COSIG CONFERENCE BROCHURE.pdf - Drexel University College ...

COSIG Co-Occurring Disorders Conference, Hershey PA, May 15-17, 2006
Stage-Wise Treatment
• Stage-wise treatment:
Vignette # 1
Allows for differing patterns of use,
decreasing or increasing.
Provides treatments/strategies for stagespecific
behaviors.
Demonstrates, behaviorally, how individuals
relate to treatment providers at different
stages of recovery.
Results in continual help to individuals, no
eject-no reject.
SAMHSA Integrated Dual Disorders Treatment Toolkit
Stage-Wise Treatment
The Substance Abuse Treatment Scale
(McHugo, Drake, Burton, Ackerson)
Pre-engagement. The person does not have contact with a case
manager, mental health counselor or substance abuse counselor,
and meets criteria for substance abuse or dependence.
Engagement. The client has had only irregular contact with an
assigned case manager or counselor, and meets criteria for
substance abuse or dependence.
Early Persuasion. The client has regular contacts with a case
manager or counselor, continues to use the same amount of
substances or has reduced substance use for less than 2 weeks,
and meets criteria for substance abuse or dependence.
Late Persuasion. The client has regular contacts with a case
manager or counselor, shows evidence of reduction in use for the
past 2-4 weeks (fewer substances, smaller quantities, or both), but
still meets criteria for substance abuse or dependence.
Stage-Wise Treatment
Early Active Treatment. The client is engaged in treatment and has
reduced substance use for more than the past month, but still
meets criteria for substance abuse or dependence during this
period of reduction.
Late Active Treatment. The person is engaged in treatment and has
not met criteria for substance abuse or dependence for the past 1-5
months.
Relapse Prevention. The client is engaged in treatment and has not
met criteria for substance abuse or dependence for the past 6-12
months.
In Remission or Recovery. The client has not met criteria for
substance abuse or dependence for more than the past year.
Stage-Wise Treatment
Treatment Matching Paradigm: Sub-Type of Dual Disorder by
Phases of Treatment
(Kenneth Minkoff,MD)
I. Low Severity MI + Low Severity SA
II. SPMI +Substance Abuse
III. Low Severity Psychiatric Disorder + High Severity SA Disorder
(addiction)
IVA. High Severity Psych (SPMI) + High Severity Substance
(addiction)
IVB. High Severity Psych Disturbance (non-SPMI ) +
High Severity Substance (addiction)
Stage-Wise Treatment
Example: Sub-type II: SPMI +Substance Abuse
Continuity Interventions
Continuing case management with an ind clinician, case
management team, or CTT team, depending on intensity of
need.
Ongoing responsibility of mental health agency/system.
Unconditional support commensurate with disability.
Continued medication, regardless of continuing substance
use.
Development of ongoing treatment plan, balancing care and
support with structured expectation and contingencies, while
maintaining continuity.
Stage-specific interventions as indicated
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