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Adult Manual Cover&Spine.Indd Co-occurring Substance Use and Mental Health Disorders in Adults: An Integrated Treatment Approach to Dual Diagnosis TRAINER’S MANUAL Co-occurring Substance Use and Mental Health Disorders in Adults: An Integrated Treatment Approach to Dual Diagnosis TRAINER’S MANUAL Co-occurring Substance Use and Mental Health Disorders in Adults: An Integrated Treatment Approach to Dual Diagnosis TRAINER’S MANUAL Co-occurring Substance Use and Mental Health Disorders in Adults: An Integrated Treatment Approach to Dual Diagnosis TRAINER’S MANUAL Co-occurring Substance Use and Mental Health Disorders in Adults: An Integrated Treatment Approach to Dual Diagnosis TRAINER’S MANUAL Co-occurring Substance Use and Mental Health Disorders in Adults: An Integrated Treatment Approach to Dual Diagnosis TRAINER’S MANUAL Co-occurring Substance Use and Mental Health Disorders in Adults An Integrated Treatment Approach to Dual Diagnosis TRAINING MANUAL Published by the Northeast Addiction Technology Transfer Center (NEATTC.) Northeast ATTC, Regional Enterprise Tower, 425 Sixth Avenue, Suite 1710, Pittsburgh, PA 15219 This publication was prepared by the Addiction Technology Transfer Center (ATTC) Network under a cooperative agreement from the Substance Abuse and Mental Health Services Administration’s (SAMHSA), Center for Substance Abuse Treatment (CSAT). All material appearing in this publication except that taken directly from copyrighted sources is in the public domain and may be reproduced or copied without permission from SAMHSA/CSAT or the authors. Citation of the source is appreciated. Do not reproduce or distribute this publication for a fee without specific written authorization from the NEATTC. For more information on obtaining copies of this publication, call 412-258-8565. At the time of this printing, Charles G. Curie, MA, ACSW, served as the SAMHSA Administrator. H. Westley Clark, MD, JD, MPH, served as the Director of CSAT., and Catherine D. Nugent served as the CSAT Project Officer. The opinions expressed herein are the views of the ATTC Network and do not reflect the official position of the Department of Health and Human Services (DHHS), SAMHSA or CSAT. No official support or endorsement of DHHS, SAMHSA or CSAT for the opinions described in this document is intended or should be inferred. MISA TRAINER’S MANUAL DEVELOPMENT Northwest Behavioral HealthNet Training Subcommittee on MISA Curriculum developed this Mental Illness Substance Abuse (MISA) The Trainer’s Manual in conjunction with Gannon University through a grant funded by the Northeastern States Addiction Technology Transfer Center. Northwest Behavioral HealthNet is a consortium of 22 behavioral health agencies that provide services in Erie County, PA. Kenneth Minkoff, M.D., provided Professional consultation for this project. Dr. Minkoff is the Director of Integrated Psychiatric and Addiction Services for Arbour Health System, and the Medical Director of Choate Health Management. He is a Board Certified psychiatrist with a certificate of additional qualifications in Addiction Psychiatry. He is a nationally known expert on dual diagnosis and the integration of mental health and substance disorder services. He has authored and edited numerous works, including “Dual Diagnosis of Serious Mental Illness and Substance Disorder,” which he co-edited with Robert Drake, M.D. Dr. Minkoff is also Chair of the Center for Mental Health Services Public Managed Care Initiatives Panel on Co- occurring Psychiatric and Substance Disorders, and a member of the board of the American Association of Community Psychiatrists. Areas of consultation expertise include: psychiatric and addiction integration, managed care systems development, quality management, physician management, contracting and reimbursement, utilization management and levels of care assessment, hospital alternatives for mental health, and substance use disorder. The manual development was directed by Margaret Shenefelt, MSW, LSW, along with the other members of the Northwest Behavioral Healthnet MISA Training subcommittee. Kathleen Pae, MS, LPC, CAC, provided grant writing and MISA expertise. Cathleen Miner Ashbaugh, M.S., David Rosswog, M.A. and Debra Thaler, M.A. of Gannon University designed and authored the manual under contract with the Northwest Behavioral Healthnet. Robert Nelson, Ed.D., Training Director and Chair of the Psychology Department of Gannon University, was an additional consultant to the project. ADULT CO-OCCURRING TRAINING MANUAL — 1 The current edition of this curriculum was completed in the Fall of 2005 and contains the newest information available on Co-occurring Disorders in Adults. This edition was re-written by Margaret Shenefelt, MSW, LSW and Kathleen Pae, MS, LPC, CAC. Thanks go to Joan