Transcript Dual Diagnosis
Slide 1
Introduction to Dual Diagnosis
Objectives
• To recognise own attitudes towards drugs and
alcohol
• To understand the reasons why people use drugs
and alcohol
• To be aware of the legality, effects, routes of use, and
risks of alcohol, cannabis and cocaine
• Begin to understand why people may use them
despite adverse effects on Mental Health and
Physical Health
Dual Diagnosis
Capabilities
• Non-Judgemental Attitude: Be aware of ones own
attitudes and values in relation to dual diagnosis
and be able to suspend judgement when working
with service users, and carers. Challenge others’
attitudes in an appropriate and useful manner.
[Dual Diagnosis Capability 4 level 2
• Education and Health Promotion: Be able to offer
basic but accurate and up to date information and
advice about effects of substances on mental and
physical health and vice versa. [Dual Diagnosis
Capability 8 level 2]
Definitions
• The term “dual diagnosis” is generally
applied to people who have two
disorders
• Combined mental health and substance
use problems
• More than “dual problems”- likely to have
complex health and social needs
• Wide range of people with varying
degrees of need - need individualised
treatment
DUAL DIAGNOSIS
• "Co-existent mental illness and substance
abuse or other disorders“
• Complex often very complex
• Pareto Principle 80/20 (DD in the 20)
• Time consuming
• Frequently undetected, (through fear?)
• Substance use / intoxication / withdrawal
• Precipitate / exacerbate condition
• Usual not exceptional
• DoH - Good Practice Guide 2002
“Mainstreaming”
• DH (2002) Good Practice Guide:
• Doesn’t advocate a separate specialist service for dual
diagnosis
• Mental health services should take primary responsibility
for those with serious mental health problems (like
schizophrenia) and substance use
• Substance use services should take primary responsibility
for those with primary substance problems and common
mental health problems (anxiety, depression)
• However mental health and substance use services
should work together and support each other
Potential or Real Management
Problems
•
Often undetected
•
Often poor compliance with medication
•
Violence and disruption is possible with
intoxication and withdrawal
•
Compromised treatment regimes interactions/selfharm / abuse
•
Is it not just another added complexity and so
should not be ignored or lessened
Mental Health Practitioner v
Substance Use Practitioner
•
•
•
•
Communication skills
Assessment skills
Relationship building and maintenance
Knowledge of health and well being
•
•
•
•
Positive outlook
Encouraging hope in recovery
Empathetic
Holistic view
Exercise 1
•
Ask yourself these questions:
• What attitudes do I have about people who use drugs and
people who use alcohol?
• Where did these attitudes come from? (Parents, school,
media, religious beliefs etc)
• How might these attitudes affect how I work with people
with substance use problems?
Effects etc
•
•
•
•
Effects people want
Ones they are not so keen about
The dreaded withdrawal
Effects they might have on Mental
Health
• Myths and legends about users!
Reasons for use
•
•
•
•
•
•
•
•
•
•
•
To feel euphoric or feel nothing
To feel more confident
To work longer hours or enhance performance
To belong to a social group (peer pressure)
To kill time (alleviate boredom)
To alleviate physical pain and other health
problems
Because it is a habit
To satisfy cravings and avoid withdrawal symptoms
For weight loss
To experience an altered state of consciousness
To unwind after a stressful day
Discussion 1
• What have been your experiences of
working with people with dual
diagnosis within your work setting?
•
Think about issues concerning:
– the individual
– the carer
– yourselves
– the service that you work for.
Withdrawal
Working Definition
• Symptoms absent prior to regular / heavy use
• Symptoms are most severe post periods of heavy intake
• Symptoms are usually experienced within one half life of
abrupt cessation or significant reduction of intake
• Symptoms usually disappear in 14 days of cessation
• Symptoms relieved by further substance use
• Symptoms relieved by other substances of the same
pharmacological group
Detoxification
• “The removal of poisons” Concise Oxford
Dictionary
• Detoxification is a process of achieving a drug
free state, usually involving the prescription of a
drug to attenuate withdrawal symptoms
• The aim is to achieve this agreed objective with a
minimum of discomfort to the individual
• At the same time monitoring the individual for
coexisting or complicating conditions.
•
.
•Motivational work
•Needle Exchange
•Maintenance
prescription
•Safer injecting
advice
•Substance
information
•Housing
•Access healthcare
•Bibliotherapy
.
•Motivational work
•Feedback
•Self-Monitoring
Introduce
Conflict
Reduce Harm
Pre-contemplation
Contemplation
Determination
Increase
Motivation
Prepare for
Change
Maintenance
Action
Relapse
Prevention
Behaviour
Change
•Sensitising/Antagonist prescription
•Revisit motivation
•Compare and contrast lifestyles
•Cognitive behavioural coping skills
High risk situations
Coping skills
•Utilising network support
•Detoxification
•Stopping injecting
•Attenuated drinking
•Planning activities
•Detoxification
•Developing social
support
Assessment of
substance use
Slide 2
Introduction to Dual Diagnosis
Objectives
• To recognise own attitudes towards drugs and
alcohol
• To understand the reasons why people use drugs
and alcohol
• To be aware of the legality, effects, routes of use, and
risks of alcohol, cannabis and cocaine
• Begin to understand why people may use them
despite adverse effects on Mental Health and
Physical Health
Dual Diagnosis
Capabilities
• Non-Judgemental Attitude: Be aware of ones own
attitudes and values in relation to dual diagnosis
and be able to suspend judgement when working
with service users, and carers. Challenge others’
attitudes in an appropriate and useful manner.
[Dual Diagnosis Capability 4 level 2
• Education and Health Promotion: Be able to offer
basic but accurate and up to date information and
advice about effects of substances on mental and
physical health and vice versa. [Dual Diagnosis
Capability 8 level 2]
Definitions
• The term “dual diagnosis” is generally
applied to people who have two
disorders
• Combined mental health and substance
use problems
• More than “dual problems”- likely to have
complex health and social needs
• Wide range of people with varying
degrees of need - need individualised
treatment
DUAL DIAGNOSIS
• "Co-existent mental illness and substance
abuse or other disorders“
• Complex often very complex
• Pareto Principle 80/20 (DD in the 20)
• Time consuming
• Frequently undetected, (through fear?)
• Substance use / intoxication / withdrawal
• Precipitate / exacerbate condition
• Usual not exceptional
• DoH - Good Practice Guide 2002
“Mainstreaming”
• DH (2002) Good Practice Guide:
• Doesn’t advocate a separate specialist service for dual
diagnosis
• Mental health services should take primary responsibility
for those with serious mental health problems (like
schizophrenia) and substance use
• Substance use services should take primary responsibility
for those with primary substance problems and common
mental health problems (anxiety, depression)
• However mental health and substance use services
should work together and support each other
Potential or Real Management
Problems
•
Often undetected
•
Often poor compliance with medication
•
Violence and disruption is possible with
intoxication and withdrawal
•
Compromised treatment regimes interactions/selfharm / abuse
•
Is it not just another added complexity and so
should not be ignored or lessened
Mental Health Practitioner v
Substance Use Practitioner
•
•
•
•
Communication skills
Assessment skills
Relationship building and maintenance
Knowledge of health and well being
•
•
•
•
Positive outlook
Encouraging hope in recovery
Empathetic
Holistic view
Exercise 1
•
Ask yourself these questions:
• What attitudes do I have about people who use drugs and
people who use alcohol?
• Where did these attitudes come from? (Parents, school,
media, religious beliefs etc)
• How might these attitudes affect how I work with people
with substance use problems?
Effects etc
•
•
•
•
Effects people want
Ones they are not so keen about
The dreaded withdrawal
Effects they might have on Mental
Health
• Myths and legends about users!
Reasons for use
•
•
•
•
•
•
•
•
•
•
•
To feel euphoric or feel nothing
To feel more confident
To work longer hours or enhance performance
To belong to a social group (peer pressure)
To kill time (alleviate boredom)
To alleviate physical pain and other health
problems
Because it is a habit
To satisfy cravings and avoid withdrawal symptoms
For weight loss
To experience an altered state of consciousness
To unwind after a stressful day
Discussion 1
• What have been your experiences of
working with people with dual
diagnosis within your work setting?
•
Think about issues concerning:
– the individual
– the carer
– yourselves
– the service that you work for.
Withdrawal
Working Definition
• Symptoms absent prior to regular / heavy use
• Symptoms are most severe post periods of heavy intake
• Symptoms are usually experienced within one half life of
abrupt cessation or significant reduction of intake
• Symptoms usually disappear in 14 days of cessation
• Symptoms relieved by further substance use
• Symptoms relieved by other substances of the same
pharmacological group
Detoxification
• “The removal of poisons” Concise Oxford
Dictionary
• Detoxification is a process of achieving a drug
free state, usually involving the prescription of a
drug to attenuate withdrawal symptoms
• The aim is to achieve this agreed objective with a
minimum of discomfort to the individual
• At the same time monitoring the individual for
coexisting or complicating conditions.
•
.
•Motivational work
•Needle Exchange
•Maintenance
prescription
•Safer injecting
advice
•Substance
information
•Housing
•Access healthcare
•Bibliotherapy
.
•Motivational work
•Feedback
•Self-Monitoring
Introduce
Conflict
Reduce Harm
Pre-contemplation
Contemplation
Determination
Increase
Motivation
Prepare for
Change
Maintenance
Action
Relapse
Prevention
Behaviour
Change
•Sensitising/Antagonist prescription
•Revisit motivation
•Compare and contrast lifestyles
•Cognitive behavioural coping skills
High risk situations
Coping skills
•Utilising network support
•Detoxification
•Stopping injecting
•Attenuated drinking
•Planning activities
•Detoxification
•Developing social
support
Assessment of
substance use
Slide 3
Introduction to Dual Diagnosis
Objectives
• To recognise own attitudes towards drugs and
alcohol
• To understand the reasons why people use drugs
and alcohol
• To be aware of the legality, effects, routes of use, and
risks of alcohol, cannabis and cocaine
• Begin to understand why people may use them
despite adverse effects on Mental Health and
Physical Health
Dual Diagnosis
Capabilities
• Non-Judgemental Attitude: Be aware of ones own
attitudes and values in relation to dual diagnosis
and be able to suspend judgement when working
with service users, and carers. Challenge others’
attitudes in an appropriate and useful manner.
[Dual Diagnosis Capability 4 level 2
• Education and Health Promotion: Be able to offer
basic but accurate and up to date information and
advice about effects of substances on mental and
physical health and vice versa. [Dual Diagnosis
Capability 8 level 2]
Definitions
• The term “dual diagnosis” is generally
applied to people who have two
disorders
• Combined mental health and substance
use problems
• More than “dual problems”- likely to have
complex health and social needs
• Wide range of people with varying
degrees of need - need individualised
treatment
DUAL DIAGNOSIS
• "Co-existent mental illness and substance
abuse or other disorders“
• Complex often very complex
• Pareto Principle 80/20 (DD in the 20)
• Time consuming
• Frequently undetected, (through fear?)
• Substance use / intoxication / withdrawal
• Precipitate / exacerbate condition
• Usual not exceptional
• DoH - Good Practice Guide 2002
“Mainstreaming”
• DH (2002) Good Practice Guide:
• Doesn’t advocate a separate specialist service for dual
diagnosis
• Mental health services should take primary responsibility
for those with serious mental health problems (like
schizophrenia) and substance use
• Substance use services should take primary responsibility
for those with primary substance problems and common
mental health problems (anxiety, depression)
• However mental health and substance use services
should work together and support each other
Potential or Real Management
Problems
•
Often undetected
•
Often poor compliance with medication
•
Violence and disruption is possible with
intoxication and withdrawal
•
Compromised treatment regimes interactions/selfharm / abuse
•
Is it not just another added complexity and so
should not be ignored or lessened
Mental Health Practitioner v
Substance Use Practitioner
•
•
•
•
Communication skills
Assessment skills
Relationship building and maintenance
Knowledge of health and well being
•
•
•
•
Positive outlook
Encouraging hope in recovery
Empathetic
Holistic view
Exercise 1
•
Ask yourself these questions:
• What attitudes do I have about people who use drugs and
people who use alcohol?
• Where did these attitudes come from? (Parents, school,
media, religious beliefs etc)
• How might these attitudes affect how I work with people
with substance use problems?
Effects etc
•
•
•
•
Effects people want
Ones they are not so keen about
The dreaded withdrawal
Effects they might have on Mental
Health
• Myths and legends about users!
