Because drug use rehabilitation services know substance abuse treatment that many of their customers have dual illnesses, they are searching for new ways to handle them. (Helzer & Pryzbeck, 1988; Regier et al., 1990; Ross, 1995). To implement more effective substance abuse treatment and recovery, several barriers need to be addressed. For instance, is there anyone generally recognised standard substance abuse treatment practice for customers with dual illnesses? Since co-occurring disorders are so rare, the patient population is very diverse. For instance, someone with a substance abuse problem and schizophrenia would be very different from alcoholism and depression. The recovery procedures for both individuals are different. Adding age, sexuality, ethnicity and other attributes to disparities, choices for rehabilitation and care are exceedingly complex. The mindset and understanding of drug addiction care services is another obstacle to effective rehabilitation or care. Many suppliers are disappointed by customers who feel COD helpless and are exhausted by their requirements. (Woody, 1996). Some of the problems lie in the fact that most substance abuse counsellors are untrained regarding the treatment of clients with COD in their formal education and the fact that much of their work is not paid for recovery.
A federally sponsored department of the Mental Health and Substance Abuse Administration for the Rehabilitation sponsored by the Center for Addiction Treatment, the Iowa Practice Improvement Collaborative has recorded numerous initiatives relating to people with disabilities and their recovery programmes. In 1999, the Iowa Policy Innovation Center was set up to reinforce Iowa academics, policymakers and practitioners’ partnership. People have known for ages the broad difference between study results and current practice in rehabilitation centres, so the PIC project was launched to solve this dilemma. The first year of the Iowa PIC saw the formation of three committees of recovery programs, each dedicated to addressing a specific gap. One of those committees was the Treatment or Intervention Committee, whose co-chair was Dr Anne Helene Skinstad, a researcher at the University of Iowa. The Committee consisted of approximately 10 drug addiction professionals and their treatment plans and two decision-makers who examined current requirements evaluation data and carried out a research study on drug abuse professionals’ concerns. They argued that the substance abuse treatment and recovery expectations of consumers with CODs in our state are a major concern. The Committee states that the majority of the COD-patients diagnosed or recovered either are concurrent (psychotherapeutic and drug addiction services were delivered individually and did not co-ordinate) or illuminated by two clear glass. These two methods of provision of rehabilitation services are inefficient and sometimes send customers misleading messages about recovery and care. The Addiction Treatment Panel suggested that the PIC try to incorporate and treat customers at the same time as COD. This study recognized that mental health recovery providers and substance abuse providers were not currently qualified to provide assessment, recovery and treatment for substance abuse in the state. Thus, a series of 3 studies relating to COD was developed to examine negative attitudes about clients with COD. The three studies will be carried out sequentially, with the first completed in the spring of 2001, the second still in progress, and the third starting in the fall of 2001.
The Residential Services Model Techniques used by drug treatment centres for decades are about to undergo a significant makeover. Due to the widespread success of substance abuse treatment programs, many states are now recommending that their citizens start going to clinics for drug addiction treatment rather than entering traditional, time-consuming inpatient rehab programs. What does this mean for those seeking substance abuse treatment? It means that those seeking substance abuse treatment will have their case numbers requested at the beginning of the program rather than being put on a waiting list.
This is a significant improvement over the status quo, which had many people signing up for drug abuse treatment and then finding out that the clinics were full and there was no room at all in the schedule. At the same time, it is almost sure that a person who has gone through drug abuse treatment will be much less likely to relapse once inside the facility, having to be admitted into a residential services clinic rather than a clinic that may not have substance abuse treatment available and can create problems for the addict. Many addicts find it very difficult to adjust to being admitted to a residential services program or substance abuse treatment and will often go back to their old habits after a short while.
Some substance abuse treatment programs will also schedule the patient not to disturb when other patients have issues. This is a good idea because there is nothing worse than dealing with a fellow addict or family member who is having a hard time dealing with their addiction. There is nothing worse for the patient receiving care in a residential services facility because all the other patients are receiving treatment with professionals trained to handle these issues and work with people from all walks of life. When the addict is taken away from others, he or she feels more comfortable and are more likely to make changes.
Case 1: Evolution of Employee and Agency Tools.
A tool for evaluating opinions and practices of customers with COD was established and pilot-tested. A questionnaire was completed by almost 100 members representing 5 drug abuse programmes, including 28 multi-choice queries and two tight topics. The organization tool was complemented by 19 managers from the twenty-eight multiple-choice things and two tight questions.
Data analyses showed that 30% of staff members felt their COD rehabilitation preparation was insufficient, but only 4% considered that they’d have a full awareness of the requirements of the customer. 78% of those interviewed agreed that drug addiction and psychiatric care should occur simultaneously and only 9% agreed that mentally disturbed patients should be treated before drug and alcohol abuse. The majority said that COD customers need more rehabilitation and care time (85 percent) and effort from their employees (77 percent ). There was also concern about the rehabilitation and treatment environment, with 27 percent finding the expand the possibilities of COD and 30 percent suggesting that treatment is more complicated for some. Almost three-quarters (72 percent) believe that therapists do not understand drug dependency rehabilitation or addiction advice. But in the other hand, 55% suggest drug abuse counsellors don’t always match drug abuse therapy.
