Table Of Content

This page intentionally left blank. TIP 42, Substance Use Disorder Treatment for People With Co-Occurring Disorders MARCH 2020 Contents Foreword ...................................................................................................................................................................... ix Executive Summary ...................................................................................................................................................... xi TIP Development Participants .................................................................................................................................... xix Acknowledgments ................................................................................................................................................... xxviii 1 Introduction to Substance Use Disorder Treatment for People With Co-Occurring Disorders .................................. 1 Scope of This TIP ................................................................................................................................................... 2 Audience ............................................................................................................................................................... 2 Approach ............................................................................................................................................................... 3 Guidance for the Reader ....................................................................................................................................... 3 Terminology in This TIP ......................................................................................................................................... 3 Person-Centered Terminology .............................................................................................................................. 6 Important Developments That Led to This TIP Update ........................................................................................ 7 Why Do We Need a TIP on CODs? ........................................................................................................................ 7 1. Prevalence and Treatment Need of CODs ........................................................................................................ 7 2. CODs and Hospitalizations ................................................................................................................................ 9 3. Trends in COD Programming ........................................................................................................................... 10 4. Complications of CODs .................................................................................................................................... 11 The Complex, Unstable, and Bidirectional Nature of CODs ................................................................................ 12 SUDs, Mental Illness, and “Self-Medicating” ...................................................................................................... 13 Conclusion .......................................................................................................................................................... 13 2 Guiding Principles for Working With People Who Have Co-Occurring Disorders .................................................... 14 General Guiding Principles ................................................................................................................................. 15 Use a Recovery Perspective ................................................................................................................................ 15 Adopt a Multiproblem Viewpoint ....................................................................................................................... 15 Develop a Phased Approach to Treatment ......................................................................................................... 16 Address Specific Real-Life Problems Early in Treatment..................................................................................... 16 Plan for the Client’s Cognitive and Functional Impairments .............................................................................. 16 Use Support Systems To Maintain and Extend Treatment Effectiveness ........................................................... 17 Guidelines for Counselors and Other Providers ................................................................................................. 18 Providing Access ................................................................................................................................................. 18 Completing a Full Assessment ............................................................................................................................ 19 Providing an Appropriate Level of Care .............................................................................................................. 19 Achieving Integrated Treatment ......................................................................................................................... 20 Providing Comprehensive Services ..................................................................................................................... 21 Ensuring Continuity of Care ................................................................................................................................ 21 Guidelines for Administrators and Supervisors .................................................................................................. 23 Providers’ Competencies .................................................................................................................................... 23 Continuing Professional Development ............................................................................................................... 24 Avoiding Burnout and Reducing Staff Turnover ................................................................................................. 25 Integrating Research and Practice ...................................................................................................................... 26 Establishing Essential Services for People With CODs ........................................................................................ 26 Assessing the Agency’s Capacity To Serve Clients With CODs ............................................................................ 30 Page iii TIP 42, Substance Use Disorder Treatment for People With Co-Occurring Disorders MARCH 2020 Conclusion .......................................................................................................................................................... 31 3 Screening and Assessment of Co-Occurring Disorders ............................................................................................. 32 Screening and Basic Assessment for CODs ......................................................................................................... 34 Screening ............................................................................................................................................................ 35 Basic Assessment ................................................................................................................................................ 36 The Complete Screening and Assessment Process ............................................................................................. 38 Using a Biopsychosocial Approach ...................................................................................................................... 39 Assessment Step 1: Engage the Client ................................................................................................................ 40 Assessment Step 2: Identify and Contact Collaterals (Family, Friends, Other Providers) To Gather Additional Information ......................................................................................................................................................... 43 Assessment Step 3: Screen for and Detect CODs ............................................................................................... 43 Assessment Step 4: Determine Quadrant and Locus of Responsibility .............................................................. 57 Assessment Step 5: Determine Level of Care ..................................................................................................... 60 Assessment Step 6: Determine Diagnosis ........................................................................................................... 61 Assessment Step 7: Determine Disability and Functional Impairment ............................................................... 63 Assessment Step 8: Identify Strengths and Supports ......................................................................................... 65 Assessment Step 9: Identify Cultural and Linguistic Needs and Supports .......................................................... 66 Assessment Step 10: Identify Problem Domains ................................................................................................ 67 Assessment Step 11: Determine Stage of Change .............................................................................................. 67 Assessment Step 12: Plan Treatment ................................................................................................................. 68 Conclusion .......................................................................................................................................................... 71 4 Mental and Substance-Related Disorders: Diagnostic and Cross-Cutting Topics ..................................................... 