Co-Occurring Disorders (Dual Diagnosis): Clinical Dilemmas in Assessment and Treatment   David Mee-Lee, M.D.   Workshop Content and Purpose A large proportion of individuals suffering from alcoholism and drug dependence also suffer from psychiatric problems and vice versa. Because clinicians often lack training in both addiction and mental health treatment, clients with co-occurring mental and substance-related disorders frequently receive inadequate care, caught in the gap between the mental health and addiction treatment systems. Clinicians can feel ill equipped to face the increasing population of multiproblem and dual diagnosis patients. This workshop will address clinical dilemmas in treating clients with the dual problems of psychiatric and addiction illness: --> How to decide whether there is a substance-induced psychiatric disorder or an actual co-occurring mental and substance-related disorder? --> Is the substance use a result of a psychiatric disorder or an attempt to self medicate a mental disorder? --> Are the mental health symptoms a result of substance use problems? Which is primary and which is secondary or doesn't it matter? --> Should there be a period of abstinence before a mental health evaluation or before medication is given? --> Or should medication be given regardless of a period of abstinence? The workshop will focus on diagnostic and treatment strategies to address these dilemmas. The issues of motivation, resistance and poor follow through with treatment will be addressed. Because many dual diagnosis patients are not ready to change their substance use and/or follow their mental health treatment, there will also be some focus on motivational interviewing and engaging people into participatory treatment. -->What if the client accepts the mental health problem, but not the substance use problem? --> Should the substance use be overlooked until a better relationship has been formed; or should further mental health treatment be contingent on the client accepting abstinence first? --> How does the therapist understand and deal with poor follow through with medication and recovery activities? While there are no simple answers for this complex population, there are concepts and clinical strategies grounded in research findings and clinical experience that can help the clinician approach dual diagnosis with some sense of direction, proactive interventions and hope.   Objectives Participants will: 1. Identify the attitude and value system changes required to work with dual diagnosis clients. 2. Discuss assessment strategies, techniques and priorities to determine treatment options and interventions. 3. Apply treatment and motivational strategies necessary to develop a treatment plan that meets the client's individual multidimensional needs and stage of change. 4. Identify staff, program and systems issues in providing less fragmented services for those with co-occurring mental and substance-related disorders.   Co-Occurring Disorders (Dual Diagnosis): Clinical Dilemmas in Assessment and Treatment   Workshop Agenda   8.30 AM Registration     9.00 AM A. Dilemmas in Definition, Diagnosis and Disposition B. Prerequisite Concepts for Dual Diagnosis Work C. Why Diagnostic Confusion? D. Why Lack of Consensus?   E. Diagnostic Dilemmas   ** Determining priorities: psychiatric versus addiction treatment   ** Decision Tree     10.30 AM Break     10.45 AM F. Treatment Dilemmas   ** Treatment options and matching treatment to multidimensional needs   ** Different Approaches for Various Dual Diagnosis Clinical Situations     12 Noon Lunch     1.00 PM G. Engaging Clients and Families into Participatory Treatment   ** Assessing Readiness to Change and What the Client Wants   ** Motivational enhancement strategies to match stage of change     2.30 PM Break     2:45 PM H. Improving Treatment Systems   ** Staff and Program Issues   ** Systems fragmentation     4 PM Adjourn