Reasons for use
•
•
•
•
•
•
•
•
•
•
•
To feel euphoric or feel nothing
To feel more confident
To work longer hours or enhance performance
To belong to a social group (peer pressure)
To kill time (alleviate boredom)
To alleviate physical pain and other health
problems
Because it is a habit
To satisfy cravings and avoid withdrawal symptoms
For weight loss
To experience an altered state of consciousness
To unwind after a stressful day
Discussion 1
• What have been your experiences of
working with people with dual
diagnosis within your work setting?
•
Think about issues concerning:
– the individual
– the carer
– yourselves
– the service that you work for.
Withdrawal
Working Definition
• Symptoms absent prior to regular / heavy use
• Symptoms are most severe post periods of heavy intake
• Symptoms are usually experienced within one half life of
abrupt cessation or significant reduction of intake
• Symptoms usually disappear in 14 days of cessation
• Symptoms relieved by further substance use
• Symptoms relieved by other substances of the same
pharmacological group
Detoxification
• “The removal of poisons” Concise Oxford
Dictionary
• Detoxification is a process of achieving a drug
free state, usually involving the prescription of a
drug to attenuate withdrawal symptoms
• The aim is to achieve this agreed objective with a
minimum of discomfort to the individual
• At the same time monitoring the individual for
coexisting or complicating conditions.
•
.
•Motivational work
•Needle Exchange
•Maintenance
prescription
•Safer injecting
advice
•Substance
information
•Housing
•Access healthcare
•Bibliotherapy
.
•Motivational work
•Feedback
•Self-Monitoring
Introduce
Conflict
Reduce Harm
Pre-contemplation
Contemplation
Determination
Increase
Motivation
Prepare for
Change
Maintenance
Action
Relapse
Prevention
Behaviour
Change
•Sensitising/Antagonist prescription
•Revisit motivation
•Compare and contrast lifestyles
•Cognitive behavioural coping skills
High risk situations
Coping skills
•Utilising network support
•Detoxification
•Stopping injecting
•Attenuated drinking
•Planning activities
•Detoxification
•Developing social
support
Assessment of
substance use
Slide 4
Introduction to Dual Diagnosis
Objectives
• To recognise own attitudes towards drugs and
alcohol
• To understand the reasons why people use drugs
and alcohol
• To be aware of the legality, effects, routes of use, and
risks of alcohol, cannabis and cocaine
• Begin to understand why people may use them
despite adverse effects on Mental Health and
Physical Health
Dual Diagnosis
Capabilities
• Non-Judgemental Attitude: Be aware of ones own
attitudes and values in relation to dual diagnosis
and be able to suspend judgement when working
with service users, and carers. Challenge others’
attitudes in an appropriate and useful manner.
[Dual Diagnosis Capability 4 level 2
• Education and Health Promotion: Be able to offer
basic but accurate and up to date information and
advice about effects of substances on mental and
physical health and vice versa. [Dual Diagnosis
Capability 8 level 2]
Definitions
• The term “dual diagnosis” is generally
applied to people who have two
disorders
• Combined mental health and substance
use problems
• More than “dual problems”- likely to have
complex health and social needs
• Wide range of people with varying
degrees of need - need individualised
treatment
DUAL DIAGNOSIS
• "Co-existent mental illness and substance
abuse or other disorders“
• Complex often very complex
• Pareto Principle 80/20 (DD in the 20)
• Time consuming
• Frequently undetected, (through fear?)
• Substance use / intoxication / withdrawal
• Precipitate / exacerbate condition
• Usual not exceptional
• DoH - Good Practice Guide 2002
“Mainstreaming”
• DH (2002) Good Practice Guide:
• Doesn’t advocate a separate specialist service for dual
diagnosis
• Mental health services should take primary responsibility
for those with serious mental health problems (like
schizophrenia) and substance use
• Substance use services should take primary responsibility
for those with primary substance problems and common
mental health problems (anxiety, depression)
• However mental health and substance use services
should work together and support each other
Potential or Real Management
Problems
•
Often undetected
•
Often poor compliance with medication
•
Violence and disruption is possible with
intoxication and withdrawal
•
Compromised treatment regimes interactions/selfharm / abuse
•
Is it not just another added complexity and so
should not be ignored or lessened
Mental Health Practitioner v
Substance Use Practitioner
•
•
•
•
Communication skills
Assessment skills
Relationship building and maintenance
Knowledge of health and well being
•
•
•
•
Positive outlook
Encouraging hope in recovery
Empathetic
Holistic view
Exercise 1
•
Ask yourself these questions:
• What attitudes do I have about people who use drugs and
people who use alcohol?
• Where did these attitudes come from? (Parents, school,
media, religious beliefs etc)
• How might these attitudes affect how I work with people
with substance use problems?
Effects etc
•
•
•
•
Effects people want
Ones they are not so keen about
The dreaded withdrawal
Effects they might have on Mental
Health
• Myths and legends about users!
Reasons for use
•
•
•
•
•
•
•
•
•
•
•
To feel euphoric or feel nothing
To feel more confident
To work longer hours or enhance performance
To belong to a social group (peer pressure)
To kill time (alleviate boredom)
To alleviate physical pain and other health
problems
Because it is a habit
To satisfy cravings and avoid withdrawal symptoms
For weight loss
To experience an altered state of consciousness
To unwind after a stressful day
Discussion 1
• What have been your experiences of
working with people with dual
diagnosis within your work setting?
•
Think about issues concerning:
– the individual
– the carer
– yourselves
– the service that you work for.
Withdrawal
Working Definition
• Symptoms absent prior to regular / heavy use
• Symptoms are most severe post periods of heavy intake
• Symptoms are usually experienced within one half life of
abrupt cessation or significant reduction of intake
• Symptoms usually disappear in 14 days of cessation
• Symptoms relieved by further substance use
• Symptoms relieved by other substances of the same
pharmacological group
Detoxification
• “The removal of poisons” Concise Oxford
Dictionary
• Detoxification is a process of achieving a drug
free state, usually involving the prescription of a
drug to attenuate withdrawal symptoms
• The aim is to achieve this agreed objective with a
minimum of discomfort to the individual
• At the same time monitoring the individual for
coexisting or complicating conditions.
•
.
•Motivational work
•Needle Exchange
•Maintenance
prescription
•Safer injecting
advice
•Substance
information
•Housing
•Access healthcare
•Bibliotherapy
.
•Motivational work
•Feedback
•Self-Monitoring
Introduce
Conflict
Reduce Harm
Pre-contemplation
Contemplation
Determination
Increase
Motivation
Prepare for
Change
Maintenance
Action
Relapse
Prevention
Behaviour
Change
•Sensitising/Antagonist prescription
•Revisit motivation
•Compare and contrast lifestyles
•Cognitive behavioural coping skills
High risk situations
Coping skills
•Utilising network support
•Detoxification
•Stopping injecting
•Attenuated drinking
•Planning activities
•Detoxification
•Developing social
support
Assessment of
substance use
Slide 5
Introduction to Dual Diagnosis
Objectives
• To recognise own attitudes towards drugs and
alcohol
• To understand the reasons why people use drugs
and alcohol
• To be aware of the legality, effects, routes of use, and
risks of alcohol, cannabis and cocaine
• Begin to understand why people may use them
despite adverse effects on Mental Health and
Physical Health
Dual Diagnosis
Capabilities
• Non-Judgemental Attitude: Be aware of ones own
attitudes and values in relation to dual diagnosis
and be able to suspend judgement when working
with service users, and carers. Challenge others’
attitudes in an appropriate and useful manner.
[Dual Diagnosis Capability 4 level 2
• Education and Health Promotion: Be able to offer
basic but accurate and up to date information and
advice about effects of substances on mental and
physical health and vice versa. [Dual Diagnosis
Capability 8 level 2]
Definitions
• The term “dual diagnosis” is generally
applied to people who have two
disorders
• Combined mental health and substance
use problems
• More than “dual problems”- likely to have
complex health and social needs
• Wide range of people with varying
degrees of need - need individualised
treatment
DUAL DIAGNOSIS
• "Co-existent mental illness and substance
abuse or other disorders“
• Complex often very complex
• Pareto Principle 80/20 (DD in the 20)
• Time consuming
• Frequently undetected, (through fear?)
• Substance use / intoxication / withdrawal
• Precipitate / exacerbate condition
• Usual not exceptional
• DoH - Good Practice Guide 2002
“Mainstreaming”
• DH (2002) Good Practice Guide:
• Doesn’t advocate a separate specialist service for dual
diagnosis
• Mental health services should take primary responsibility
for those with serious mental health problems (like
schizophrenia) and substance use
• Substance use services should take primary responsibility
for those with primary substance problems and common
mental health problems (anxiety, depression)
• However mental health and substance use services
should work together and support each other
Potential or Real Management
Problems
•
Often undetected
•
Often poor compliance with medication
•
Violence and disruption is possible with
intoxication and withdrawal
•
Compromised treatment regimes interactions/selfharm / abuse
•
Is it not just another added complexity and so
should not be ignored or lessened
Mental Health Practitioner v
Substance Use Practitioner
•
•
•
•
Communication skills
Assessment skills
Relationship building and maintenance
Knowledge of health and well being
•
•
•
•
Positive outlook
Encouraging hope in recovery
Empathetic
Holistic view
Exercise 1
•
Ask yourself these questions:
• What attitudes do I have about people who use drugs and
people who use alcohol?
• Where did these attitudes come from? (Parents, school,
media, religious beliefs etc)
• How might these attitudes affect how I work with people
with substance use problems?
Effects etc
•
•
•
•
Effects people want
Ones they are not so keen about
The dreaded withdrawal
Effects they might have on Mental
Health
• Myths and legends about users!
Reasons for use
•
•
•
•
•
•
•
•
•
•
•
To feel euphoric or feel nothing
To feel more confident
To work longer hours or enhance performance
To belong to a social group (peer pressure)
To kill time (alleviate boredom)
To alleviate physical pain and other health
problems
Because it is a habit
To satisfy cravings and avoid withdrawal symptoms
For weight loss
To experience an altered state of consciousness
To unwind after a stressful day
Discussion 1
• What have been your experiences of
working with people with dual
diagnosis within your work setting?
•
Think about issues concerning:
– the individual
– the carer
– yourselves
– the service that you work for.
Withdrawal
Working Definition
• Symptoms absent prior to regular / heavy use
• Symptoms are most severe post periods of heavy intake
• Symptoms are usually experienced within one half life of
abrupt cessation or significant reduction of intake
• Symptoms usually disappear in 14 days of cessation
• Symptoms relieved by further substance use
• Symptoms relieved by other substances of the same
pharmacological group
Detoxification
• “The removal of poisons” Concise Oxford
Dictionary
• Detoxification is a process of achieving a drug
free state, usually involving the prescription of a
drug to attenuate withdrawal symptoms
• The aim is to achieve this agreed objective with a
minimum of discomfort to the individual
• At the same time monitoring the individual for
coexisting or complicating conditions.
•
.
•Motivational work
•Needle Exchange
•Maintenance
prescription
•Safer injecting
advice
•Substance
information
•Housing
•Access healthcare
•Bibliotherapy
.
•Motivational work
•Feedback
•Self-Monitoring
Introduce
Conflict
Reduce Harm
Pre-contemplation
Contemplation
Determination
Increase
Motivation
Prepare for
Change
Maintenance
Action
Relapse
Prevention
Behaviour
Change
•Sensitising/Antagonist prescription
•Revisit motivation
•Compare and contrast lifestyles
•Cognitive behavioural coping skills
High risk situations
Coping skills
•Utilising network support
•Detoxification
•Stopping injecting
•Attenuated drinking
•Planning activities
•Detoxification
•Developing social
support
Assessment of
substance use
Slide 6
Introduction to Dual Diagnosis
Objectives
• To recognise own attitudes towards drugs and
alcohol
• To understand the reasons why people use drugs
and alcohol
• To be aware of the legality, effects, routes of use, and
risks of alcohol, cannabis and cocaine
• Begin to understand why people may use them
despite adverse effects on Mental Health and
Physical Health
Dual Diagnosis
Capabilities
• Non-Judgemental Attitude: Be aware of ones own
attitudes and values in relation to dual diagnosis
and be able to suspend judgement when working
with service users, and carers. Challenge others’
attitudes in an appropriate and useful manner.