72 Organization of the Chapter ............................................................................................................................... 72 Scope of the Chapter .......................................................................................................................................... 73 Depressive Disorders .......................................................................................................................................... 74 MDD .................................................................................................................................................................... 74 PDD ..................................................................................................................................................................... 76 Prevalence........................................................................................................................................................... 78 Depressive Disorders and SUDs .......................................................................................................................... 78 Bipolar I Disorder ................................................................................................................................................ 80 Prevalence........................................................................................................................................................... 84 Bipolar I Disorder and SUDs ................................................................................................................................ 84 PTSD .................................................................................................................................................................... 86 Prevalence........................................................................................................................................................... 88 PTSD and SUDs .................................................................................................................................................... 88 PDs ...................................................................................................................................................................... 91 PD Clusters .......................................................................................................................................................... 93 Prevalence........................................................................................................................................................... 93 PDs and SUDs ...................................................................................................................................................... 94 BPD ...................................................................................................................................................................... 95 ASPD .................................................................................................................................................................... 98 Anxiety Disorders .............................................................................................................................................. 100 GAD ................................................................................................................................................................... 100 Panic Disorder ................................................................................................................................................... 101 SAD .................................................................................................................................................................... 103 Prevalence......................................................................................................................................................... 104 Anxiety Disorders and SUDs .............................................................................................................................. 104 Schizophrenia and Other Psychotic Disorders .................................................................................................. 106 Page iv TIP 42, Substance Use Disorder Treatment for People With Co-Occurring Disorders MARCH 2020 Psychotic Disorders ........................................................................................................................................... 106 Schizophrenia .................................................................................................................................................... 107 Prevalence......................................................................................................................................................... 108 Schizophrenia/Other Psychotic Disorders and SUDs ........................................................................................ 109 ADHD ................................................................................................................................................................ 111 Prevalence......................................................................................................................................................... 113 ADHD and SUDs ................................................................................................................................................ 113 Feeding and Eating Disorders ........................................................................................................................... 115 AN ..................................................................................................................................................................... 116 BN...................................................................................................................................................................... 117 BED .................................................................................................................................................................... 118 Prevalence......................................................................................................................................................... 118 Feeding and Eating Disorders and SUDs ........................................................................................................... 119 Substance-Related Disorders ............................................................................................................................ 121 SUDs .................................................................................................................................................................. 122 Substance-Induced Mental Disorders ............................................................................................................... 122 Cross-Cutting Topics: Suicide and Trauma ........................................................................................................ 129 Suicide ............................................................................................................................................................... 130 Trauma .............................................................................................................................................................. 135 Conclusion ........................................................................................................................................................ 140 5 Strategies for Working With People Who Have Co-Occurring Disorders ............................................................... 141 Competencies for Working With Clients Who Have CODs ................................................................................. 142 Guidelines for a Successful Therapeutic Relationship ...................................................................................... 142 Develop and Use a Therapeutic Alliance To Engage Clients in Treatment ....................................................... 143 Maintain a Recovery Perspective ...................................................................................................................... 144 Ensure Continuity of Care ................................................................................................................................. 146 Address Common Clinical Challenges ............................................................................................................... 146 Monitor Psychiatric Symptoms ......................................................................................................................... 150 Use Supportive and Empathic Counseling ........................................................................................................ 151 Use Culturally Appropriate Methods ................................................................................................................ 154 Using Motivational Enhancement Consistent With Clients’ Specific Stage of Change ..................................... 155 Teaching Relapse Prevention Techniques ........................................................................................................ 157 Use Repetition and Skill Building To Address Deficits in Functioning ............................................................... 160 Guidance for Working With Clients Who Have Specific Co-Occurring Mental Disorders ................................ 161 MDD .................................................................................................................................................................. 