Leary, Alabama Manager for the Southern Coast Addiction Technology Transfer Center, at University of Alabama-Birmingham and Kathy Seifried, Alabama Department of Mental Health, Substance Abuse Division, and the forty Co- Occurring Trainers from Alabama who gave us invaluable feedback for the revisions needed. The second edition revision was funded and supported by the Northeast Addiction Technology Transfer Center at the Institute for Research, Education and Training in Addictions (IRETA) in Pittsburgh, PA. Included in this manual are trainee and trainer rating and evaluation scales to provide for ongoing improvement and adjustments by both trainers and trainees. If you have questions, suggestions or need additional help as a trainer, or would like to hire a trainer for this curriculum, please contact: NEATTC/IRETA Regional Enterprise Tower 425 Sixth Avenue, Suite 1710 Pittsburgh, PA 15219 412-258-8565 www.neattc.org www.ireta.org www.pa-co-occurring.org ADULT CO-OCCURRING TRAINING MANUAL — 2 AUDIO/VIDEO RESOURCE INFORMATION CONTENT: MODULE 1 Minkoff, K. (2000). Dual Diagnosis: An integrated model for the treatment of people with co- occurring psychiatric and substance disorders. A lecture by Kenneth Minkoff. Brookline Village, MA: Mental Illness Education Program Videos, 2000. Available at: www. kennethminkoff.com or call 1-800-343-5540. SAMHSA, Video VHS 167, When Addiction and Mental Disorders Co-Occur, 2003. Available at: www.samhsa.gov. MODULE 2 Csernansky, J., Department of Psychiatry, Washington University School of Medicine, Malcolm Bliss Mental Health Center. (1994). Diagnosis according to the DSM-IV: Real patients talking about their problems in their own words. Tapes 1-4. Produced & directed by Wohl, I., Only Child Motion Pictures, Inc. A Newbridge Professional Program. New York: Brooks/Cole Publishing Company. Linehan, Marsha, Pfizer Inc., Life After Trauma: What Every Person Should Know, TL334Y99, 2000. Available from: Pfizer Inc. OPTIONAL AUDIO TAPE Virtual Hallucinations, a simulation of auditory hallucinations. (1997) Janssen Pharmaceutical. No longer available from Janssen, but your local NAMI chapter will probably have a copy somewhere in their library. MODULE 3 Csernansky, John, MD, Department of Psychiatry, Washington University School of Medicine, Malcom Bliss Mental Health Center. (1994) “Diagnosis according to the DSM-IV: Real patients talking about their problems in their own words”. Tape 3. Produced by Ira Wohl, Only Child Motion Pictures, Inc. A Newbridge Professional Program. New York; Brooks/Cole Publishing Co. ADULT CO-OCCURRING TRAINING MANUAL — 3 AGENDA AGENDA MODULE 1~ 6 HOURS INSTRUCTION TIME • Introduction (60 minutes) • Historical Trends & Barriers to Integrated Treatment (30 minutes) • BREAK (15 minutes) • Definitions and Principles of Integrated Treatment Approach to Dual Diagnosis (90 minutes) • LUNCH (60 minutes) • The Process of Recovery (60 minutes) • Other Models of Dual Diagnosis Treatment (30 minutes) • BREAK (15 minutes) • Cultural Differences: Implications for Practitioner’s Role & Intervention (75 minutes) • Summary, Post-test & Evaluation (15 minutes) AGENDA MODULE 2 ~ 6 HOURS INSTRUCTION TIME • Introduction (30 minutes) • What is a Mental Disorder? (30 minutes) • Review of DSM -IV and DSM-IV TR (30 minutes) • BREAK (15 minutes) • Risk Assessment (30 minutes) • Multi-axial Assessment (45 minutes) ADULT CO-OCCURRING TRAINING MANUAL — 4 AGENDA AGENDA MODULE 2 ~ CONTINUED • LUNCH (60 minutes) • Axis I Disorders (90 minutes) • BREAK (15 minutes) • Axis II Disorders (45 minutes) • Summary, Post-test & Evaluation (15 minutes ) AGENDA MODULE 3 ~ 6 HOURS INSTRUCTION TIME • Introduction & Review of Goals and Agenda (30 minutes) • Definitions & Considerations: Substance Related Disorders (60 minutes) • BREAK (15 minutes) • Treatment Selection and Modalities (30 minutes) • Substance Abuse Diagnosis in the DSM-IV-TR (60 minutes) • LUNCH (60 minutes) • Substance Abuse Diagnosis Continued (45 minutes) • Drugs of Abuse Exercises (60 minutes) • BREAK (15 minutes) • Continue Drugs of Abuse Exercises (60 minutes) • Summary, Post-test & Evaluation (15 minutes) ADULT CO-OCCURRING TRAINING MANUAL — 5 Co-occurring Substance Use and Mental Health Disorders in Adults An Integrated Treatment Approach to Dual Diagnosis MODULE ONE: Integrated Concepts and Approaches ADULT CO-OCCURRING TRAINING MANUAL / MODULE ONE — 6 MODULE 1 HANDOUTS 1.0 Pre-test (Optional) 1.2 Definition of Serious Mental Illness—PA MH Bulletin 1.7a Levels of Functioning 1.7b Mini Cases 1.18 Four Categories of Client Resistant Behavior (adapted from Miller & Rollnick) 1.19 Counselor Responses that Heighten Resistance (adapted from Gordon, 1970; Miller & Jackson, 1985) 1.20 The Four “R’s” Other Than Resistance 1.21 Strategies for Handling Resistance
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