[Dual Diagnosis Capability 4 level 2
• Education and Health Promotion: Be able to offer
basic but accurate and up to date information and
advice about effects of substances on mental and
physical health and vice versa. [Dual Diagnosis
Capability 8 level 2]
Definitions
• The term “dual diagnosis” is generally
applied to people who have two
disorders
• Combined mental health and substance
use problems
• More than “dual problems”- likely to have
complex health and social needs
• Wide range of people with varying
degrees of need - need individualised
treatment
DUAL DIAGNOSIS
• "Co-existent mental illness and substance
abuse or other disorders“
• Complex often very complex
• Pareto Principle 80/20 (DD in the 20)
• Time consuming
• Frequently undetected, (through fear?)
• Substance use / intoxication / withdrawal
• Precipitate / exacerbate condition
• Usual not exceptional
• DoH - Good Practice Guide 2002
“Mainstreaming”
• DH (2002) Good Practice Guide:
• Doesn’t advocate a separate specialist service for dual
diagnosis
• Mental health services should take primary responsibility
for those with serious mental health problems (like
schizophrenia) and substance use
• Substance use services should take primary responsibility
for those with primary substance problems and common
mental health problems (anxiety, depression)
• However mental health and substance use services
should work together and support each other
Potential or Real Management
Problems
•
Often undetected
•
Often poor compliance with medication
•
Violence and disruption is possible with
intoxication and withdrawal
•
Compromised treatment regimes interactions/selfharm / abuse
•
Is it not just another added complexity and so
should not be ignored or lessened
Mental Health Practitioner v
Substance Use Practitioner
•
•
•
•
Communication skills
Assessment skills
Relationship building and maintenance
Knowledge of health and well being
•
•
•
•
Positive outlook
Encouraging hope in recovery
Empathetic
Holistic view
Exercise 1
•
Ask yourself these questions:
• What attitudes do I have about people who use drugs and
people who use alcohol?
• Where did these attitudes come from? (Parents, school,
media, religious beliefs etc)
• How might these attitudes affect how I work with people
with substance use problems?
Effects etc
•
•
•
•
Effects people want
Ones they are not so keen about
The dreaded withdrawal
Effects they might have on Mental
Health
• Myths and legends about users!
Reasons for use
•
•
•
•
•
•
•
•
•
•
•
To feel euphoric or feel nothing
To feel more confident
To work longer hours or enhance performance
To belong to a social group (peer pressure)
To kill time (alleviate boredom)
To alleviate physical pain and other health
problems
Because it is a habit
To satisfy cravings and avoid withdrawal symptoms
For weight loss
To experience an altered state of consciousness
To unwind after a stressful day
Discussion 1
• What have been your experiences of
working with people with dual
diagnosis within your work setting?
•
Think about issues concerning:
– the individual
– the carer
– yourselves
– the service that you work for.
Withdrawal
Working Definition
• Symptoms absent prior to regular / heavy use
• Symptoms are most severe post periods of heavy intake
• Symptoms are usually experienced within one half life of
abrupt cessation or significant reduction of intake
• Symptoms usually disappear in 14 days of cessation
• Symptoms relieved by further substance use
• Symptoms relieved by other substances of the same
pharmacological group
Detoxification
• “The removal of poisons” Concise Oxford
Dictionary
• Detoxification is a process of achieving a drug
free state, usually involving the prescription of a
drug to attenuate withdrawal symptoms
• The aim is to achieve this agreed objective with a
minimum of discomfort to the individual
• At the same time monitoring the individual for
coexisting or complicating conditions.
•
.
•Motivational work
•Needle Exchange
•Maintenance
prescription
•Safer injecting
advice
•Substance
information
•Housing
•Access healthcare
•Bibliotherapy
.
•Motivational work
•Feedback
•Self-Monitoring
Introduce
Conflict
Reduce Harm
Pre-contemplation
Contemplation
Determination
Increase
Motivation
Prepare for
Change
Maintenance
Action
Relapse
Prevention
Behaviour
Change
•Sensitising/Antagonist prescription
•Revisit motivation
•Compare and contrast lifestyles
•Cognitive behavioural coping skills
High risk situations
Coping skills
•Utilising network support
•Detoxification
•Stopping injecting
•Attenuated drinking
•Planning activities
•Detoxification
•Developing social
support
Assessment of
substance use
Slide 7
Introduction to Dual Diagnosis
Objectives
• To recognise own attitudes towards drugs and
alcohol
• To understand the reasons why people use drugs
and alcohol
• To be aware of the legality, effects, routes of use, and
risks of alcohol, cannabis and cocaine
• Begin to understand why people may use them
despite adverse effects on Mental Health and
Physical Health
Dual Diagnosis
Capabilities
• Non-Judgemental Attitude: Be aware of ones own
attitudes and values in relation to dual diagnosis
and be able to suspend judgement when working
with service users, and carers. Challenge others’
attitudes in an appropriate and useful manner.
[Dual Diagnosis Capability 4 level 2
• Education and Health Promotion: Be able to offer
basic but accurate and up to date information and
advice about effects of substances on mental and
physical health and vice versa. [Dual Diagnosis
Capability 8 level 2]
Definitions
• The term “dual diagnosis” is generally
applied to people who have two
disorders
• Combined mental health and substance
use problems
• More than “dual problems”- likely to have
complex health and social needs
• Wide range of people with varying
degrees of need - need individualised
treatment
DUAL DIAGNOSIS
• "Co-existent mental illness and substance
abuse or other disorders“
• Complex often very complex
• Pareto Principle 80/20 (DD in the 20)
• Time consuming
• Frequently undetected, (through fear?)
• Substance use / intoxication / withdrawal
• Precipitate / exacerbate condition
• Usual not exceptional
• DoH - Good Practice Guide 2002
“Mainstreaming”
• DH (2002) Good Practice Guide:
• Doesn’t advocate a separate specialist service for dual
diagnosis
• Mental health services should take primary responsibility
for those with serious mental health problems (like
schizophrenia) and substance use
• Substance use services should take primary responsibility
for those with primary substance problems and common
mental health problems (anxiety, depression)
• However mental health and substance use services
should work together and support each other
Potential or Real Management
Problems
•
Often undetected
•
Often poor compliance with medication
•
Violence and disruption is possible with
intoxication and withdrawal
•
Compromised treatment regimes interactions/selfharm / abuse
•
Is it not just another added complexity and so
should not be ignored or lessened
Mental Health Practitioner v
Substance Use Practitioner
•
•
•
•
Communication skills
Assessment skills
Relationship building and maintenance
Knowledge of health and well being
•
•
•
•
Positive outlook
Encouraging hope in recovery
Empathetic
Holistic view
Exercise 1
•
Ask yourself these questions:
• What attitudes do I have about people who use drugs and
people who use alcohol?
• Where did these attitudes come from? (Parents, school,
media, religious beliefs etc)
• How might these attitudes affect how I work with people
with substance use problems?
Effects etc
•
•
•
•
Effects people want
Ones they are not so keen about
The dreaded withdrawal
Effects they might have on Mental
Health
• Myths and legends about users!
Reasons for use
•
•
•
•
•
•
•
•
•
•
•
To feel euphoric or feel nothing
To feel more confident
To work longer hours or enhance performance
To belong to a social group (peer pressure)
To kill time (alleviate boredom)
To alleviate physical pain and other health
problems
Because it is a habit
To satisfy cravings and avoid withdrawal symptoms
For weight loss
To experience an altered state of consciousness
To unwind after a stressful day
Discussion 1
• What have been your experiences of
working with people with dual
diagnosis within your work setting?
•
Think about issues concerning:
– the individual
– the carer
– yourselves
– the service that you work for.
Withdrawal
Working Definition
• Symptoms absent prior to regular / heavy use
• Symptoms are most severe post periods of heavy intake
• Symptoms are usually experienced within one half life of
abrupt cessation or significant reduction of intake
• Symptoms usually disappear in 14 days of cessation
• Symptoms relieved by further substance use
• Symptoms relieved by other substances of the same
pharmacological group
Detoxification
• “The removal of poisons” Concise Oxford
Dictionary
• Detoxification is a process of achieving a drug
free state, usually involving the prescription of a
drug to attenuate withdrawal symptoms
• The aim is to achieve this agreed objective with a
minimum of discomfort to the individual
• At the same time monitoring the individual for
coexisting or complicating conditions.
•
.
•Motivational work
•Needle Exchange
•Maintenance
prescription
•Safer injecting
advice
•Substance
information
•Housing
•Access healthcare
•Bibliotherapy
.
•Motivational work
•Feedback
•Self-Monitoring
Introduce
Conflict
Reduce Harm
Pre-contemplation
Contemplation
Determination
Increase
Motivation
Prepare for
Change
Maintenance
Action
Relapse
Prevention
Behaviour
Change
•Sensitising/Antagonist prescription
•Revisit motivation
•Compare and contrast lifestyles
•Cognitive behavioural coping skills
High risk situations
Coping skills
•Utilising network support
•Detoxification
•Stopping injecting
•Attenuated drinking
•Planning activities
•Detoxification
•Developing social
support
Assessment of
substance use
Slide 8
Introduction to Dual Diagnosis
Objectives
• To recognise own attitudes towards drugs and
alcohol
• To understand the reasons why people use drugs
and alcohol
• To be aware of the legality, effects, routes of use, and
risks of alcohol, cannabis and cocaine
• Begin to understand why people may use them
despite adverse effects on Mental Health and
Physical Health
Dual Diagnosis
Capabilities
• Non-Judgemental Attitude: Be aware of ones own
attitudes and values in relation to dual diagnosis
and be able to suspend judgement when working
with service users, and carers. Challenge others’
attitudes in an appropriate and useful manner.
[Dual Diagnosis Capability 4 level 2
• Education and Health Promotion: Be able to offer
basic but accurate and up to date information and
advice about effects of substances on mental and
physical health and vice versa. [Dual Diagnosis
Capability 8 level 2]
Definitions
• The term “dual diagnosis” is generally
applied to people who have two
disorders
• Combined mental health and substance
use problems
• More than “dual problems”- likely to have
complex health and social needs
• Wide range of people with varying
degrees of need - need individualised
treatment
DUAL DIAGNOSIS
• "Co-existent mental illness and substance
abuse or other disorders“
• Complex often very complex
• Pareto Principle 80/20 (DD in the 20)
• Time consuming
• Frequently undetected, (through fear?)
• Substance use / intoxication / withdrawal
• Precipitate / exacerbate condition
• Usual not exceptional
• DoH - Good Practice Guide 2002
“Mainstreaming”
• DH (2002) Good Practice Guide:
• Doesn’t advocate a separate specialist service for dual
diagnosis
• Mental health services should take primary responsibility
for those with serious mental health problems (like
schizophrenia) and substance use
• Substance use services should take primary responsibility
for those with primary substance problems and common
mental health problems (anxiety, depression)
• However mental health and substance use services
should work together and support each other
Potential or Real Management
Problems
•
Often undetected
•
Often poor compliance with medication
•
Violence and disruption is possible with
intoxication and withdrawal
•
Compromised treatment regimes interactions/selfharm / abuse
•
Is it not just another added complexity and so
should not be ignored or lessened
Mental Health Practitioner v
Substance Use Practitioner
•
•
•
•
Communication skills
Assessment skills
Relationship building and maintenance
Knowledge of health and well being
•
•
•
•
Positive outlook
Encouraging hope in recovery
Empathetic
Holistic view
Exercise 1
•
Ask yourself these questions:
• What attitudes do I have about people who use drugs and
people who use alcohol?
• Where did these attitudes come from? (Parents, school,
media, religious beliefs etc)
• How might these attitudes affect how I work with people
with substance use problems?
Effects etc
•
•
•
•
Effects people want
Ones they are not so keen about
The dreaded withdrawal
Effects they might have on Mental
Health
• Myths and legends about users!
Reasons for use
•
•
•
•
•
•
•
•
•
•
•
To feel euphoric or feel nothing
To feel more confident
To work longer hours or enhance performance
To belong to a social group (peer pressure)
To kill time (alleviate boredom)
To alleviate physical pain and other health
problems
Because it is a habit
To satisfy cravings and avoid withdrawal symptoms
For weight loss
To experience an altered state of consciousness
To unwind after a stressful day
Discussion 1
• What have been your experiences of
working with people with dual
diagnosis within your work setting?
•
Think about issues concerning:
– the individual
– the carer
– yourselves
– the service that you work for.