161 Anxiety Disorders .............................................................................................................................................. 162 PTSD .................................................................................................................................................................. 163 SMI .................................................................................................................................................................... 163 Conclusion ........................................................................................................................................................ 164 6 Co-Occurring Disorders Among Special Populations .................................................................................................. 166 People Experiencing Homelessness .................................................................................................................. 167 Homelessness, Mental Health, and Substance Misuse ..................................................................................... 167 Service Models for People With CODs Who Are Experiencing Homelessness ................................................. 168 People Involved in the Criminal Justice System ................................................................................................ 172 Rationale for Treatment ................................................................................................................................... 172 Treatment Features, Approaches, and Empirical Evidence .............................................................................. 172 Evidence in Support of Postrelease Treatment and Follow-up ........................................................................ 173 Women ............................................................................................................................................................. 174 Page v TIP 42, Substance Use Disorder Treatment for People With Co-Occurring Disorders MARCH 2020 Substance Misuse and Mental Illness in Women ............................................................................................. 174 Treatment Approaches for Women .................................................................................................................. 175 Pregnancy and CODs ......................................................................................................................................... 178 Women, Trauma, and Violence ........................................................................................................................ 181 People of Diverse Racial/Ethnic Backgrounds .................................................................................................. 182 Treatment Access and Utilization ..................................................................................................................... 183 Reducing Racial/Ethnic Disparities .................................................................................................................... 184 Conclusion ........................................................................................................................................................ 185 7 Treatment Models and Settings for People With Co-Occurring Disorders ............................................................. 186 Treatment Overview ......................................................................................................................................... 187 Treatment Programs ......................................................................................................................................... 187 Levels of Service ................................................................................................................................................ 188 Episodes of Treatment ...................................................................................................................................... 189 Integrated Versus Nonintegrated Treatment ................................................................................................... 189 Culturally Responsive Treatment ...................................................................................................................... 190 Barriers to Treatment ....................................................................................................................................... 190 Treatment Models ............................................................................................................................................ 192 Integrated Care ................................................................................................................................................. 192 ACT .................................................................................................................................................................... 194 ICM .................................................................................................................................................................... 198 Dual Recovery Mutual Support Programs ........................................................................................................ 204 Treatment Settings ........................................................................................................................................... 209 TCs ..................................................................................................................................................................... 209 Outpatient SUD treatment ............................................................................................................................... 213 Residential SUD treatment ............................................................................................................................... 217 Acute Care and Other Medical Settings ............................................................................................................ 220 Pharmacotherapy ............................................................................................................................................. 226 Medication for Mental Illness ........................................................................................................................... 226 Medication for SUDs ......................................................................................................................................... 232 Conclusion ........................................................................................................................................................ 233 8 Workforce and Administrative Concerns in Working With People Who Have Co-Occurring Disorders ................ 234 Recruitment, Hiring, and Retention .................................................................................................................. 235 Recruitment and Retention .............................................................................................................................. 236 Competency and Professional Development ................................................................................................... 239 Attitudes and Values ......................................................................................................................................... 240 Provider Competencies ..................................................................................................................................... 241 Supervision........................................................................................................................................................ 244 Continuing Professional Development ............................................................................................................. 245 Conclusion ........................................................................................................................................................ 249 Appendix A: Bibliography .......................................................................................................................................... 250 Appendix B: Resources .............................................................................................................................................. 285 Training for Providers and Administrators ....................................................................................................... 285 Sources of Training in Substance Use Disorders ............................................................................................... 285 Sources of Training in Mental Health................................................................................................................ 286 Sources of Training in CODs .............................................................................................................................. 286 Other Resources for Counselors, Providers, and Programs .............................................................................. 287 Publications ....................................................................................................................................................... 287 Treatment Locators ........................................................................................................................................... 289 Page vi TIP 42, Substance Use Disorder Treatment for People With Co-Occurring Disorders MARCH 2020 General Resources ............................................................................................................................................ 290 Client and Family Resources ............................................................................................................................. 