Transcript Co-occurring Drug and Alcohol and Mental Health Conditions

Co-occurring Alcohol and Other Drug and
Mental Health Conditions in Alcohol and
other Drug Treatment Settings
Session 3:
Identifying
Comorbidity
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Comorbidity Guidelines
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Refer to:
 Chapter 6
 Appendices F to P
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Identifying Comorbidity
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Routine screening/assessment as part of case
formulation
Consider range of aspects in process of case
formulation, not only AOD and mental health
issues
Assessment should occur subsequent to
period of abstinence, or at least when not
withdrawing or intoxicated
Multiple assessments needed throughout
treatment as symptoms may change over
time
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Case Formulation
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Involves gathering information regarding
factors relevant to treatment planning,
formulating an hypothesis re how factors fit
together to form the current presentation
Primary goal of AOD treatment services is to
address clients’ AOD use. However, in order
to do so effectively, AOD workers must take
into account broad range of issues clients
present with.
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Case Formulation Process
Discharge
Informal assessment
(including mental state
examination)
Use of standardised
screening & assessment
tools (as required)
Intake
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Informal Assessment
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Mental state
Source of referral and
current health care
providers
Presenting issues
AOD use history
Current situation
Personal, medical and
family history
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Trauma history
Psychiatric history
Risk assessment
Criminal history
Strengths and
weaknesses
Readiness for change
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Mental State Assessment
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Standardised approach to assessing current
mental state
Based on what see, hear, perceive in present,
not history/past
Very useful method for communicating with
mental health and other services
Useful baseline assessment
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Mental State Assessment
Components
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Appearance
Behaviour
Speech and language
Mood and affect
Thought content
Perception
Cognition
Insight and judgement.
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Psychiatric History
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If client has experienced mental health
symptoms or diagnosis in past, ask about
timing of symptoms:
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When did symptoms start (prior to AOD use)?
Only occur when intoxicated or withdrawing?
Have symptoms continued after period of
abstinence (approximately 1 month)?
Do symptoms change when client stops using
substances?
Family history of particular mental health
condition?
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Trauma History
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Raising issue of trauma is important.
However needs to carried out in sensitive
manner and NOT pursued if client does not
wish to discuss history of trauma
Before conducting trauma assessment
workers should seek training and supervision
in dealing with trauma responses
Workers who have experienced trauma need
to take particular care
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Trauma History
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Before questioning AOD worker should:
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Seek client’s permission
Advise client does not have to talk about these
experiences
Communicate reasons for asking about past
trauma
Advise client talking about traumatic events can
be distressing; (can also be positive experience)
Advise client of any restrictions on confidentiality
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Trauma History
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Adopt non-judgemental attitude.
Display comfortable attitude if client describes
their trauma experience.
Praise client for having courage to talk about
what happened.
Normalise client’s response to trauma and
validate their experiences.
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Risk Assessment
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Includes suicidal thoughts/attempts, selfharm, DV, homicidal thoughts/attempts, and
child welfare
When risk perceived as alarming, other
services may need to be enlisted (eg: police,
ambulance, crisis teams)
Also include evaluation of safety re sexual
practices, injecting practices and other highrisk behaviours
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Suicide Risk Assessment
Questions include:
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Have things been so bad lately that you have thought
you would rather not be here?
Because of the high rates of suicide, I ask all my
clients about whether they have ever had any
suicidal thoughts. I am wondering if you have ever
been feeling so awful that you have begun thinking
about suicide?
Have you had any thoughts of harming yourself? Are
you thinking of suicide?
How often do you have these thoughts of killing
yourself?
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Suicide Risk Assessment
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Have you made any current plans?
What has happened that makes life not worth living?
Have you ever tried to harm yourself?
Do you have access to firearms or any other lethal
means?
Is there anyone you rely upon for support?
Is there anything that is preventing you from acting
on your thoughts?
Do you think that the treatment offered is going to
help you get better?
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Readiness for Change
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Assessment of readiness for change
regarding AOD and/or mental health
conditions is an important component of
assessment and case formulation
See IMAT, tool for assessing motivation
regarding AOD treatment and psychiatric
treatment (Appendix I in Guidelines)
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Standardised Screening
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Useful means of gathering data by providing
reliable and valid view of client’s difficulties
and current life situation
Provides baseline for both AOD workers and
clients to refer back to later in the treatment
process
Provides an opening for discussion of client
concerns
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Standardised Screening
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Important to:
 Provide client with reasons for assessment
and purpose of each instrument
 Explain that it is a standard procedure
 Explain how standardised assessment can
be useful in helping clients achieve goals
 Provide appropriate and timely feedback of
results of assessment
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Standardised Tools
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Kessler Psychological Distress Scale (K10)
PsyCheck
Depression Anxiety Stress Scale (DASS)
Primary Care PTSD Screen (PC-PTSD)
Trauma Screening Questionnaire (TSQ)
Psychosis Screener (PS)
Indigenous Risk Impact Screen (IRIS)
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Feedback
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Following assessment it is important to
interpret the results for client in a manner
that the client can understand (i.e. not just
numerical test scores)
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Focus first on strengths
Gently and tactfully outline client’s difficulties
Focus on the pattern of results rather than just an
overall score
Pull assessment results together and offer hope by
discussing treatment plan
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Note!
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Screening measures are not diagnostic;
important not to label a client as having a
diagnosis of a disorder unless it has been
made by a suitably qualified mental health
professional.
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In sum…
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Routinely assess for a range of mental health
concerns with all AOD clients
Assessment is a process not a single event
Assessment can be an intervention in itself
For further information refer to Chapter 6 and
screening tools in appendices of Guidelines
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