Transcript Inpatient treatment and recovery process of adolescents

Inpatient treatment and recovery
process of adolescents with comorbid
mental and substance use disorders
Anna Robert
Área de Adolescentes.
Benito Menni CASM .
St. Boi de Llobregat (Barcelona)
Benito Menni CASM
Bed capacity: 603 (50 ados)
In St. Boi de Llobregat, at 20 Km. SW of Barcelona
For adolescents from all Catalonia between the ages of 12-18 years.
Involuntary admissions (parents agrees to their admission)
Scheduled admissions
Maximum inpatient beds: 50.
- Crisis Unit (U1). Average stay: 25 days
-Subacute Unit (U2). Average stay: 180 days
Diagnosis
Behavioral disorders (U1)
Affective disorders
Severe personality dysfunction
Psychotic disorders (U2)
Other: autism, PTSD, …
Frequent concomitant problems
Social isolation
Self harming
Hetero-agressive behaviour
Impulsivity
Dysthymia
Eating disorders
School failure
Family problems
Substance use
Substances use in our
patients
Study 1: % of habitual consumption in a clinical sample
(n=221)
Muñoz y Fatjó-Vilas (2009)
Study 1: Frequency of substance use
Among smokers, 90% are daily smokers.
Alcohol consumers: 51% make a “recreational” alcohol use
on the weekends, 46% are casual drinkers, 3% drink daily
or almost daily.
Marijuana users: 41% smoke daily, 44% smoke marijuana
occasionaly, and 15% smoke on the weekend.
Muñoz y Fatjó-Vilas (2009)
Study 2: Inpatients Personality risk profile (N=94)
•
In the U.S., a high prevalence (42-75%) of Conduct Disorder has been
found
among
adolescent
inpatients
with
SUD
(Grilo,
1996;
Langenbach, 2010). These adolescents are characterized by higher
levels of unruliness and social insensitivity (i.e., lack of empathy).
•
In our study, all patients were interviewed and evaluated using the
Millon Adolescent Clinical Inventory (MACI) as part of the clinical
assessment process.
Robert y cols (2011)
Personality styles related to Conduct Disorders
stratified by SUD group (MACI results)
90
80
*
*
70
*
60
50
40
Unruly (antisocial)
Forceful (sadistic)
SUD group
Oppositional
(negativistic)
Non-SUD group
Unruly personality style was positively associated with SUD.
Clinical Syndromes (MACI)
110
90
*
*
*
70
50
*
30
10
Substance abuse
proneness
Delinquent
predisposition
SUD group
Impulsive
propensity
Anxious feelings
Non-SUD group
More unregulated behaviors in the SUD group.
Expressed concerns (MACI)
90
80
*
70
*
60
50
Social insensitivity
SUD group
Family discord
Non-SUD group
SUD group reported more interpersonal problems.
Dual diagnosis treatment
Basic treatment principles
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Identify and treat SUD’s as quickly as possible
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Treatment should address the needs for the whole person
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Monitor drug use during hospitalization (e.g. urinalysis)
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Promote a drug-free lifestyle
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Assess motivation for change
Recovery process in the Subacute Unit
Individualized Therapeutic Plan (ITP)
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Psychological intervention
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Psychiatric intervention
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Social intervention
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School Program: educational group sessions
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Occupational Therapy Intervention Plan: “Good morning” group,
Cognitive
Stimulation,
Relaxation,
Autonomy
workshop, psychomotor group, “Pis escola”
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Other interventions
group,
Creative
Agility group - Animals assisted therapy
“Better… with ICT’s” group
Projecte Pont: activities
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Scholar suport
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Workshops/activities:
cooking, music (lipdub),
etc.
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“Free time”
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ICT/Computer group
Psychological Treatment of suvstance use
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Behavioral therapy/intervention
– To motivate adolescents to participate in treatment (Motivational
Enhancement Therapy: MET)
– To modify attitudes and behaviors related to drug abuse
(Cognitive Behavior Therapy: CBT)
– To increase life skills to cope with stress (CBT)
•
Group therapy (take care: drug use can be glorified and antisocial
behavior encouraged)
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Family therapy
“You never walk alone…”
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Coordination of care across inpatient and outpatient providers
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Discharge planning (Day Hospitals, special education units, etc.)
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Continuity of nursing care plan
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Link adolescent/family with community services
Treatment is not recovery
Detox/dishabituation and rehabilitation are necessary but not sufficient
conditions
For long-term recovery maintenance, adolescents/their families must
build naturally occurring, healing environments in the community.
[email protected]