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Cultural Clashes in Co-Occurring
Disorders: Clinical Dilemmas in Assessment and Treatment
David Mee-Lee, M.D.
Workshop Overview:
The addiction and mental health treatment fields have arisen from very different roots. This has accounted for the ongoing fragmentation that has been aggravated by different training, systems and funding. Clients and clinicians are separated by ideology and treatment orientations that do not serve well the co-occurring disorders client. This workshop will review the obstacles to integrated services and offer solutions to these cultural clashes.
Even though many are committed to best practices in integrated dual disorders treatment, it is difficult to actually change clinician attitudes and skills to provide truly integrated services. 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?
Workshop Objectives:
1. Identify the major ideological differences that divide addiction and mental health systems
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 integrated services for those with co-occurring mental and substance-related disorders.
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Cultural Clashes in Co-Occurring Disorders: Clinical Dilemmas in Assessment and Treatment
Workshop Agenda
| 8:30 AM | Registration |
| 9:00 AM | A. Cultural Clashes in the Behavioral Health Field |
| * Polarized Perspectives about Presenting Problems | |
| * Different Theoretical Perspectives; Different Treatment Methodologies | |
| B. Dilemmas in Definition, Diagnosis and Disposition | |
| * Prerequisite Concepts for Dual Diagnosis Work | |
| * Why Diagnostic Confusion? | |
| C. Assessment Dilemmas | |
| * Determining priorities: psychiatric versus addiction treatment | |
| * Decision Tree | |
| 10:30 AM | Break |
| 10:45 AM | D. Treatment Dilemmas |
| * Person-Centered assessment and treatment services | |
| * Treatment options and matching treatment to multidimensional needs | |
| * Different Approaches for Various Dual Diagnosis Clinical Situations | |
| 12:00 PM | Lunch |
| 1:00 PM | E. 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 | G. Improving Treatment Systems |
| * Staff and Program Issues | |
| * Systems fragmentation | |
| H. Individualized Staff and Agency Development Plan | |
| * Identifying and honoring you and your agency's stage of change | |
| * How to move to the next stage to improve services - Your Plan | |
| * Next steps and needs for ongoing training and technical assistance | |
| 4:00 PM | Adjourn |