Withdrawal
Working Definition
• Symptoms absent prior to regular / heavy use
• Symptoms are most severe post periods of heavy intake
• Symptoms are usually experienced within one half life of
abrupt cessation or significant reduction of intake
• Symptoms usually disappear in 14 days of cessation
• Symptoms relieved by further substance use
• Symptoms relieved by other substances of the same
pharmacological group
Detoxification
• “The removal of poisons” Concise Oxford
Dictionary
• Detoxification is a process of achieving a drug
free state, usually involving the prescription of a
drug to attenuate withdrawal symptoms
• The aim is to achieve this agreed objective with a
minimum of discomfort to the individual
• At the same time monitoring the individual for
coexisting or complicating conditions.
•
.
•Motivational work
•Needle Exchange
•Maintenance
prescription
•Safer injecting
advice
•Substance
information
•Housing
•Access healthcare
•Bibliotherapy
.
•Motivational work
•Feedback
•Self-Monitoring
Introduce
Conflict
Reduce Harm
Pre-contemplation
Contemplation
Determination
Increase
Motivation
Prepare for
Change
Maintenance
Action
Relapse
Prevention
Behaviour
Change
•Sensitising/Antagonist prescription
•Revisit motivation
•Compare and contrast lifestyles
•Cognitive behavioural coping skills
High risk situations
Coping skills
•Utilising network support
•Detoxification
•Stopping injecting
•Attenuated drinking
•Planning activities
•Detoxification
•Developing social
support
Assessment of
substance use
Slide 9
Introduction to Dual Diagnosis
Objectives
• To recognise own attitudes towards drugs and
alcohol
• To understand the reasons why people use drugs
and alcohol
• To be aware of the legality, effects, routes of use, and
risks of alcohol, cannabis and cocaine
• Begin to understand why people may use them
despite adverse effects on Mental Health and
Physical Health
Dual Diagnosis
Capabilities
• Non-Judgemental Attitude: Be aware of ones own
attitudes and values in relation to dual diagnosis
and be able to suspend judgement when working
with service users, and carers. Challenge others’
attitudes in an appropriate and useful manner.
[Dual Diagnosis Capability 4 level 2
• Education and Health Promotion: Be able to offer
basic but accurate and up to date information and
advice about effects of substances on mental and
physical health and vice versa. [Dual Diagnosis
Capability 8 level 2]
Definitions
• The term “dual diagnosis” is generally
applied to people who have two
disorders
• Combined mental health and substance
use problems
• More than “dual problems”- likely to have
complex health and social needs
• Wide range of people with varying
degrees of need - need individualised
treatment
DUAL DIAGNOSIS
• "Co-existent mental illness and substance
abuse or other disorders“
• Complex often very complex
• Pareto Principle 80/20 (DD in the 20)
• Time consuming
• Frequently undetected, (through fear?)
• Substance use / intoxication / withdrawal
• Precipitate / exacerbate condition
• Usual not exceptional
• DoH - Good Practice Guide 2002
“Mainstreaming”
• DH (2002) Good Practice Guide:
• Doesn’t advocate a separate specialist service for dual
diagnosis
• Mental health services should take primary responsibility
for those with serious mental health problems (like
schizophrenia) and substance use
• Substance use services should take primary responsibility
for those with primary substance problems and common
mental health problems (anxiety, depression)
• However mental health and substance use services
should work together and support each other
Potential or Real Management
Problems
•
Often undetected
•
Often poor compliance with medication
•
Violence and disruption is possible with
intoxication and withdrawal
•
Compromised treatment regimes interactions/selfharm / abuse
•
Is it not just another added complexity and so
should not be ignored or lessened
Mental Health Practitioner v
Substance Use Practitioner
•
•
•
•
Communication skills
Assessment skills
Relationship building and maintenance
Knowledge of health and well being
•
•
•
•
Positive outlook
Encouraging hope in recovery
Empathetic
Holistic view
Exercise 1
•
Ask yourself these questions:
• What attitudes do I have about people who use drugs and
people who use alcohol?
• Where did these attitudes come from? (Parents, school,
media, religious beliefs etc)
• How might these attitudes affect how I work with people
with substance use problems?
Effects etc
•
•
•
•
Effects people want
Ones they are not so keen about
The dreaded withdrawal
Effects they might have on Mental
Health
• Myths and legends about users!
Reasons for use
•
•
•
•
•
•
•
•
•
•
•
To feel euphoric or feel nothing
To feel more confident
To work longer hours or enhance performance
To belong to a social group (peer pressure)
To kill time (alleviate boredom)
To alleviate physical pain and other health
problems
Because it is a habit
To satisfy cravings and avoid withdrawal symptoms
For weight loss
To experience an altered state of consciousness
To unwind after a stressful day
Discussion 1
• What have been your experiences of
working with people with dual
diagnosis within your work setting?
•
Think about issues concerning:
– the individual
– the carer
– yourselves
– the service that you work for.
Withdrawal
Working Definition
• Symptoms absent prior to regular / heavy use
• Symptoms are most severe post periods of heavy intake
• Symptoms are usually experienced within one half life of
abrupt cessation or significant reduction of intake
• Symptoms usually disappear in 14 days of cessation
• Symptoms relieved by further substance use
• Symptoms relieved by other substances of the same
pharmacological group
Detoxification
• “The removal of poisons” Concise Oxford
Dictionary
• Detoxification is a process of achieving a drug
free state, usually involving the prescription of a
drug to attenuate withdrawal symptoms
• The aim is to achieve this agreed objective with a
minimum of discomfort to the individual
• At the same time monitoring the individual for
coexisting or complicating conditions.
•
.
•Motivational work
•Needle Exchange
•Maintenance
prescription
•Safer injecting
advice
•Substance
information
•Housing
•Access healthcare
•Bibliotherapy
.
•Motivational work
•Feedback
•Self-Monitoring
Introduce
Conflict
Reduce Harm
Pre-contemplation
Contemplation
Determination
Increase
Motivation
Prepare for
Change
Maintenance
Action
Relapse
Prevention
Behaviour
Change
•Sensitising/Antagonist prescription
•Revisit motivation
•Compare and contrast lifestyles
•Cognitive behavioural coping skills
High risk situations
Coping skills
•Utilising network support
•Detoxification
•Stopping injecting
•Attenuated drinking
•Planning activities
•Detoxification
•Developing social
support
Assessment of
substance use
Slide 10
Introduction to Dual Diagnosis
Objectives
• To recognise own attitudes towards drugs and
alcohol
• To understand the reasons why people use drugs
and alcohol
• To be aware of the legality, effects, routes of use, and
risks of alcohol, cannabis and cocaine
• Begin to understand why people may use them
despite adverse effects on Mental Health and
Physical Health
Dual Diagnosis
Capabilities
• Non-Judgemental Attitude: Be aware of ones own
attitudes and values in relation to dual diagnosis
and be able to suspend judgement when working
with service users, and carers. Challenge others’
attitudes in an appropriate and useful manner.
[Dual Diagnosis Capability 4 level 2
• Education and Health Promotion: Be able to offer
basic but accurate and up to date information and
advice about effects of substances on mental and
physical health and vice versa. [Dual Diagnosis
Capability 8 level 2]
Definitions
• The term “dual diagnosis” is generally
applied to people who have two
disorders
• Combined mental health and substance
use problems
• More than “dual problems”- likely to have
complex health and social needs
• Wide range of people with varying
degrees of need - need individualised
treatment
DUAL DIAGNOSIS
• "Co-existent mental illness and substance
abuse or other disorders“
• Complex often very complex
• Pareto Principle 80/20 (DD in the 20)
• Time consuming
• Frequently undetected, (through fear?)
• Substance use / intoxication / withdrawal
• Precipitate / exacerbate condition
• Usual not exceptional
• DoH - Good Practice Guide 2002
“Mainstreaming”
• DH (2002) Good Practice Guide:
• Doesn’t advocate a separate specialist service for dual
diagnosis
• Mental health services should take primary responsibility
for those with serious mental health problems (like
schizophrenia) and substance use
• Substance use services should take primary responsibility
for those with primary substance problems and common
mental health problems (anxiety, depression)
• However mental health and substance use services
should work together and support each other
Potential or Real Management
Problems
•
Often undetected
•
Often poor compliance with medication
•
Violence and disruption is possible with
intoxication and withdrawal
•
Compromised treatment regimes interactions/selfharm / abuse
•
Is it not just another added complexity and so
should not be ignored or lessened
Mental Health Practitioner v
Substance Use Practitioner
•
•
•
•
Communication skills
Assessment skills
Relationship building and maintenance
Knowledge of health and well being
•
•
•
•
Positive outlook
Encouraging hope in recovery
Empathetic
Holistic view
Exercise 1
•
Ask yourself these questions:
• What attitudes do I have about people who use drugs and
people who use alcohol?
• Where did these attitudes come from? (Parents, school,
media, religious beliefs etc)
• How might these attitudes affect how I work with people
with substance use problems?
Effects etc
•
•
•
•
Effects people want
Ones they are not so keen about
The dreaded withdrawal
Effects they might have on Mental
Health
• Myths and legends about users!
Reasons for use
•
•
•
•
•
•
•
•
•
•
•
To feel euphoric or feel nothing
To feel more confident
To work longer hours or enhance performance
To belong to a social group (peer pressure)
To kill time (alleviate boredom)
To alleviate physical pain and other health
problems
Because it is a habit
To satisfy cravings and avoid withdrawal symptoms
For weight loss
To experience an altered state of consciousness
To unwind after a stressful day
Discussion 1
• What have been your experiences of
working with people with dual
diagnosis within your work setting?
•
Think about issues concerning:
– the individual
– the carer
– yourselves
– the service that you work for.
Withdrawal
Working Definition
• Symptoms absent prior to regular / heavy use
• Symptoms are most severe post periods of heavy intake
• Symptoms are usually experienced within one half life of
abrupt cessation or significant reduction of intake
• Symptoms usually disappear in 14 days of cessation
• Symptoms relieved by further substance use
• Symptoms relieved by other substances of the same
pharmacological group
Detoxification
• “The removal of poisons” Concise Oxford
Dictionary
• Detoxification is a process of achieving a drug
free state, usually involving the prescription of a
drug to attenuate withdrawal symptoms
• The aim is to achieve this agreed objective with a
minimum of discomfort to the individual
• At the same time monitoring the individual for
coexisting or complicating conditions.
•
.
•Motivational work
•Needle Exchange
•Maintenance
prescription
•Safer injecting
advice
•Substance
information
•Housing
•Access healthcare
•Bibliotherapy
.
•Motivational work
•Feedback
•Self-Monitoring
Introduce
Conflict
Reduce Harm
Pre-contemplation
Contemplation
Determination
Increase
Motivation
Prepare for
Change
Maintenance
Action
Relapse
Prevention
Behaviour
Change
•Sensitising/Antagonist prescription
•Revisit motivation
•Compare and contrast lifestyles
•Cognitive behavioural coping skills
High risk situations
Coping skills
•Utilising network support
•Detoxification
•Stopping injecting
•Attenuated drinking
•Planning activities
•Detoxification
•Developing social
support
Assessment of
substance use
Slide 11
Introduction to Dual Diagnosis
Objectives
• To recognise own attitudes towards drugs and
alcohol
• To understand the reasons why people use drugs
and alcohol
• To be aware of the legality, effects, routes of use, and
risks of alcohol, cannabis and cocaine
• Begin to understand why people may use them
despite adverse effects on Mental Health and
Physical Health
Dual Diagnosis
Capabilities
• Non-Judgemental Attitude: Be aware of ones own
attitudes and values in relation to dual diagnosis
and be able to suspend judgement when working
with service users, and carers. Challenge others’
attitudes in an appropriate and useful manner.
[Dual Diagnosis Capability 4 level 2
• Education and Health Promotion: Be able to offer
basic but accurate and up to date information and
advice about effects of substances on mental and
physical health and vice versa. [Dual Diagnosis
Capability 8 level 2]
Definitions
• The term “dual diagnosis” is generally
applied to people who have two
disorders
• Combined mental health and substance
use problems
• More than “dual problems”- likely to have
complex health and social needs
• Wide range of people with varying
degrees of need - need individualised
treatment
DUAL DIAGNOSIS
• "Co-existent mental illness and substance
abuse or other disorders“
• Complex often very complex
• Pareto Principle 80/20 (DD in the 20)
• Time consuming
• Frequently undetected, (through fear?)
