Drug Abuse Treatment for Patients with Severe Mental Illness
Citation: Amy A. Mericle, Ph.D.; Jennifer Alvidrez, Ph.D.; Barbara E. Havassy, Ph.D. Mental Health Provider Perspectives on Co-Occurring Substance Use Among Severely Mentally Ill Clients. Journal of Psychoactive Drugs, June 2007, 39(2), p.173-181
Although there is a well-established relationship between severe mental illness and substance abuse, few studies have directly addressed the practical issues that psychotherapists face in working with clients suffering from comorbid severe mental illness and alcohol or drug abuse disorders.
The studies that have been done have begun to explore clinicians’ perceptions of and attitudes toward the challenges of implementing drug abuse treatment strategies with these individuals, as well some of the administrative challenges that arise. These studies have found that clinicians’ tend to experience these clients as more challenging than simpler cases but no less rewarding, and that administrators rank social stigma and historical differences between treatment modalities for the two types of disorders as the greatest barriers to treatment.
However, the authors claim that the existing literature does not provide an adequate understanding of “what it is actually like for providers working directly with individuals with such disorders…” or the strategies that providers find success with. The authors’ interest in advancing this area of research is to expand the presently available knowledge of structural impediments to successful treatment of dual-diagnosis severe mental illness/substance abuse patients in order to suggest policy improvements. To that end, the authors conducted focus groups with service providers from public intensive case management (ICM) programs which provide intensive integrated services to “high users of county psychiatric services due to primary mental disorders.”
Strategies In Use For Drug Abuse Treatment With The Severely Mentally Ill
The authors identified a number of strategies that their participants use for alcohol and drug abuse treatment among severe mental illness clients and the perceived barriers to implementing those strategies. The primary strategies used in terms of direct therapeutic interventions were harm reduction techniques, confrontation, and motivational interviewing. The main strategy appeared to be “sheer persistence in bringing up the clients’ substance use over time.”
More indirect strategies that the providers were using revolved around basic psychotherapeutic strategies that a clinician would use with any client: building a trusting therapeutic relationship and strong working alliance. Study participants also reported capitalizing on external pressures, such as court mandates, and providing information and referrals to push their clients in the direction of recognizing and getting treatment for their drug and alcohol abuse disorders.
Barriers To Implementing Drug Abuse Treatment Strategies
The main barriers to implementing these strategies for treating drug and alcohol abuse occurred at the client level, the provider level, the system level, and the environmental level. Client-level barriers revolved around denial of substance abuse problems and lack of motivation to receive treatment. The main provider-level barriers were the need to address competing treatment demands, lack of training in addictions treatment, and the desire to preserve the therapeutic relationship in the face of strong resistance to recognition that substance abuse is a problem for the client at all.
Systemic barriers to alcohol and drug abuse treatment revolved around a lack of resources: lack of adequate case management resources and continuity of care, and lack of economic resources to provide treatment to all individuals in need of it. Finally, the study participants noted environmental barriers including severe poverty and isolation from healthy individuals and communities. severe mental illness substance abuse patients are frequently surrounded by other substance-users.
Tags: alcohol abuse, drug and alcohol, intervention, mental illness, substance abuseRelated posts
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