296 Organizations .................................................................................................................................................... 296 Mutual Support Programs ................................................................................................................................ 296 Publications and Other Resources .................................................................................................................... 298 Online Boards and Chat Rooms ........................................................................................................................ 298 Mobile Apps ...................................................................................................................................................... 299 Appendix C: Provider Forms, Measures, and Tools ................................................................................................... 301 Biopsychosocial Intake Forms ........................................................................................................................... 301 Suicide and Safety Screening and Assessment Tools ........................................................................................ 301 Mental Disorder Screening and Assessment Tools ........................................................................................... 301 Substance Use/Misuse Screening and Assessment Tools ................................................................................ 303 Substance Withdrawal Screening Tools ............................................................................................................ 308 Trauma Screening and Assessment Tools ......................................................................................................... 310 Levels of Care Tool ............................................................................................................................................ 312 Functioning and Disability Tools ....................................................................................................................... 312 Stage of Change Tools ...................................................................................................................................... 312 Page vii TIP 42, Substance Use Disorder Treatment for People With Co-Occurring Disorders MARCH 2020 This page intentionally left blank. Page viii TIP 42, Substance Use Disorder Treatment for People With Co-Occurring Disorders MARCH 2020 Foreword The Substance Abuse and Mental Health Services Administration (SAMHSA) is the U.S. Department of Health and Human Services agency that leads public health efforts to reduce the impact of substance abuse and mental illness on America’s communities. An important component of SAMHSA’s work is focused on dissemination of evidence-based practices, and providing training and technical assistance to healthcare practitioners on implementation of these best practices. The Treatment Improvement Protocol (TIP) series contributes to SAMHSA’s mission by providing science-based, best-practice guidance to the behavioral health field. TIPs reflect careful consideration of all relevant clinical and health service research, demonstrated experience, and implementation requirements. Select nonfederal clinical researchers, service providers, program administrators, and patient advocates comprising each TIP’s consensus panel discuss these factors, offering input on the TIP’s specific topics in their areas of expertise to reach consensus on best practices. Field reviewers then assess draft content and the TIP is finalized. The talent, dedication, and hard work that TIP panelists and reviewers bring to this highly participatory process have helped bridge the gap between the promise of research and the needs of practicing clinicians and administrators to serve, in the most scientifically sound and effective ways, people in need of care and treatment of mental and substance use disorders. My sincere thanks to all who have contributed their time and expertise to the development of this TIP. It is my hope that clinicians will find it useful and informative to their work. Elinore F. McCance-Katz, M.D., Ph.D. Assistant Secretary for Mental Health and Substance Use U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration Page ix TIP 42, Substance Use Disorder Treatment for People With Co-Occurring Disorders MARCH 2020 This page intentionally left blank. Page x

ebook img

TIP 42: Substance Use Disorder Treatment for People with Co-Occurring Disorders: Updated 2020 PDF

2020·8 MB·English
by  
#americana #salis
Save to my drive
Quick download
Download
Upgrade Premium
Most books are stored in the elastic cloud where traffic is expensive. For this reason, we have a limit on daily download.

Preview TIP 42: Substance Use Disorder Treatment for People with Co-Occurring Disorders: Updated 2020

This page intentionally left blank. TIP 42, Substance Use Disorder Treatment for People With Co-Occurring Disorders MARCH 2020 Contents Foreword ...................................................................................................................................................................... ix Executive Summary ...................................................................................................................................................... xi TIP Development Participants .................................................................................................................................... xix Acknowledgments ................................................................................................................................................... xxviii 1 Introduction to Substance Use Disorder Treatment for People With Co-Occurring Disorders .................................. 1 Scope of This TIP ................................................................................................................................................... 2 Audience ............................................................................................................................................................... 2 Approach ............................................................................................................................................................... 3 Guidance for the Reader ....................................................................................................................................... 3 Terminology in This TIP ......................................................................................................................................... 3 Person-Centered Terminology .............................................................................................................................. 6 Important Developments That Led to This TIP Update ........................................................................................ 7 Why Do We Need a TIP on CODs? ........................................................................................................................ 7 1. Prevalence and Treatment Need of CODs ........................................................................................................ 7 2. CODs and Hospitalizations ................................................................................................................................ 9 3. Trends in COD Programming ........................................................................................................................... 10 4. Complications of CODs .................................................................................................................................... 11 The Complex, Unstable, and Bidirectional Nature of CODs ................................................................................ 12 SUDs, Mental Illness, and “Self-Medicating” ...................................................................................................... 13 Conclusion .......................................................................................................................................................... 13 2 Guiding Principles for Working With People Who Have Co-Occurring Disorders .................................................... 14 General Guiding Principles ................................................................................................................................. 15 Use a Recovery Perspective ................................................................................................................................ 15 Adopt a Multiproblem Viewpoint ....................................................................................................................... 15 Develop a Phased Approach to Treatment ......................................................................................................... 16 Address Specific Real-Life Problems Early in Treatment..................................................................................... 16 Plan for the Client’s Cognitive and Functional Impairments .............................................................................. 16 Use Support Systems To Maintain and Extend Treatment Effectiveness ........................................................... 17 Guidelines for Counselors and Other Providers ................................................................................................. 18 Providing Access ................................................................................................................................................. 18 Completing a Full Assessment ............................................................................................................................ 