: half of the patients with schizophrenia have a concurrent substance use disorder
true
role of RPN: Psychotic Illnesses and Substance Abuse
- Management may vary according to severity of symptoms.
- Initial focus on severity of presenting symptoms (not diagnosis)
- Acute crisis intervention and crisis management
- Acute, subacute, and long-term stabilization
- Ongoing diagnostic efforts
- Multiple contact longitudinal treatment
true or false: 1 in 5 persons presenting with a mental disorder also suffers from a substance-related/addictive disorder
true
true or false: 1 in 5 persons presenting with a mental disorder also suffers from a substance-related/addictive disorder
true
true or false: the term concurrent disorders is used to describe the situation when an individual suffers from at least one substance-related/addictive disorder as well as at least one other mental disorder
true
Assessment Approaches for RPN
Assessment of the following six domains is recommended:
- Acute intoxication and/or withdrawal potential
- Biomedical conditions and complications
- Emotional/behavioural/cognitive conditions and complications
- Readiness to change
- Relapse/continued use/continued problem potential
- Recovery environment
Sequential (serial) treatment
- we don’t do this anymore – we want to treat both disorders simultaneously
- whereby care is received in sequential treatment episodes in separate systems of care
Parallel care
- we don’t do this anymore
- accessed for all disorders simultaneously, but in different systems, with varying degrees of coordination
(no communication between therapist and nurses)
Integrated care
what RPNs do
- holistic tx
- psychiatric disorder and substance use disorder treated at the same time
- where care is provided for both disorders by the same cross-trained team members in the same program, resulting in an integration of services
Seven Components of Integrated Care in Best Practice Guidelines
- Integration of services (integrated care)
- Comprehensive approach to assessment and treatment
- Assertiveness (actively reaching out to persons with concurrent disorders) = outreach (e.g., ACT TEAM)
- Reduction of negative consequences (e.g., harm reduction)
- Time-unlimited services (reflecting the chronic and severe nature of concurrent disorders) – not time-limited/ongoing
- Adapting interventions to the person’s stage of treatment
- Using multiple psychotherapeutic modalities (medication or group therapies etc)
Seven Components of Integrated Care in Best Practice Guidelines
- Integration of services (integrated care)
- Comprehensive approach to assessment and treatment
- Assertiveness (actively reaching out to persons with concurrent disorders) = outreach (e.g., ACT TEAM)
- Reduction of negative consequences (e.g., harm reduction)
- Time-unlimited services (reflecting the chronic and severe nature of concurrent disorders) – not time-limited/ongoing
- Adapting interventions to the person’s stage of treatment
- Using multiple psychotherapeutic modalities (medication or group therapies etc)
Treatment matching
- The overarching principle in matching persons to the right level of care is to provide treatment at the least restrictive level of care that will be effective and safe.
- Multidimensional assessment; treatment placement on one of five levels is recommended:
Level 0.5 (early intervention),
Level I (outpatient services),
Level II (intensive outpatient/partial hospitalization services),
Level III (residential/inpatient services),
or Level IV (medically managed intensive inpatient services)
- Indication for hospitalization
Co-occurring addictive disorders and most prevalent with which mental disorders
Mood disorders & anxiety disorders highest prevalence in concurrency
Specific Concurrent Disorders
- Concurrent addictive and mood disorders
- Concurrent addictive and anxiety disorders
- Concurrent addictive and posttraumatic stress disorder (PTSD)
- Concurrent addictive and attention deficit /hyperactivity disorder
- Concurrent addictive and psychotic disorders
- Concurrent addictive and personality disorders
What topics would be included in relapse prevention education? Select all that apply.
A. Understanding addiction
B. Communicating with others
C. Cost of the addiction
D. Dealing with crisis
E. Coping with stress
A, B, D, E
- All the topics are appropriate for discussion with the exception of a discussion of the cost of the addiction.
What topics would be included in relapse prevention education? Select all that apply.
A. Understanding addiction
B. Communicating with others
C. Cost of the addiction
D. Dealing with crisis
E. Coping with stress
A, B, D, E
- All the topics are appropriate for discussion with the exception of a discussion of the cost of the addiction.
Psychoeducational Topics for Relapse Prevention
- Understanding addiction
- Effects and interaction of tobacco, alcohol, and other drugs in the body
- What is my relationship with tobacco, alcohol, and other drugs?
- How to live in a healthy way
- Leisure and relaxation
- Coping with stress
- Coping with anger
- Communicating with others
- Problem-solving strategies
- The relapse cycle
- Strategies for preventing relapse
- My plan for avoiding relapse
- My personal cues that relapse is imminent
- Dealing with crisis