Program managers for the recovery of illness appear to be more like advisers, although certain variations exist as well. Program managers, for example, felt that their administrators were more trained than their supervisors to deal with COD customers, and that the managers were happier with the rehabilitation and treatment that customers with COD received in their organisations than their employees. Most (58 percent) programme managers agree that psychological health organisations are successfully coordinating treatment with drug addiction organizations.
The integrated treatment should ideally occur in the substance abuse treatment program, not in mental health treatment. Study 2 describes the training program that was developed using the findings of this study. Moreover, the complete results of our survey are published on our webpage: www.uiowa.edu/iowapic. The integrated treatment should ideally occur in the substance abuse treatment program, not in mental health treatment. Study 2 describes the training program that was developed using the findings of this study.
Case 2: Combined Training Regimens for Co-existing Disorders
It started in May 2001, includes more than 100 practitioners from 3 areas dealing with DCO clients: drug addiction counsellors, social workers in mental health and correctional personnel. These groups also do not work together or even dispute each other when they care for the same customers. The curriculum consists of an immersive two-day, hands-on training session on behaviour, skills, interprofessional collaboration, a day professional practice consultation for COD patients and a frequent case study conference to incorporate knowledge and skills through the remote network infrastructure. Since Iowa is mainly countryside, it is important to find as many training options as possible, using distance learning whenever possible. Due to lost income and long-range to large towns hosting intensive operations, small treatment organizations in rural districts find it impossible to send their employees out for days on end.
The model for specialized training was developed to address long-term changes in rehabilitation practice, as the literature shows that one-shot activities are unable to produce a sustainable shift. In comparison, deep programmes that strengthen training and allow people to address impediments to adoption are far more successful (Change Book 2000). The evaluation methods were built-in Study 1 to decide if awareness is improved or behaviours are changed prior then at the end of the training.
Case 3: Review of the Long-term Impact of COD Training
A follow-up phase will commence after the COD recovery training intervention study. The aim of this study is to assess how deep the consequences of the learning are to change the mental attitude of clients with COD and to increase the expertise and knowledge of drug addiction advisors, mental health advisers and correctional departments. We also hope that greater cooperation between these disciplines will result in at least more fantastic communication.
Clients with co-occurring disorders require specialist management, as their needs are complex. However, both drug treatment and mental health treatment have not adequately addressed the needs of these clients. As often as psychological health and opioid rehabilitation paying strategies remain distinct, the care of these clients is difficult. The Iowa PIC aims at improving individuals with COD by providing assistance and rehabilitation to tackle behaviours, skills, abilities and technical assistance.
There is no reason to believe that the substance abuse treatment programs for patient scheduling should not continue to be in use. Some drug abuse treatment clinics have started to use an intervention team approach to get people in the facility to address their addiction. Sometimes, this involves having a family member or close friend steps in to take over the patient’s role on a methadone maintenance plan. The intervention team approach makes for a great model for substance abuse treatment because it gives everyone involved a chance to address the addiction and to communicate their feelings and needs to the patient. It is believed that this is much more effective than simply having the patient make his or her way into a therapist’s office.
Another critical factor in the success of the residential services model is the involvement of all the different parts of the treatment team. In other words, there must be an integrated team approach. Family members and friends may not be able to be physically present at the facility, so they are not expected to mediate between patient and therapist or between patient and doctor. All of the individuals involved should be committed to the cause and work together as a unit. This can only be accomplished when everyone is aware that what is shared is confidential for substance abuse treatment.
- Change Book (2000). A blueprint for technology transfer. Washington, D.C.: Center for Substance Abuse Treatment, Substance Abuse, and Mental Health Services Administration.
- Helzer, J., & Pryzbeck, T. (1988). The co-occurrence of alcoholism with other psychiatric disorders in the general population and its impact on treatment. Journal of Studies on Alcohol, 49, 219-224.
- Regier, D., Farmer, M., Rae, D., Locke, B., Keith, S., Judd, L., & Goodwin, F. (1990). Comorbidity of mental disorders with alcohol and other drug abuse: Results from the Epidemiological Catchment Area study. JAMA, 264, 2511-2519.
- Ross, H. (1995). DSM-IIIR alcohol abuse and dependence and psychiatric comorbidity in Ontario: Results from the Mental Health Supplement to the Ontario Health Survey. Drug and Alcohol Dependence, 39, 111-128.
- Woody, G. (1996). The challenge of dual diagnosis. Alcohol
- Health and Research World, 20(2), 76-86.
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