19 Providing an Appropriate Level of Care .............................................................................................................. 19 Achieving Integrated Treatment ......................................................................................................................... 20 Providing Comprehensive Services ..................................................................................................................... 21 Ensuring Continuity of Care ................................................................................................................................ 21 Guidelines for Administrators and Supervisors .................................................................................................. 23 Providers’ Competencies .................................................................................................................................... 23 Continuing Professional Development ............................................................................................................... 24 Avoiding Burnout and Reducing Staff Turnover ................................................................................................. 25 Integrating Research and Practice ...................................................................................................................... 26 Establishing Essential Services for People With CODs ........................................................................................ 26 Assessing the Agency’s Capacity To Serve Clients With CODs ............................................................................ 30 Page iii TIP 42, Substance Use Disorder Treatment for People With Co-Occurring Disorders MARCH 2020 Conclusion .......................................................................................................................................................... 31 3 Screening and Assessment of Co-Occurring Disorders ............................................................................................. 32 Screening and Basic Assessment for CODs ......................................................................................................... 34 Screening ............................................................................................................................................................ 35 Basic Assessment ................................................................................................................................................ 36 The Complete Screening and Assessment Process ............................................................................................. 38 Using a Biopsychosocial Approach ...................................................................................................................... 39 Assessment Step 1: Engage the Client ................................................................................................................ 40 Assessment Step 2: Identify and Contact Collaterals (Family, Friends, Other Providers) To Gather Additional Information ......................................................................................................................................................... 43 Assessment Step 3: Screen for and Detect CODs ............................................................................................... 43 Assessment Step 4: Determine Quadrant and Locus of Responsibility .............................................................. 57 Assessment Step 5: Determine Level of Care ..................................................................................................... 60 Assessment Step 6: Determine Diagnosis ........................................................................................................... 61 Assessment Step 7: Determine Disability and Functional Impairment ............................................................... 63 Assessment Step 8: Identify Strengths and Supports ......................................................................................... 65 Assessment Step 9: Identify Cultural and Linguistic Needs and Supports .......................................................... 66 Assessment Step 10: Identify Problem Domains ................................................................................................ 67 Assessment Step 11: Determine Stage of Change .............................................................................................. 67 Assessment Step 12: Plan Treatment ................................................................................................................. 68 Conclusion .......................................................................................................................................................... 71 4 Mental and Substance-Related Disorders: Diagnostic and Cross-Cutting Topics ..................................................... 72 Organization of the Chapter ............................................................................................................................... 72 Scope of the Chapter .......................................................................................................................................... 73 Depressive Disorders .......................................................................................................................................... 74 MDD .................................................................................................................................................................... 74 PDD ..................................................................................................................................................................... 76 Prevalence........................................................................................................................................................... 78 Depressive Disorders and SUDs .......................................................................................................................... 78 Bipolar I Disorder ................................................................................................................................................ 80 Prevalence........................................................................................................................................................... 84 Bipolar I Disorder and SUDs ................................................................................................................................ 84 PTSD .................................................................................................................................................................... 86 Prevalence........................................................................................................................................................... 88 PTSD and SUDs .................................................................................................................................................... 88 PDs ...................................................................................................................................................................... 91 PD Clusters .......................................................................................................................................................... 93 Prevalence........................................................................................................................................................... 93 PDs and SUDs ...................................................................................................................................................... 94 BPD ...................................................................................................................................................................... 95 ASPD .................................................................................................................................................................... 98 Anxiety Disorders .............................................................................................................................................. 100 GAD ................................................................................................................................................................... 100 Panic Disorder ................................................................................................................................................... 101 SAD .................................................................................................................................................................... 103 Prevalence......................................................................................................................................................... 104 Anxiety Disorders and SUDs .............................................................................................................................. 104 Schizophrenia and Other Psychotic Disorders .................................................................................................. 106 Page iv TIP 42, Substance Use Disorder Treatment for People With Co-Occurring Disorders MARCH 2020 Psychotic Disorders ........................................................................................................................................... 106 Schizophrenia .................................................................................................................................................... 107 Prevalence......................................................................................................................................................... 