Multiconstruct

wasn’t feeling well today. a day of rest behind me and i don’t feel substantially better. will allow the days events to carry me through. feeling better then the neighbor though i imagine she was just taken away by the police. that is never really a good thing. it was the campus police which always weirds me out because their cop cars say “Mu Police” which always makes me think agents from the lost continent are prowling about.

i am watching the tigers game, up on the whitesox by 2 in the 3rd. planning on doing a little work. I have a training i am doing on wednesday and i swore i would write a handout. as per usual i like to do my creating on my own time in my own forum so that i own the fruits of my labor. plus work is a terrible place to try to create. you need space free of demands to make something new. mostly my work creativity is drug out me responding to situations. allowing solutions to develop.

if your a new reader i am a counselor at a substance abuse treatment agency where i coordinate some of our mental health programming and staff training. i have been trying to increase the counselors comfort in helping individuals with co-occurring mental health disorders because its way to common for me to handle all those folks.

Integrating Co-occurring Disorders Treatment into Substance Abuse Counseling Sessions

Principles:

The client is the biggest expert on their situation. You don’t have to know anything about the disorder to help the client manage it. So tell me about disorder X? What does it mean for you? Is there a time when it has been better then other times? What was that like? What did you do that made it better? Oh, that sounds like a good idea, do you think we could try that again?

There are no magic wands or “experts” who can do substantially more then you can. When I was a young clinician i referred out most tough stuff but when i did follow up contacts i learned that those referrals that were so hard to hustle up rarely yielded results. Appointments don’t get made, eligibility changes, someone doesn’t get engaged, there are endless ways that things go wrong. I began to notice my simple interventions were usually the most helpful thing. If you’ve got them engaged then likely no one can help them more then you can.

Mental illness is a concept with a lot of give and uncertainty. They can be thought of as nothing more then names we give to clusters of symptoms. Breaking down what symptoms are occurring and developing separate management plans for each symptom can be tremendously helpful.

Data is really useful and collecting it is good for you. Documenting negative behaviors decreases their frequency and the data collected can point to management strategies.

Treatments that people believe in are more effective. Treatments that individuals believe will not be effective will not be effective; we call this the Nocebo Effect and it is real and measurable and more powerful then morphine. Present yourself in a hopeful and confident manner, share some brief success stories.

Listening is still the most helpful thing you can do for someone. When someone tells their story to a supportive listener their self efficacy increases. A rising tide lifts all boats. Validate their struggle.

Techniques by Symptom:

Depression: Sunlight and exercise. Reframing. Separating feelings from behaviors. Cognitive approaches.

Mania: Catch it early. Sleep every night. Progressive relaxation.

Impulsivity: Slow things down. Strengthen powers of reflective thought. Keep long term goals in working memory. reward curbing impulses. work on something that happens all the time and then generalize.

Hallucinations/Delusions: Ask if they know if its real or not. If they do tell them don’t attend to them or give them energy. Learn to ignore it. Shift to the concrete. Never feed into it or ask for unneeded details. If they can’t tell its real they have to ask people they trust.

Paranoia: note if they describe it as such, it means they know its not real. If they truly think people are out to get them de-escalate and reassure.

anxiety: cognitive approaches work well as does data collection. scaling and exposure are the classic approaches. de-escalation and teaching self soothing is also key. exercise.

attention deficit: point out there are times they can pay attention. measure them and grow them systematically with rewards.

OCD: cognitive approaches.

suicidal ideation: ask, contract, normalize

SIB: validate as a valid coping mechanism, identify healthier coping mechanisms

Sleep Problems: exercise earlier in the day, cut back on caffeine, routine, progressive relaxation, Trazodone

Nightmares: Propranol,

Finding a doctor: Primary care is not a bad place to start they use less psychiatric medications in lower doses which can be a good thing for patients with addiction. If no insurance contact the Family Health Center (214-2314)and ask for the medical social worker for a referral to Medzou. If you frame it as a psychiatric issue he may not refer.

The Phoenix psychiatrist is reserved for existing patients and MAT evaluations. Good candidates: have no insurance, are alcohol or opiate dependent, have had numerous treatments, are willing to do aftercare with Phoenix for the long haul.