Integrated Dual Diagnosis Treatment Spotlighted in Chicago

(Submitted by Susan Stracke)

The NAMI National Convention in Chicago offered a workshop called Real Help For People Living With Mental Illness and Substance Abuse:  An Introduction to Integrated Dual Disorders Treatment (IDDT) was by Melanie Kinley of Thresholds in Chicago, Illinois.  She stated that the co-occurrence of substance abuse and mental illness is an established fact.  The “abysmal track record of our current systems of care in providing effective services for this doubly challenged group of people” is also an established fact.  An Integrated Dual Diagnosis Treatment plan is an approach that is evidenced-based and provides treatment for both disorders in the same place and time by specially trained service providers.  Originally the treatment plan was developed by the Psychiatric Research Center at Dartmouth and is now being implemented by Thresholds in Chicago.

According to Ms. Kinley, one third of all those with mental illness have a co-occurring substance abuse problem and 56% of those with bipolar disorder have problems with substance abuse.  Reasons why substances are abused are to alleviate distressing  symptoms, reduce stigma, cope emotionally with a mental illness, to combat boredom and isolation, to manage side effects of medications, or to feel normal or a sense of community.  Generally, people do not stop using substances until it doesn’t work anymore or there is loss or a threat of loss of employment, relationships, housing, freedom, medical problems, or guilt and shame.

The history of treatment began with a single problem approach in the 1970’s, but there were poor outcomes.  People had severe relapses, more hospitalizations, medical and family problems, or violence and jail.  This was followed by 12 Step Programs based on accepting people for whom, what and where they were.  Clients were motivated and ready to do something to change.  IDDT is a similar approach, but does not insist upon total abstinence.  It is based on stages of treatment and the principles of recovery are flexible, based on unconditional respect and compassion, making decisions together, and cultivating hope.  Change takes time and people recover in stages.  The elements of recovery include meaningful activity (school, volunteering, or work); housing; sober support networks; trusted clinical relationships; and stage-based interventions.  People can change when others listen and are respectful in safe environments.

Stage-based interventions move back and forth and are fluid.  They meet the consumer where he is, promote safety, build motivation, and promote consistency.  The goal is to listen without judgment and move to the next stage of intervention.  More information is available on www.samhsa.gov .