108 Schizophrenia/Other Psychotic Disorders and SUDs ........................................................................................ 109 ADHD ................................................................................................................................................................ 111 Prevalence......................................................................................................................................................... 113 ADHD and SUDs ................................................................................................................................................ 113 Feeding and Eating Disorders ........................................................................................................................... 115 AN ..................................................................................................................................................................... 116 BN...................................................................................................................................................................... 117 BED .................................................................................................................................................................... 118 Prevalence......................................................................................................................................................... 118 Feeding and Eating Disorders and SUDs ........................................................................................................... 119 Substance-Related Disorders ............................................................................................................................ 121 SUDs .................................................................................................................................................................. 122 Substance-Induced Mental Disorders ............................................................................................................... 122 Cross-Cutting Topics: Suicide and Trauma ........................................................................................................ 129 Suicide ............................................................................................................................................................... 130 Trauma .............................................................................................................................................................. 135 Conclusion ........................................................................................................................................................ 140 5 Strategies for Working With People Who Have Co-Occurring Disorders ............................................................... 141 Competencies for Working With Clients Who Have CODs ................................................................................. 142 Guidelines for a Successful Therapeutic Relationship ...................................................................................... 142 Develop and Use a Therapeutic Alliance To Engage Clients in Treatment ....................................................... 143 Maintain a Recovery Perspective ...................................................................................................................... 144 Ensure Continuity of Care ................................................................................................................................. 146 Address Common Clinical Challenges ............................................................................................................... 146 Monitor Psychiatric Symptoms ......................................................................................................................... 150 Use Supportive and Empathic Counseling ........................................................................................................ 151 Use Culturally Appropriate Methods ................................................................................................................ 154 Using Motivational Enhancement Consistent With Clients’ Specific Stage of Change ..................................... 155 Teaching Relapse Prevention Techniques ........................................................................................................ 157 Use Repetition and Skill Building To Address Deficits in Functioning ............................................................... 160 Guidance for Working With Clients Who Have Specific Co-Occurring Mental Disorders ................................ 161 MDD .................................................................................................................................................................. 161 Anxiety Disorders .............................................................................................................................................. 162 PTSD .................................................................................................................................................................. 163 SMI .................................................................................................................................................................... 163 Conclusion ........................................................................................................................................................ 164 6 Co-Occurring Disorders Among Special Populations .................................................................................................. 166 People Experiencing Homelessness .................................................................................................................. 167 Homelessness, Mental Health, and Substance Misuse ..................................................................................... 167 Service Models for People With CODs Who Are Experiencing Homelessness ................................................. 168 People Involved in the Criminal Justice System ................................................................................................ 172 Rationale for Treatment ................................................................................................................................... 172 Treatment Features, Approaches, and Empirical Evidence .............................................................................. 172 Evidence in Support of Postrelease Treatment and Follow-up ........................................................................ 173 Women ............................................................................................................................................................. 174 Page v TIP 42, Substance Use Disorder Treatment for People With Co-Occurring Disorders MARCH 2020 Substance Misuse and Mental Illness in Women ............................................................................................. 174 Treatment Approaches for Women .................................................................................................................. 175 Pregnancy and CODs ......................................................................................................................................... 178 Women, Trauma, and Violence ........................................................................................................................ 181 People of Diverse Racial/Ethnic Backgrounds .................................................................................................. 182 Treatment Access and Utilization ..................................................................................................................... 183 Reducing Racial/Ethnic Disparities .................................................................................................................... 184 Conclusion ........................................................................................................................................................ 185 7 Treatment Models and Settings for People With Co-Occurring Disorders ............................................................. 186 Treatment Overview ......................................................................................................................................... 187 Treatment Programs ......................................................................................................................................... 187 Levels of Service ................................................................................................................................................ 188 Episodes of Treatment ...................................................................................................................................... 189 Integrated Versus Nonintegrated Treatment ................................................................................................... 189 Culturally Responsive Treatment ...................................................................................................................... 190 Barriers to Treatment ....................................................................................................................................... 190 Treatment Models ............................................................................................................................................ 192 Integrated Care ................................................................................................................................................. 192 ACT .................................................................................................................................................................... 