COSIG CONFERENCE BROCHURE.pdf - Drexel University College ...
COSIG CONFERENCE BROCHURE.pdf - Drexel University College ... COSIG CONFERENCE BROCHURE.pdf - Drexel University College ...
Cultural Clashes in Co-Occurring Disorders: David Mee-Lee, M.D. Clinical Dilemmas in Assessment and Treatment ___________________________________________________________________________________ 3. Care versus Confrontation • mental health - care, support, understanding, passivity • addiction - accountability, behavior change 4. Abstinence-oriented versus Abstinence-mandated • treatment as a process, not an event • respective roles in both approaches 5. Deinstitutionalization versus Recovery and Rehabilitation C. Dilemmas in Definition, Diagnosis and Disposition • Definition - diagnosis or diagnoses; “multiproblem” - any client who presents with significant alcohol and/or other drug use and active psychiatric Sxs • Diagnosis - substance use disorder or psychiatric diagnosis or both?; primary or secondary disorder, or doesn’t it matter? • Disposition - where to treat? - addiction treatment settings; mental health settings; or special dual diagnosis services; use treatment-priority to determine placement - how to treat? - medications; motivation; meetings D. Why Diagnostic Confusion? - Diagnostic Confusion due to: • Alcohol/drugs can cause psychiatric symptoms in anyone (acute toxicity) • Prolonged alcohol/drug use can cause short or long-term psychiatric illness • Alcohol/drug use can escalate in episodes of psychiatric illness • Psychiatric symptoms and alcohol/drug use can occur in other psychiatric disorders • Independent addiction and psychiatric illnesses (“Dual Diagnosis”) (Marc A. Schuckit: Am. J. Psychiatry, 143:2 p. 141 - modified) E. Why Lack of Consensus? • Lack of consistency in research findings; research methodologies; prevalence rates • Different training and experience • Different patient populations • Different research methodologies 2 ______________________________________________________________________________
Cultural Clashes in Co-Occurring Disorders: David Mee-Lee, M.D. Clinical Dilemmas in Assessment and Treatment ___________________________________________________________________________________ II. What to do about Philosophical Clashes F. Person-Centered Assessment and Individualized Treatment 1. Multidimensional Assessment • Because mental and substance-related disorders are biopsychosocial disorders in etiology, expression and treatment, assessment must be comprehensive and multidimensional to plan effective care. The common language of six assessment dimensions of the ASAM Criteria (modified for mental disorders in Second Edition, Revised, ASAM PPC-2R, 2001) are used to focus assessment and treatment. 1. Acute intoxication and/or withdrawal potential 2. Biomedical conditions and complications 3. Emotional/behavioral/Cognitive conditions and complications 4. Readiness to Change 5. Relapse/Continued Use/Continued Problem potential 6. Recovery environment 2. Individualized Treatment PATIENT/PARTICIPANT ASSESSMENT Data from all BIOPSYCHOSOCIAL Dimensions PROGRESS Response to Treatment BIOPSYCHOSOCIAL Severity (SI) and Level of Functioning (LOF) PRIORITIES BIOPSYCHOSOCIAL Severity (SI) and Level of Functioning (LOF) PLAN BIOPSYCHOSOCIAL Treatment Intensity of Service (IS) - Modalities and Levels of Service 3. Biopsychosocial Treatment - Overview: 5 M’s * Motivate - Dimension 4 issues; intervention; “raising the bottom”; motivational enhancement * Manage - the family, significant others, work/school, legal * Medication - detox; anti-craving meds; Antabuse; opioid antagonists; methadone and buprenorphine; psychotropic medication * Meetings - AA, NA, Al-Anon; Smart Recovery, Dual Recovery Anonymous, etc. * Monitor - continuity of care; relapse prevention; family and significant others 4. Treatment Levels of Service - levels of care/service to match severity of problems: I Outpatient Services II Intensive Outpatient/Partial Hospitalization Services III Residential/Inpatient Services IV Medically-Managed Intensive Inpatient Services 3 ______________________________________________________________________________
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Cultural Clashes in Co-Occurring Disorders:<br />
David Mee-Lee, M.D.<br />
Clinical Dilemmas in Assessment and Treatment<br />
___________________________________________________________________________________<br />
II. What to do about Philosophical Clashes<br />
F. Person-Centered Assessment and Individualized Treatment<br />
1. Multidimensional Assessment<br />
• Because mental and substance-related disorders are biopsychosocial disorders in etiology, expression<br />
and treatment, assessment must be comprehensive and multidimensional to plan effective care. The<br />
common language of six assessment dimensions of the ASAM Criteria (modified for mental disorders<br />
in Second Edition, Revised, ASAM PPC-2R, 2001) are used to focus assessment and treatment.<br />
1. Acute intoxication and/or withdrawal potential<br />
2. Biomedical conditions and complications<br />
3. Emotional/behavioral/Cognitive conditions and complications<br />
4. Readiness to Change<br />
5. Relapse/Continued Use/Continued Problem potential<br />
6. Recovery environment<br />
2. Individualized Treatment<br />
PATIENT/PARTICIPANT ASSESSMENT<br />
Data from all<br />
BIOPSYCHOSOCIAL<br />
Dimensions<br />
PROGRESS<br />
Response to Treatment<br />
BIOPSYCHOSOCIAL Severity (SI)<br />
and Level of Functioning (LOF)<br />
PRIORITIES<br />
BIOPSYCHOSOCIAL Severity (SI)<br />
and Level of Functioning (LOF)<br />
PLAN<br />
BIOPSYCHOSOCIAL Treatment<br />
Intensity of Service (IS) - Modalities and Levels of Service<br />
3. Biopsychosocial Treatment - Overview: 5 M’s<br />
* Motivate - Dimension 4 issues; intervention; “raising the bottom”; motivational enhancement<br />
* Manage - the family, significant others, work/school, legal<br />
* Medication - detox; anti-craving meds; Antabuse; opioid antagonists; methadone and<br />
buprenorphine; psychotropic medication<br />
* Meetings - AA, NA, Al-Anon; Smart Recovery, Dual Recovery Anonymous, etc.<br />
* Monitor - continuity of care; relapse prevention; family and significant others<br />
4. Treatment Levels of Service - levels of care/service to match severity of problems:<br />
I Outpatient Services<br />
II Intensive Outpatient/Partial Hospitalization Services<br />
III Residential/Inpatient Services<br />
IV Medically-Managed Intensive Inpatient Services<br />
3<br />
______________________________________________________________________________
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