• Substance use / intoxication / withdrawal
• Precipitate / exacerbate condition
• Usual not exceptional
• DoH - Good Practice Guide 2002
“Mainstreaming”
• DH (2002) Good Practice Guide:
• Doesn’t advocate a separate specialist service for dual
diagnosis
• Mental health services should take primary responsibility
for those with serious mental health problems (like
schizophrenia) and substance use
• Substance use services should take primary responsibility
for those with primary substance problems and common
mental health problems (anxiety, depression)
• However mental health and substance use services
should work together and support each other
Potential or Real Management
Problems
•
Often undetected
•
Often poor compliance with medication
•
Violence and disruption is possible with
intoxication and withdrawal
•
Compromised treatment regimes interactions/selfharm / abuse
•
Is it not just another added complexity and so
should not be ignored or lessened
Mental Health Practitioner v
Substance Use Practitioner
•
•
•
•
Communication skills
Assessment skills
Relationship building and maintenance
Knowledge of health and well being
•
•
•
•
Positive outlook
Encouraging hope in recovery
Empathetic
Holistic view
Exercise 1
•
Ask yourself these questions:
• What attitudes do I have about people who use drugs and
people who use alcohol?
• Where did these attitudes come from? (Parents, school,
media, religious beliefs etc)
• How might these attitudes affect how I work with people
with substance use problems?
Effects etc
•
•
•
•
Effects people want
Ones they are not so keen about
The dreaded withdrawal
Effects they might have on Mental
Health
• Myths and legends about users!
Reasons for use
•
•
•
•
•
•
•
•
•
•
•
To feel euphoric or feel nothing
To feel more confident
To work longer hours or enhance performance
To belong to a social group (peer pressure)
To kill time (alleviate boredom)
To alleviate physical pain and other health
problems
Because it is a habit
To satisfy cravings and avoid withdrawal symptoms
For weight loss
To experience an altered state of consciousness
To unwind after a stressful day
Discussion 1
• What have been your experiences of
working with people with dual
diagnosis within your work setting?
•
Think about issues concerning:
– the individual
– the carer
– yourselves
– the service that you work for.
Withdrawal
Working Definition
• Symptoms absent prior to regular / heavy use
• Symptoms are most severe post periods of heavy intake
• Symptoms are usually experienced within one half life of
abrupt cessation or significant reduction of intake
• Symptoms usually disappear in 14 days of cessation
• Symptoms relieved by further substance use
• Symptoms relieved by other substances of the same
pharmacological group
Detoxification
• “The removal of poisons” Concise Oxford
Dictionary
• Detoxification is a process of achieving a drug
free state, usually involving the prescription of a
drug to attenuate withdrawal symptoms
• The aim is to achieve this agreed objective with a
minimum of discomfort to the individual
• At the same time monitoring the individual for
coexisting or complicating conditions.
•
.
•Motivational work
•Needle Exchange
•Maintenance
prescription
•Safer injecting
advice
•Substance
information
•Housing
•Access healthcare
•Bibliotherapy
.
•Motivational work
•Feedback
•Self-Monitoring
Introduce
Conflict
Reduce Harm
Pre-contemplation
Contemplation
Determination
Increase
Motivation
Prepare for
Change
Maintenance
Action
Relapse
Prevention
Behaviour
Change
•Sensitising/Antagonist prescription
•Revisit motivation
•Compare and contrast lifestyles
•Cognitive behavioural coping skills
High risk situations
Coping skills
•Utilising network support
•Detoxification
•Stopping injecting
•Attenuated drinking
•Planning activities
•Detoxification
•Developing social
support
Assessment of
substance use
Slide 12
Introduction to Dual Diagnosis
Objectives
• To recognise own attitudes towards drugs and
alcohol
• To understand the reasons why people use drugs
and alcohol
• To be aware of the legality, effects, routes of use, and
risks of alcohol, cannabis and cocaine
• Begin to understand why people may use them
despite adverse effects on Mental Health and
Physical Health
Dual Diagnosis
Capabilities
• Non-Judgemental Attitude: Be aware of ones own
attitudes and values in relation to dual diagnosis
and be able to suspend judgement when working
with service users, and carers. Challenge others’
attitudes in an appropriate and useful manner.
[Dual Diagnosis Capability 4 level 2
• Education and Health Promotion: Be able to offer
basic but accurate and up to date information and
advice about effects of substances on mental and
physical health and vice versa. [Dual Diagnosis
Capability 8 level 2]
Definitions
• The term “dual diagnosis” is generally
applied to people who have two
disorders
• Combined mental health and substance
use problems
• More than “dual problems”- likely to have
complex health and social needs
• Wide range of people with varying
degrees of need - need individualised
treatment
DUAL DIAGNOSIS
• "Co-existent mental illness and substance
abuse or other disorders“
• Complex often very complex
• Pareto Principle 80/20 (DD in the 20)
• Time consuming
• Frequently undetected, (through fear?)
• Substance use / intoxication / withdrawal
• Precipitate / exacerbate condition
• Usual not exceptional
• DoH - Good Practice Guide 2002
“Mainstreaming”
• DH (2002) Good Practice Guide:
• Doesn’t advocate a separate specialist service for dual
diagnosis
• Mental health services should take primary responsibility
for those with serious mental health problems (like
schizophrenia) and substance use
• Substance use services should take primary responsibility
for those with primary substance problems and common
mental health problems (anxiety, depression)
• However mental health and substance use services
should work together and support each other
Potential or Real Management
Problems
•
Often undetected
•
Often poor compliance with medication
•
Violence and disruption is possible with
intoxication and withdrawal
•
Compromised treatment regimes interactions/selfharm / abuse
•
Is it not just another added complexity and so
should not be ignored or lessened
Mental Health Practitioner v
Substance Use Practitioner
•
•
•
•
Communication skills
Assessment skills
Relationship building and maintenance
Knowledge of health and well being
•
•
•
•
Positive outlook
Encouraging hope in recovery
Empathetic
Holistic view
Exercise 1
•
Ask yourself these questions:
• What attitudes do I have about people who use drugs and
people who use alcohol?
• Where did these attitudes come from? (Parents, school,
media, religious beliefs etc)
• How might these attitudes affect how I work with people
with substance use problems?
Effects etc
•
•
•
•
Effects people want
Ones they are not so keen about
The dreaded withdrawal
Effects they might have on Mental
Health
• Myths and legends about users!
Reasons for use
•
•
•
•
•
•
•
•
•
•
•
To feel euphoric or feel nothing
To feel more confident
To work longer hours or enhance performance
To belong to a social group (peer pressure)
To kill time (alleviate boredom)
To alleviate physical pain and other health
problems
Because it is a habit
To satisfy cravings and avoid withdrawal symptoms
For weight loss
To experience an altered state of consciousness
To unwind after a stressful day
Discussion 1
• What have been your experiences of
working with people with dual
diagnosis within your work setting?
•
Think about issues concerning:
– the individual
– the carer
– yourselves
– the service that you work for.
Withdrawal
Working Definition
• Symptoms absent prior to regular / heavy use
• Symptoms are most severe post periods of heavy intake
• Symptoms are usually experienced within one half life of
abrupt cessation or significant reduction of intake
• Symptoms usually disappear in 14 days of cessation
• Symptoms relieved by further substance use
• Symptoms relieved by other substances of the same
pharmacological group
Detoxification
• “The removal of poisons” Concise Oxford
Dictionary
• Detoxification is a process of achieving a drug
free state, usually involving the prescription of a
drug to attenuate withdrawal symptoms
• The aim is to achieve this agreed objective with a
minimum of discomfort to the individual
• At the same time monitoring the individual for
coexisting or complicating conditions.
•
.
•Motivational work
•Needle Exchange
•Maintenance
prescription
•Safer injecting
advice
•Substance
information
•Housing
•Access healthcare
•Bibliotherapy
.
•Motivational work
•Feedback
•Self-Monitoring
Introduce
Conflict
Reduce Harm
Pre-contemplation
Contemplation
Determination
Increase
Motivation
Prepare for
Change
Maintenance
Action
Relapse
Prevention
Behaviour
Change
•Sensitising/Antagonist prescription
•Revisit motivation
•Compare and contrast lifestyles
•Cognitive behavioural coping skills
High risk situations
Coping skills
•Utilising network support
•Detoxification
•Stopping injecting
•Attenuated drinking
•Planning activities
•Detoxification
•Developing social
support
Assessment of
substance use
Slide 13
Introduction to Dual Diagnosis
Objectives
• To recognise own attitudes towards drugs and
alcohol
• To understand the reasons why people use drugs
and alcohol
• To be aware of the legality, effects, routes of use, and
risks of alcohol, cannabis and cocaine
• Begin to understand why people may use them
despite adverse effects on Mental Health and
Physical Health
Dual Diagnosis
Capabilities
• Non-Judgemental Attitude: Be aware of ones own
attitudes and values in relation to dual diagnosis
and be able to suspend judgement when working
with service users, and carers. Challenge others’
attitudes in an appropriate and useful manner.
[Dual Diagnosis Capability 4 level 2
• Education and Health Promotion: Be able to offer
basic but accurate and up to date information and
advice about effects of substances on mental and
physical health and vice versa. [Dual Diagnosis
Capability 8 level 2]
Definitions
• The term “dual diagnosis” is generally
applied to people who have two
disorders
• Combined mental health and substance
use problems
• More than “dual problems”- likely to have
complex health and social needs
• Wide range of people with varying
degrees of need - need individualised
treatment
DUAL DIAGNOSIS
• "Co-existent mental illness and substance
abuse or other disorders“
• Complex often very complex
• Pareto Principle 80/20 (DD in the 20)
• Time consuming
• Frequently undetected, (through fear?)
• Substance use / intoxication / withdrawal
• Precipitate / exacerbate condition
• Usual not exceptional
• DoH - Good Practice Guide 2002
“Mainstreaming”
• DH (2002) Good Practice Guide:
• Doesn’t advocate a separate specialist service for dual
diagnosis
• Mental health services should take primary responsibility
for those with serious mental health problems (like
schizophrenia) and substance use
• Substance use services should take primary responsibility
for those with primary substance problems and common
mental health problems (anxiety, depression)
• However mental health and substance use services
should work together and support each other
Potential or Real Management
Problems
•
Often undetected
•
Often poor compliance with medication
•
Violence and disruption is possible with
intoxication and withdrawal
•
Compromised treatment regimes interactions/selfharm / abuse
•
Is it not just another added complexity and so
should not be ignored or lessened
Mental Health Practitioner v
Substance Use Practitioner
•
•
•
•
Communication skills
Assessment skills
Relationship building and maintenance
Knowledge of health and well being
•
•
•
•
Positive outlook
Encouraging hope in recovery
Empathetic
Holistic view
Exercise 1
•
Ask yourself these questions:
• What attitudes do I have about people who use drugs and
people who use alcohol?
• Where did these attitudes come from? (Parents, school,
media, religious beliefs etc)
• How might these attitudes affect how I work with people
with substance use problems?
Effects etc
•
•
•
•
Effects people want
Ones they are not so keen about
The dreaded withdrawal
Effects they might have on Mental
Health
• Myths and legends about users!
Reasons for use
•
•
•
•
•
•
•
•
•
•
•
To feel euphoric or feel nothing
To feel more confident
To work longer hours or enhance performance
To belong to a social group (peer pressure)
To kill time (alleviate boredom)
To alleviate physical pain and other health
problems
Because it is a habit
To satisfy cravings and avoid withdrawal symptoms
For weight loss
To experience an altered state of consciousness
To unwind after a stressful day
Discussion 1
• What have been your experiences of
working with people with dual
diagnosis within your work setting?
•
Think about issues concerning:
– the individual
– the carer
– yourselves
– the service that you work for.
Withdrawal
Working Definition
• Symptoms absent prior to regular / heavy use
• Symptoms are most severe post periods of heavy intake
• Symptoms are usually experienced within one half life of
abrupt cessation or significant reduction of intake
• Symptoms usually disappear in 14 days of cessation
• Symptoms relieved by further substance use
• Symptoms relieved by other substances of the same
pharmacological group
Detoxification
• “The removal of poisons” Concise Oxford
Dictionary
• Detoxification is a process of achieving a drug
free state, usually involving the prescription of a
drug to attenuate withdrawal symptoms
• The aim is to achieve this agreed objective with a
minimum of discomfort to the individual
• At the same time monitoring the individual for
coexisting or complicating conditions.
•
.
•Motivational work
•Needle Exchange
•Maintenance
prescription
•Safer injecting
advice
•Substance
information
•Housing
•Access healthcare
•Bibliotherapy
.