194 ICM .................................................................................................................................................................... 198 Dual Recovery Mutual Support Programs ........................................................................................................ 204 Treatment Settings ........................................................................................................................................... 209 TCs ..................................................................................................................................................................... 209 Outpatient SUD treatment ............................................................................................................................... 213 Residential SUD treatment ............................................................................................................................... 217 Acute Care and Other Medical Settings ............................................................................................................ 220 Pharmacotherapy ............................................................................................................................................. 226 Medication for Mental Illness ........................................................................................................................... 226 Medication for SUDs ......................................................................................................................................... 232 Conclusion ........................................................................................................................................................ 233 8 Workforce and Administrative Concerns in Working With People Who Have Co-Occurring Disorders ................ 234 Recruitment, Hiring, and Retention .................................................................................................................. 235 Recruitment and Retention .............................................................................................................................. 236 Competency and Professional Development ................................................................................................... 239 Attitudes and Values ......................................................................................................................................... 240 Provider Competencies ..................................................................................................................................... 241 Supervision........................................................................................................................................................ 244 Continuing Professional Development ............................................................................................................. 245 Conclusion ........................................................................................................................................................ 249 Appendix A: Bibliography .......................................................................................................................................... 250 Appendix B: Resources .............................................................................................................................................. 285 Training for Providers and Administrators ....................................................................................................... 285 Sources of Training in Substance Use Disorders ............................................................................................... 285 Sources of Training in Mental Health................................................................................................................ 286 Sources of Training in CODs .............................................................................................................................. 286 Other Resources for Counselors, Providers, and Programs .............................................................................. 287 Publications ....................................................................................................................................................... 287 Treatment Locators ........................................................................................................................................... 289 Page vi TIP 42, Substance Use Disorder Treatment for People With Co-Occurring Disorders MARCH 2020 General Resources ............................................................................................................................................ 290 Client and Family Resources ............................................................................................................................. 296 Organizations .................................................................................................................................................... 296 Mutual Support Programs ................................................................................................................................ 296 Publications and Other Resources .................................................................................................................... 298 Online Boards and Chat Rooms ........................................................................................................................ 298 Mobile Apps ...................................................................................................................................................... 299 Appendix C: Provider Forms, Measures, and Tools ................................................................................................... 301 Biopsychosocial Intake Forms ........................................................................................................................... 301 Suicide and Safety Screening and Assessment Tools ........................................................................................ 301 Mental Disorder Screening and Assessment Tools ........................................................................................... 301 Substance Use/Misuse Screening and Assessment Tools ................................................................................ 303 Substance Withdrawal Screening Tools ............................................................................................................ 308 Trauma Screening and Assessment Tools ......................................................................................................... 310 Levels of Care Tool ............................................................................................................................................ 312 Functioning and Disability Tools ....................................................................................................................... 312 Stage of Change Tools ...................................................................................................................................... 312 Page vii TIP 42, Substance Use Disorder Treatment for People With Co-Occurring Disorders MARCH 2020 This page intentionally left blank. Page viii TIP 42, Substance Use Disorder Treatment for People With Co-Occurring Disorders MARCH 2020 Foreword The Substance Abuse and Mental Health Services Administration (SAMHSA) is the U.S. Department of Health and Human Services agency that leads public health efforts to reduce the impact of substance abuse and mental illness on America’s communities. An important component of SAMHSA’s work is focused on dissemination of evidence-based practices, and providing training and technical assistance to healthcare practitioners on implementation of these best practices. The Treatment Improvement Protocol (TIP) series contributes to SAMHSA’s mission by providing science-based, best-practice guidance to the behavioral health field. TIPs reflect careful consideration of all relevant clinical and health service research, demonstrated experience, and implementation requirements. Select nonfederal clinical researchers, service providers, program administrators, and patient advocates comprising each TIP’s consensus panel discuss these factors, offering input on the TIP’s specific topics in their areas of expertise to reach consensus on best practices. Field reviewers then assess draft content and the TIP is finalized. The talent, dedication, and hard work that TIP panelists and reviewers bring to this highly participatory process have helped bridge the gap between the promise of research and the needs of practicing clinicians and administrators to serve, in the most scientifically sound and effective ways, people in need of care and treatment of mental and substance use disorders. My sincere thanks to all who have contributed their time and expertise to the development of this TIP. It is my hope that clinicians will find it useful and informative to their work. Elinore F. McCance-Katz, M.D., Ph.D. Assistant Secretary for Mental Health and Substance Use U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration Page ix TIP 42, Substance Use Disorder Treatment for People With Co-Occurring Disorders MARCH 2020 This page intentionally left blank. Page x

See more

The list of books you might like

Upgrade Premium
Most books are stored in the elastic cloud where traffic is expensive. For this reason, we have a limit on daily download.
DMCA & Copyright: Dear all, most of the website is community built, users are uploading hundred of books everyday, which makes really hard for us to identify copyrighted material, please contact us if you want any material removed.
Copyright @ PDFdrive.to, 2022 | We love our users