Health Canada
Symbol of the Government of Canada
Skip to content | Skip to institutional links

Common menu bar links

Home > Health Concerns > Reports & Publications > Alcohol & Drug Prevention Publications

Institutional links

Health Concerns

Best Practices - Concurrent Mental Health and Substance Use Disorders

Table of Contents

Appendix G

Tools and Interventions for Working with People with Co-occurring Substance Abuse and Severe and Persistent Mental Illness (from Mueser et al., in press)44

Common Obstacles to Assessment and Solutions for Concurrent Substance Abuse and Severe Mental Illness

Obstacles
Solution
Failure to take a proper history
Ask client directly about substance use and its consequences, beginning with past use.
Denial and minimization
Expect denial and minimization and tap additional sources of information about clients' substance abuse.
Confusion about effects of substance use
Explore associations between substance use and course of psychiatric illness; if client uses substances, assume problems in functioning are at least partly related to substance use.
The primary-secondary mental illness substance use disorder distinction
View both substance abuse and mental illness as primary disorders.
Sudden, unexplained mood shifts
depression and hopelessness, anger, euphoria, anxiety, expansiveness
Cognitive, psychotic, and mood related distortions
Be aware of possible distortions without ruling out all client self-reports; seek out other sources of information about client's substance abuse.
History of sanctions
Openly discuss the clinician's legal responsibilities, the client's concerns about legal issues, and control over the client's finances.
Pre-motivational state
Recognize that low motivation is common early in dual diagnosis treatment and seek to actively engage client.
Different norms for substance use disorder
Remember that client may experience adverse consequences to much lower amounts of alcohol and drug use than people with no psychiatric illness; the quality ofsubstance use is less important than the consequences of use.

Top of Page

 

Potential Interventions at Different Stages of Treatment (continued from Mueser et al.44)

Stage of Treatment

Case Management

Engagement:  X

Persuasion:  X

Active Treatment:  X

Relapse Prevention:  X

 

Stage of Treatment

Family Work

Engagement:  X

Persuasion:  X

Active Treatment:  X

Relapse Prevention:  X

 

Stage of Treatment

Pharmacologic Treatment

Engagement:  X

Persuasion:  X

Active Treatment:  X

Relapse Prevention:  X

 


Top of Page

Stage of Treatment

Assertive Outreach

Engagement:  X

Persuasion:  X

Active Treatment:  X

Relapse Prevention:  X

 

Stage of Treatment

Coerced or Involunary Interventions

Engagement:  X

Persuasion:  X

Active Treatment:  X

Relapse Prevention:  X

 

Stage of Treatment

Residential Programs  

Engagement

Persuasion:  X

Active Treatment:  X

Relapse Prevention

 


Top of Page

Stage of Treatment

Motivational Interviewing

Engagement

Persuasion:  X

Active Treatment:  X

Relapse Prevention:  X

 

Stage of Treatment

Persuasion Groups

Engagement

Persuasion:  X

Active Treatment:  X

Relapse Prevention

 

Stage of Treatment

Cognitive-Behavioural Counseling

Engagement

Persuasion:  X

Active Treatment:  X

Relapse Prevention:  X

 


Top of Page

Stage of Treatment

Social Skills Training

Engagement

Persuasion:  X

Active Treatment:  X

Relapse Prevention:  X

 

Stage of Treatment

Vocational Rehabilitation

Engagement

Persuasion

Active Treatment:  X

Relapse Prevention:  X

 

Stage of Treatment

Active Treatment Groups

Engagement

Persuasion

Active Treatment:  X

Relapse Prevention:  X

 

Stage of Treatment

Self-help Groups

Engagement

Persuasion

Active Treatment:  X

Relapse Prevention:  X

 

Table of Contents
Date Modified: 2007-12-28

Top of Page
Important Notices