•Motivational work
•Feedback
•Self-Monitoring
Introduce
Conflict
Reduce Harm
Pre-contemplation
Contemplation
Determination
Increase
Motivation
Prepare for
Change
Maintenance
Action
Relapse
Prevention
Behaviour
Change
•Sensitising/Antagonist prescription
•Revisit motivation
•Compare and contrast lifestyles
•Cognitive behavioural coping skills
High risk situations
Coping skills
•Utilising network support
•Detoxification
•Stopping injecting
•Attenuated drinking
•Planning activities
•Detoxification
•Developing social
support
Assessment of
substance use
Slide 14
Introduction to Dual Diagnosis
Objectives
• To recognise own attitudes towards drugs and
alcohol
• To understand the reasons why people use drugs
and alcohol
• To be aware of the legality, effects, routes of use, and
risks of alcohol, cannabis and cocaine
• Begin to understand why people may use them
despite adverse effects on Mental Health and
Physical Health
Dual Diagnosis
Capabilities
• Non-Judgemental Attitude: Be aware of ones own
attitudes and values in relation to dual diagnosis
and be able to suspend judgement when working
with service users, and carers. Challenge others’
attitudes in an appropriate and useful manner.
[Dual Diagnosis Capability 4 level 2
• Education and Health Promotion: Be able to offer
basic but accurate and up to date information and
advice about effects of substances on mental and
physical health and vice versa. [Dual Diagnosis
Capability 8 level 2]
Definitions
• The term “dual diagnosis” is generally
applied to people who have two
disorders
• Combined mental health and substance
use problems
• More than “dual problems”- likely to have
complex health and social needs
• Wide range of people with varying
degrees of need - need individualised
treatment
DUAL DIAGNOSIS
• "Co-existent mental illness and substance
abuse or other disorders“
• Complex often very complex
• Pareto Principle 80/20 (DD in the 20)
• Time consuming
• Frequently undetected, (through fear?)
• Substance use / intoxication / withdrawal
• Precipitate / exacerbate condition
• Usual not exceptional
• DoH - Good Practice Guide 2002
“Mainstreaming”
• DH (2002) Good Practice Guide:
• Doesn’t advocate a separate specialist service for dual
diagnosis
• Mental health services should take primary responsibility
for those with serious mental health problems (like
schizophrenia) and substance use
• Substance use services should take primary responsibility
for those with primary substance problems and common
mental health problems (anxiety, depression)
• However mental health and substance use services
should work together and support each other
Potential or Real Management
Problems
•
Often undetected
•
Often poor compliance with medication
•
Violence and disruption is possible with
intoxication and withdrawal
•
Compromised treatment regimes interactions/selfharm / abuse
•
Is it not just another added complexity and so
should not be ignored or lessened
Mental Health Practitioner v
Substance Use Practitioner
•
•
•
•
Communication skills
Assessment skills
Relationship building and maintenance
Knowledge of health and well being
•
•
•
•
Positive outlook
Encouraging hope in recovery
Empathetic
Holistic view
Exercise 1
•
Ask yourself these questions:
• What attitudes do I have about people who use drugs and
people who use alcohol?
• Where did these attitudes come from? (Parents, school,
media, religious beliefs etc)
• How might these attitudes affect how I work with people
with substance use problems?
Effects etc
•
•
•
•
Effects people want
Ones they are not so keen about
The dreaded withdrawal
Effects they might have on Mental
Health
• Myths and legends about users!
Reasons for use
•
•
•
•
•
•
•
•
•
•
•
To feel euphoric or feel nothing
To feel more confident
To work longer hours or enhance performance
To belong to a social group (peer pressure)
To kill time (alleviate boredom)
To alleviate physical pain and other health
problems
Because it is a habit
To satisfy cravings and avoid withdrawal symptoms
For weight loss
To experience an altered state of consciousness
To unwind after a stressful day
Discussion 1
• What have been your experiences of
working with people with dual
diagnosis within your work setting?
•
Think about issues concerning:
– the individual
– the carer
– yourselves
– the service that you work for.
Withdrawal
Working Definition
• Symptoms absent prior to regular / heavy use
• Symptoms are most severe post periods of heavy intake
• Symptoms are usually experienced within one half life of
abrupt cessation or significant reduction of intake
• Symptoms usually disappear in 14 days of cessation
• Symptoms relieved by further substance use
• Symptoms relieved by other substances of the same
pharmacological group
Detoxification
• “The removal of poisons” Concise Oxford
Dictionary
• Detoxification is a process of achieving a drug
free state, usually involving the prescription of a
drug to attenuate withdrawal symptoms
• The aim is to achieve this agreed objective with a
minimum of discomfort to the individual
• At the same time monitoring the individual for
coexisting or complicating conditions.
•
.
•Motivational work
•Needle Exchange
•Maintenance
prescription
•Safer injecting
advice
•Substance
information
•Housing
•Access healthcare
•Bibliotherapy
.
•Motivational work
•Feedback
•Self-Monitoring
Introduce
Conflict
Reduce Harm
Pre-contemplation
Contemplation
Determination
Increase
Motivation
Prepare for
Change
Maintenance
Action
Relapse
Prevention
Behaviour
Change
•Sensitising/Antagonist prescription
•Revisit motivation
•Compare and contrast lifestyles
•Cognitive behavioural coping skills
High risk situations
Coping skills
•Utilising network support
•Detoxification
•Stopping injecting
•Attenuated drinking
•Planning activities
•Detoxification
•Developing social
support
Assessment of
substance use
Slide 15
Introduction to Dual Diagnosis
Objectives
• To recognise own attitudes towards drugs and
alcohol
• To understand the reasons why people use drugs
and alcohol
• To be aware of the legality, effects, routes of use, and
risks of alcohol, cannabis and cocaine
• Begin to understand why people may use them
despite adverse effects on Mental Health and
Physical Health
Dual Diagnosis
Capabilities
• Non-Judgemental Attitude: Be aware of ones own
attitudes and values in relation to dual diagnosis
and be able to suspend judgement when working
with service users, and carers. Challenge others’
attitudes in an appropriate and useful manner.
[Dual Diagnosis Capability 4 level 2
• Education and Health Promotion: Be able to offer
basic but accurate and up to date information and
advice about effects of substances on mental and
physical health and vice versa. [Dual Diagnosis
Capability 8 level 2]
Definitions
• The term “dual diagnosis” is generally
applied to people who have two
disorders
• Combined mental health and substance
use problems
• More than “dual problems”- likely to have
complex health and social needs
• Wide range of people with varying
degrees of need - need individualised
treatment
DUAL DIAGNOSIS
• "Co-existent mental illness and substance
abuse or other disorders“
• Complex often very complex
• Pareto Principle 80/20 (DD in the 20)
• Time consuming
• Frequently undetected, (through fear?)
• Substance use / intoxication / withdrawal
• Precipitate / exacerbate condition
• Usual not exceptional
• DoH - Good Practice Guide 2002
“Mainstreaming”
• DH (2002) Good Practice Guide:
• Doesn’t advocate a separate specialist service for dual
diagnosis
• Mental health services should take primary responsibility
for those with serious mental health problems (like
schizophrenia) and substance use
• Substance use services should take primary responsibility
for those with primary substance problems and common
mental health problems (anxiety, depression)
• However mental health and substance use services
should work together and support each other
Potential or Real Management
Problems
•
Often undetected
•
Often poor compliance with medication
•
Violence and disruption is possible with
intoxication and withdrawal
•
Compromised treatment regimes interactions/selfharm / abuse
•
Is it not just another added complexity and so
should not be ignored or lessened
Mental Health Practitioner v
Substance Use Practitioner
•
•
•
•
Communication skills
Assessment skills
Relationship building and maintenance
Knowledge of health and well being
•
•
•
•
Positive outlook
Encouraging hope in recovery
Empathetic
Holistic view
Exercise 1
•
Ask yourself these questions:
• What attitudes do I have about people who use drugs and
people who use alcohol?
• Where did these attitudes come from? (Parents, school,
media, religious beliefs etc)
• How might these attitudes affect how I work with people
with substance use problems?
Effects etc
•
•
•
•
Effects people want
Ones they are not so keen about
The dreaded withdrawal
Effects they might have on Mental
Health
• Myths and legends about users!
Reasons for use
•
•
•
•
•
•
•
•
•
•
•
To feel euphoric or feel nothing
To feel more confident
To work longer hours or enhance performance
To belong to a social group (peer pressure)
To kill time (alleviate boredom)
To alleviate physical pain and other health
problems
Because it is a habit
To satisfy cravings and avoid withdrawal symptoms
For weight loss
To experience an altered state of consciousness
To unwind after a stressful day
Discussion 1
• What have been your experiences of
working with people with dual
diagnosis within your work setting?
•
Think about issues concerning:
– the individual
– the carer
– yourselves
– the service that you work for.
Withdrawal
Working Definition
• Symptoms absent prior to regular / heavy use
• Symptoms are most severe post periods of heavy intake
• Symptoms are usually experienced within one half life of
abrupt cessation or significant reduction of intake
• Symptoms usually disappear in 14 days of cessation
• Symptoms relieved by further substance use
• Symptoms relieved by other substances of the same
pharmacological group
Detoxification
• “The removal of poisons” Concise Oxford
Dictionary
• Detoxification is a process of achieving a drug
free state, usually involving the prescription of a
drug to attenuate withdrawal symptoms
• The aim is to achieve this agreed objective with a
minimum of discomfort to the individual
• At the same time monitoring the individual for
coexisting or complicating conditions.
•
.
•Motivational work
•Needle Exchange
•Maintenance
prescription
•Safer injecting
advice
•Substance
information
•Housing
•Access healthcare
•Bibliotherapy
.
•Motivational work
•Feedback
•Self-Monitoring
Introduce
Conflict
Reduce Harm
Pre-contemplation
Contemplation
Determination
Increase
Motivation
Prepare for
Change
Maintenance
Action
Relapse
Prevention
Behaviour
Change
•Sensitising/Antagonist prescription
•Revisit motivation
•Compare and contrast lifestyles
•Cognitive behavioural coping skills
High risk situations
Coping skills
•Utilising network support
•Detoxification
•Stopping injecting
•Attenuated drinking
•Planning activities
•Detoxification
•Developing social
support
Assessment of
substance use
Slide 16
Introduction to Dual Diagnosis
Objectives
• To recognise own attitudes towards drugs and
alcohol
• To understand the reasons why people use drugs
and alcohol
• To be aware of the legality, effects, routes of use, and
risks of alcohol, cannabis and cocaine
• Begin to understand why people may use them
despite adverse effects on Mental Health and
Physical Health
Dual Diagnosis
Capabilities
• Non-Judgemental Attitude: Be aware of ones own
attitudes and values in relation to dual diagnosis
and be able to suspend judgement when working
with service users, and carers. Challenge others’
attitudes in an appropriate and useful manner.
[Dual Diagnosis Capability 4 level 2
• Education and Health Promotion: Be able to offer
basic but accurate and up to date information and
advice about effects of substances on mental and
physical health and vice versa. [Dual Diagnosis
Capability 8 level 2]
Definitions
• The term “dual diagnosis” is generally
applied to people who have two
disorders
• Combined mental health and substance
use problems
• More than “dual problems”- likely to have
complex health and social needs
• Wide range of people with varying
degrees of need - need individualised
treatment
DUAL DIAGNOSIS
• "Co-existent mental illness and substance
abuse or other disorders“
• Complex often very complex
• Pareto Principle 80/20 (DD in the 20)
• Time consuming
• Frequently undetected, (through fear?)
• Substance use / intoxication / withdrawal
• Precipitate / exacerbate condition
• Usual not exceptional
• DoH - Good Practice Guide 2002
“Mainstreaming”
• DH (2002) Good Practice Guide:
• Doesn’t advocate a separate specialist service for dual
diagnosis
• Mental health services should take primary responsibility
for those with serious mental health problems (like
schizophrenia) and substance use
• Substance use services should take primary responsibility
for those with primary substance problems and common
mental health problems (anxiety, depression)
• However mental health and substance use services
should work together and support each other
Potential or Real Management
Problems
•
Often undetected
•
Often poor compliance with medication
•
Violence and disruption is possible with
intoxication and withdrawal
•
Compromised treatment regimes interactions/selfharm / abuse
•
Is it not just another added complexity and so
should not be ignored or lessened
Mental Health Practitioner v
Substance Use Practitioner
•
•
•
•
Communication skills
Assessment skills
Relationship building and maintenance
Knowledge of health and well being
•
•
•
•
Positive outlook
Encouraging hope in recovery
Empathetic
Holistic view
Exercise 1
•
Ask yourself these questions:
• What attitudes do I have about people who use drugs and
people who use alcohol?
• Where did these attitudes come from? (Parents, school,
media, religious beliefs etc)
• How might these attitudes affect how I work with people
with substance use problems?
Effects etc
•
•
•
•
Effects people want
Ones they are not so keen about
The dreaded withdrawal
Effects they might have on Mental
Health
• Myths and legends about users!
Reasons for use
•
•
•
•
•
•
•
•
•
•
•
To feel euphoric or feel nothing
To feel more confident
To work longer hours or enhance performance
To belong to a social group (peer pressure)
To kill time (alleviate boredom)
To alleviate physical pain and other health
problems
Because it is a habit
To satisfy cravings and avoid withdrawal symptoms
For weight loss
To experience an altered state of consciousness
To unwind after a stressful day
Discussion 1
• What have been your experiences of
working with people with dual
diagnosis within your work setting?
•
Think about issues concerning:
– the individual
– the carer
– yourselves
– the service that you work for.
Withdrawal
Working Definition
• Symptoms absent prior to regular / heavy use
• Symptoms are most severe post periods of heavy intake
• Symptoms are usually experienced within one half life of
abrupt cessation or significant reduction of intake
• Symptoms usually disappear in 14 days of cessation
• Symptoms relieved by further substance use
• Symptoms relieved by other substances of the same
pharmacological group
Detoxification
• “The removal of poisons” Concise Oxford
Dictionary
• Detoxification is a process of achieving a drug
free state, usually involving the prescription of a
drug to attenuate withdrawal symptoms
• The aim is to achieve this agreed objective with a
minimum of discomfort to the individual
• At the same time monitoring the individual for
coexisting or complicating conditions.
•
.
•Motivational work
•Needle Exchange
•Maintenance
prescription
•Safer injecting
advice
•Substance
information
•Housing
•Access healthcare
•Bibliotherapy
.
•Motivational work
•Feedback
•Self-Monitoring
Introduce
Conflict
Reduce Harm
Pre-contemplation
Contemplation
Determination
Increase
Motivation
Prepare for
Change
Maintenance
Action
Relapse
Prevention
Behaviour
Change
•Sensitising/Antagonist prescription
•Revisit motivation
•Compare and contrast lifestyles
•Cognitive behavioural coping skills
High risk situations
Coping skills
•Utilising network support
•Detoxification
•Stopping injecting
•Attenuated drinking
•Planning activities
•Detoxification
•Developing social
support
Assessment of
substance use
Introduction to Dual Diagnosis
Objectives
• To recognise own attitudes towards drugs and
alcohol
• To understand the reasons why people use drugs
and alcohol
• To be aware of the legality, effects, routes of use, and
risks of alcohol, cannabis and cocaine
• Begin to understand why people may use them
despite adverse effects on Mental Health and
Physical Health
Dual Diagnosis
Capabilities
• Non-Judgemental Attitude: Be aware of ones own
attitudes and values in relation to dual diagnosis
and be able to suspend judgement when working
with service users, and carers. Challenge others’
attitudes in an appropriate and useful manner.
[Dual Diagnosis Capability 4 level 2
• Education and Health Promotion: Be able to offer
basic but accurate and up to date information and
advice about effects of substances on mental and
physical health and vice versa. [Dual Diagnosis
Capability 8 level 2]
Definitions
• The term “dual diagnosis” is generally
applied to people who have two
disorders
• Combined mental health and substance
use problems
• More than “dual problems”- likely to have
complex health and social needs
• Wide range of people with varying
degrees of need - need individualised
treatment
DUAL DIAGNOSIS
• "Co-existent mental illness and substance
abuse or other disorders“
• Complex often very complex
• Pareto Principle 80/20 (DD in the 20)
• Time consuming
• Frequently undetected, (through fear?)
• Substance use / intoxication / withdrawal
• Precipitate / exacerbate condition
• Usual not exceptional
• DoH - Good Practice Guide 2002
“Mainstreaming”
• DH (2002) Good Practice Guide:
• Doesn’t advocate a separate specialist service for dual
diagnosis
• Mental health services should take primary responsibility
for those with serious mental health problems (like
schizophrenia) and substance use
• Substance use services should take primary responsibility
for those with primary substance problems and common
mental health problems (anxiety, depression)
• However mental health and substance use services
should work together and support each other
Potential or Real Management
Problems
•
Often undetected
•
Often poor compliance with medication
•
Violence and disruption is possible with
intoxication and withdrawal
•
Compromised treatment regimes interactions/selfharm / abuse
•
Is it not just another added complexity and so
should not be ignored or lessened
Mental Health Practitioner v
Substance Use Practitioner
•
•
•
•
Communication skills
Assessment skills
Relationship building and maintenance
Knowledge of health and well being
•
•
•
•
Positive outlook
Encouraging hope in recovery
Empathetic
Holistic view
Exercise 1
•
Ask yourself these questions:
• What attitudes do I have about people who use drugs and
people who use alcohol?
• Where did these attitudes come from? (Parents, school,
media, religious beliefs etc)
• How might these attitudes affect how I work with people
with substance use problems?
Effects etc
•
•
•
•
Effects people want
Ones they are not so keen about
The dreaded withdrawal
Effects they might have on Mental
Health
• Myths and legends about users!
Reasons for use
•
•
•
•
•
•
•
•
•
•
•
To feel euphoric or feel nothing
To feel more confident
To work longer hours or enhance performance
To belong to a social group (peer pressure)
To kill time (alleviate boredom)
To alleviate physical pain and other health
problems
Because it is a habit
To satisfy cravings and avoid withdrawal symptoms
For weight loss
To experience an altered state of consciousness
To unwind after a stressful day
Discussion 1
• What have been your experiences of
working with people with dual
diagnosis within your work setting?
•
Think about issues concerning:
– the individual
– the carer
– yourselves
– the service that you work for.
Withdrawal
Working Definition
• Symptoms absent prior to regular / heavy use
• Symptoms are most severe post periods of heavy intake
• Symptoms are usually experienced within one half life of
abrupt cessation or significant reduction of intake
• Symptoms usually disappear in 14 days of cessation
• Symptoms relieved by further substance use
• Symptoms relieved by other substances of the same
pharmacological group
Detoxification
• “The removal of poisons” Concise Oxford
Dictionary
• Detoxification is a process of achieving a drug
free state, usually involving the prescription of a
drug to attenuate withdrawal symptoms
• The aim is to achieve this agreed objective with a
minimum of discomfort to the individual
• At the same time monitoring the individual for
coexisting or complicating conditions.
•
.
•Motivational work
•Needle Exchange
•Maintenance
prescription
•Safer injecting
advice
•Substance
information
•Housing
•Access healthcare
•Bibliotherapy
.
•Motivational work
•Feedback
•Self-Monitoring
Introduce
Conflict
Reduce Harm
Pre-contemplation
Contemplation
Determination
Increase
Motivation
Prepare for
Change
Maintenance
Action
Relapse
Prevention
Behaviour
Change
•Sensitising/Antagonist prescription
•Revisit motivation
•Compare and contrast lifestyles
•Cognitive behavioural coping skills
High risk situations
Coping skills
•Utilising network support
•Detoxification
•Stopping injecting
•Attenuated drinking
•Planning activities
•Detoxification
•Developing social
support
Assessment of
substance use
Slide 2
Introduction to Dual Diagnosis
Objectives
• To recognise own attitudes towards drugs and
alcohol
• To understand the reasons why people use drugs
and alcohol
• To be aware of the legality, effects, routes of use, and
risks of alcohol, cannabis and cocaine
• Begin to understand why people may use them
despite adverse effects on Mental Health and
Physical Health
Dual Diagnosis
Capabilities
• Non-Judgemental Attitude: Be aware of ones own
attitudes and values in relation to dual diagnosis
and be able to suspend judgement when working
with service users, and carers. Challenge others’
attitudes in an appropriate and useful manner.
[Dual Diagnosis Capability 4 level 2
• Education and Health Promotion: Be able to offer
basic but accurate and up to date information and
advice about effects of substances on mental and
physical health and vice versa. [Dual Diagnosis
Capability 8 level 2]
Definitions
• The term “dual diagnosis” is generally
applied to people who have two
disorders
• Combined mental health and substance
use problems
• More than “dual problems”- likely to have
complex health and social needs
• Wide range of people with varying
degrees of need - need individualised
treatment
DUAL DIAGNOSIS
• "Co-existent mental illness and substance
abuse or other disorders“
• Complex often very complex
• Pareto Principle 80/20 (DD in the 20)
• Time consuming
• Frequently undetected, (through fear?)
• Substance use / intoxication / withdrawal
• Precipitate / exacerbate condition
• Usual not exceptional
• DoH - Good Practice Guide 2002
“Mainstreaming”
• DH (2002) Good Practice Guide:
• Doesn’t advocate a separate specialist service for dual
diagnosis
• Mental health services should take primary responsibility
for those with serious mental health problems (like
schizophrenia) and substance use
• Substance use services should take primary responsibility
for those with primary substance problems and common
mental health problems (anxiety, depression)
• However mental health and substance use services
should work together and support each other
Potential or Real Management
Problems
•
Often undetected
•
Often poor compliance with medication
•
Violence and disruption is possible with
intoxication and withdrawal
•
Compromised treatment regimes interactions/selfharm / abuse
•
Is it not just another added complexity and so
should not be ignored or lessened
Mental Health Practitioner v
Substance Use Practitioner
•
•
•
•
Communication skills
Assessment skills
Relationship building and maintenance
Knowledge of health and well being
•
•
•
•
Positive outlook
Encouraging hope in recovery
Empathetic
Holistic view
Exercise 1
•
Ask yourself these questions:
• What attitudes do I have about people who use drugs and
people who use alcohol?
• Where did these attitudes come from? (Parents, school,
media, religious beliefs etc)
• How might these attitudes affect how I work with people
with substance use problems?
Effects etc
•
•
•
•
Effects people want
Ones they are not so keen about
The dreaded withdrawal
Effects they might have on Mental
Health
• Myths and legends about users!
Reasons for use
•
•
•
•
•
•
•
•
•
•
•
To feel euphoric or feel nothing
To feel more confident
To work longer hours or enhance performance
To belong to a social group (peer pressure)
To kill time (alleviate boredom)
To alleviate physical pain and other health
problems
Because it is a habit
To satisfy cravings and avoid withdrawal symptoms
For weight loss
To experience an altered state of consciousness
To unwind after a stressful day
Discussion 1
• What have been your experiences of
working with people with dual
diagnosis within your work setting?
•
Think about issues concerning:
– the individual
– the carer
– yourselves
– the service that you work for.
Withdrawal
Working Definition
• Symptoms absent prior to regular / heavy use
• Symptoms are most severe post periods of heavy intake
• Symptoms are usually experienced within one half life of
abrupt cessation or significant reduction of intake
• Symptoms usually disappear in 14 days of cessation
• Symptoms relieved by further substance use
• Symptoms relieved by other substances of the same
pharmacological group
Detoxification
• “The removal of poisons” Concise Oxford
Dictionary
• Detoxification is a process of achieving a drug
free state, usually involving the prescription of a
drug to attenuate withdrawal symptoms
• The aim is to achieve this agreed objective with a
minimum of discomfort to the individual
• At the same time monitoring the individual for
coexisting or complicating conditions.
•
.
•Motivational work
•Needle Exchange
•Maintenance
prescription
•Safer injecting
advice
•Substance
information
•Housing
•Access healthcare
•Bibliotherapy
.
•Motivational work
•Feedback
•Self-Monitoring
Introduce
Conflict
Reduce Harm
Pre-contemplation
Contemplation
Determination
Increase
Motivation
Prepare for
Change
Maintenance
Action
Relapse
Prevention
Behaviour
Change
•Sensitising/Antagonist prescription
•Revisit motivation
•Compare and contrast lifestyles
•Cognitive behavioural coping skills
High risk situations
Coping skills
•Utilising network support
•Detoxification
•Stopping injecting
•Attenuated drinking
•Planning activities
•Detoxification
•Developing social
support
Assessment of
substance use
Slide 3
Introduction to Dual Diagnosis
Objectives
• To recognise own attitudes towards drugs and
alcohol
• To understand the reasons why people use drugs
and alcohol
• To be aware of the legality, effects, routes of use, and
risks of alcohol, cannabis and cocaine
• Begin to understand why people may use them
despite adverse effects on Mental Health and
Physical Health
Dual Diagnosis
Capabilities
• Non-Judgemental Attitude: Be aware of ones own
attitudes and values in relation to dual diagnosis
and be able to suspend judgement when working
with service users, and carers. Challenge others’
attitudes in an appropriate and useful manner.
[Dual Diagnosis Capability 4 level 2
• Education and Health Promotion: Be able to offer
basic but accurate and up to date information and
advice about effects of substances on mental and
physical health and vice versa. [Dual Diagnosis
Capability 8 level 2]
Definitions
• The term “dual diagnosis” is generally
applied to people who have two
disorders
• Combined mental health and substance
use problems
• More than “dual problems”- likely to have
complex health and social needs
• Wide range of people with varying
degrees of need - need individualised
treatment
DUAL DIAGNOSIS
• "Co-existent mental illness and substance
abuse or other disorders“
• Complex often very complex
• Pareto Principle 80/20 (DD in the 20)
• Time consuming
• Frequently undetected, (through fear?)
• Substance use / intoxication / withdrawal
• Precipitate / exacerbate condition
• Usual not exceptional
• DoH - Good Practice Guide 2002
“Mainstreaming”
• DH (2002) Good Practice Guide:
• Doesn’t advocate a separate specialist service for dual
diagnosis
• Mental health services should take primary responsibility
for those with serious mental health problems (like
schizophrenia) and substance use
• Substance use services should take primary responsibility
for those with primary substance problems and common
mental health problems (anxiety, depression)
• However mental health and substance use services
should work together and support each other
Potential or Real Management
Problems
•
Often undetected
•
Often poor compliance with medication
•
Violence and disruption is possible with
intoxication and withdrawal
•
Compromised treatment regimes interactions/selfharm / abuse
•
Is it not just another added complexity and so
should not be ignored or lessened
Mental Health Practitioner v
Substance Use Practitioner
•
•
•
•
Communication skills
Assessment skills
Relationship building and maintenance
Knowledge of health and well being
•
•
•
•
Positive outlook
Encouraging hope in recovery
Empathetic
Holistic view
Exercise 1
•
Ask yourself these questions:
• What attitudes do I have about people who use drugs and
people who use alcohol?
• Where did these attitudes come from? (Parents, school,
media, religious beliefs etc)
• How might these attitudes affect how I work with people
with substance use problems?
Effects etc
•
•
•
•
Effects people want
Ones they are not so keen about
The dreaded withdrawal
Effects they might have on Mental
Health
• Myths and legends about users!
Reasons for use
•
•
•
•
•
•
•
•
•
•
•
To feel euphoric or feel nothing
To feel more confident
To work longer hours or enhance performance
To belong to a social group (peer pressure)
To kill time (alleviate boredom)
To alleviate physical pain and other health
problems
Because it is a habit
To satisfy cravings and avoid withdrawal symptoms
For weight loss
To experience an altered state of consciousness
To unwind after a stressful day
Discussion 1
• What have been your experiences of
working with people with dual
diagnosis within your work setting?
•
Think about issues concerning:
– the individual
– the carer
– yourselves
– the service that you work for.
Withdrawal
Working Definition
• Symptoms absent prior to regular / heavy use
• Symptoms are most severe post periods of heavy intake
• Symptoms are usually experienced within one half life of
abrupt cessation or significant reduction of intake
• Symptoms usually disappear in 14 days of cessation
• Symptoms relieved by further substance use
• Symptoms relieved by other substances of the same
pharmacological group
Detoxification
• “The removal of poisons” Concise Oxford
Dictionary
• Detoxification is a process of achieving a drug
free state, usually involving the prescription of a
drug to attenuate withdrawal symptoms
• The aim is to achieve this agreed objective with a
minimum of discomfort to the individual
• At the same time monitoring the individual for
coexisting or complicating conditions.
•
.
•Motivational work
•Needle Exchange
•Maintenance
prescription
•Safer injecting
advice
•Substance
information
•Housing
•Access healthcare
•Bibliotherapy
.
•Motivational work
•Feedback
•Self-Monitoring
Introduce
Conflict
Reduce Harm
Pre-contemplation
Contemplation
Determination
Increase
Motivation
Prepare for
Change
Maintenance
Action
Relapse
Prevention
Behaviour
Change
•Sensitising/Antagonist prescription
•Revisit motivation
•Compare and contrast lifestyles
•Cognitive behavioural coping skills
High risk situations
Coping skills
•Utilising network support
•Detoxification
•Stopping injecting
•Attenuated drinking
•Planning activities
•Detoxification
•Developing social
support
Assessment of
substance use
Slide 4
Introduction to Dual Diagnosis
Objectives
• To recognise own attitudes towards drugs and
alcohol
• To understand the reasons why people use drugs
and alcohol
• To be aware of the legality, effects, routes of use, and
risks of alcohol, cannabis and cocaine
• Begin to understand why people may use them
despite adverse effects on Mental Health and
Physical Health
Dual Diagnosis
Capabilities
• Non-Judgemental Attitude: Be aware of ones own
attitudes and values in relation to dual diagnosis
and be able to suspend judgement when working
with service users, and carers. Challenge others’
attitudes in an appropriate and useful manner.
[Dual Diagnosis Capability 4 level 2
• Education and Health Promotion: Be able to offer
basic but accurate and up to date information and
advice about effects of substances on mental and
physical health and vice versa. [Dual Diagnosis
Capability 8 level 2]
Definitions
• The term “dual diagnosis” is generally
applied to people who have two
disorders
• Combined mental health and substance
use problems
• More than “dual problems”- likely to have
complex health and social needs
• Wide range of people with varying
degrees of need - need individualised
treatment
DUAL DIAGNOSIS
• "Co-existent mental illness and substance
abuse or other disorders“
• Complex often very complex
• Pareto Principle 80/20 (DD in the 20)
• Time consuming
• Frequently undetected, (through fear?)
• Substance use / intoxication / withdrawal
• Precipitate / exacerbate condition
• Usual not exceptional
• DoH - Good Practice Guide 2002
“Mainstreaming”
• DH (2002) Good Practice Guide:
• Doesn’t advocate a separate specialist service for dual
diagnosis
• Mental health services should take primary responsibility
for those with serious mental health problems (like
schizophrenia) and substance use
• Substance use services should take primary responsibility
for those with primary substance problems and common
mental health problems (anxiety, depression)
• However mental health and substance use services
should work together and support each other
Potential or Real Management
Problems
•
Often undetected
•
Often poor compliance with medication
•
Violence and disruption is possible with
intoxication and withdrawal
•
Compromised treatment regimes interactions/selfharm / abuse
•
Is it not just another added complexity and so
should not be ignored or lessened
Mental Health Practitioner v
Substance Use Practitioner
•
•
•
•
Communication skills
Assessment skills
Relationship building and maintenance
Knowledge of health and well being
•
•
•
•
Positive outlook
Encouraging hope in recovery
Empathetic
Holistic view
Exercise 1
•
Ask yourself these questions:
• What attitudes do I have about people who use drugs and
people who use alcohol?
• Where did these attitudes come from? (Parents, school,
media, religious beliefs etc)
• How might these attitudes affect how I work with people
with substance use problems?
Effects etc
•
•
•
•
Effects people want
Ones they are not so keen about
The dreaded withdrawal
Effects they might have on Mental
Health
• Myths and legends about users!
Reasons for use
•
•
•
•
•
•
•
•
•
•
•
To feel euphoric or feel nothing
To feel more confident
To work longer hours or enhance performance
To belong to a social group (peer pressure)
To kill time (alleviate boredom)
To alleviate physical pain and other health
problems
Because it is a habit
To satisfy cravings and avoid withdrawal symptoms
For weight loss
To experience an altered state of consciousness
To unwind after a stressful day
Discussion 1
• What have been your experiences of
working with people with dual
diagnosis within your work setting?
•
Think about issues concerning:
– the individual
– the carer
– yourselves
– the service that you work for.
Withdrawal
Working Definition
• Symptoms absent prior to regular / heavy use
• Symptoms are most severe post periods of heavy intake
• Symptoms are usually experienced within one half life of
abrupt cessation or significant reduction of intake
• Symptoms usually disappear in 14 days of cessation
• Symptoms relieved by further substance use
• Symptoms relieved by other substances of the same
pharmacological group
Detoxification
• “The removal of poisons” Concise Oxford
Dictionary
• Detoxification is a process of achieving a drug
free state, usually involving the prescription of a
drug to attenuate withdrawal symptoms
• The aim is to achieve this agreed objective with a
minimum of discomfort to the individual
• At the same time monitoring the individual for
coexisting or complicating conditions.
•
.
•Motivational work
•Needle Exchange
•Maintenance
prescription
•Safer injecting
advice
•Substance
information
•Housing
•Access healthcare
•Bibliotherapy
.
•Motivational work
•Feedback
•Self-Monitoring
Introduce
Conflict
Reduce Harm
Pre-contemplation
Contemplation
Determination
Increase
Motivation
Prepare for
Change
Maintenance
Action
Relapse
Prevention
Behaviour
Change
•Sensitising/Antagonist prescription
•Revisit motivation
•Compare and contrast lifestyles
•Cognitive behavioural coping skills
High risk situations
Coping skills
•Utilising network support
•Detoxification
•Stopping injecting
•Attenuated drinking
•Planning activities
•Detoxification
•Developing social
support
Assessment of
substance use
Slide 5
Introduction to Dual Diagnosis
Objectives
• To recognise own attitudes towards drugs and
alcohol
• To understand the reasons why people use drugs
and alcohol
• To be aware of the legality, effects, routes of use, and
risks of alcohol, cannabis and cocaine
• Begin to understand why people may use them
despite adverse effects on Mental Health and
Physical Health
Dual Diagnosis
Capabilities
• Non-Judgemental Attitude: Be aware of ones own
attitudes and values in relation to dual diagnosis
and be able to suspend judgement when working
with service users, and carers. Challenge others’
attitudes in an appropriate and useful manner.
[Dual Diagnosis Capability 4 level 2
• Education and Health Promotion: Be able to offer
basic but accurate and up to date information and
advice about effects of substances on mental and
physical health and vice versa. [Dual Diagnosis
Capability 8 level 2]
Definitions
• The term “dual diagnosis” is generally
applied to people who have two
disorders
• Combined mental health and substance
use problems
• More than “dual problems”- likely to have
complex health and social needs
• Wide range of people with varying
degrees of need - need individualised
treatment
DUAL DIAGNOSIS
• "Co-existent mental illness and substance
abuse or other disorders“
• Complex often very complex
• Pareto Principle 80/20 (DD in the 20)
• Time consuming
• Frequently undetected, (through fear?)
• Substance use / intoxication / withdrawal
• Precipitate / exacerbate condition
• Usual not exceptional
• DoH - Good Practice Guide 2002
“Mainstreaming”
• DH (2002) Good Practice Guide:
• Doesn’t advocate a separate specialist service for dual
diagnosis
• Mental health services should take primary responsibility
for those with serious mental health problems (like
schizophrenia) and substance use
• Substance use services should take primary responsibility
for those with primary substance problems and common
mental health problems (anxiety, depression)
• However mental health and substance use services
should work together and support each other
Potential or Real Management
Problems
•
Often undetected
•
Often poor compliance with medication
•
Violence and disruption is possible with
intoxication and withdrawal
•
Compromised treatment regimes interactions/selfharm / abuse
•
Is it not just another added complexity and so
should not be ignored or lessened
Mental Health Practitioner v
Substance Use Practitioner
•
•
•
•
Communication skills
Assessment skills
Relationship building and maintenance
Knowledge of health and well being
•
•
•
•
Positive outlook
Encouraging hope in recovery
Empathetic
Holistic view
Exercise 1
•
Ask yourself these questions:
• What attitudes do I have about people who use drugs and
people who use alcohol?
• Where did these attitudes come from? (Parents, school,
media, religious beliefs etc)
• How might these attitudes affect how I work with people
with substance use problems?
Effects etc
•
•
•
•
Effects people want
Ones they are not so keen about
The dreaded withdrawal
Effects they might have on Mental
Health
• Myths and legends about users!
Reasons for use
•
•
•
•
•
•
•
•
•
•
•
To feel euphoric or feel nothing
To feel more confident
To work longer hours or enhance performance
To belong to a social group (peer pressure)
To kill time (alleviate boredom)
To alleviate physical pain and other health
problems
Because it is a habit
To satisfy cravings and avoid withdrawal symptoms
For weight loss
To experience an altered state of consciousness
To unwind after a stressful day
Discussion 1
• What have been your experiences of
working with people with dual
diagnosis within your work setting?
•
Think about issues concerning:
– the individual
– the carer
– yourselves
– the service that you work for.
Withdrawal
Working Definition
• Symptoms absent prior to regular / heavy use
• Symptoms are most severe post periods of heavy intake
• Symptoms are usually experienced within one half life of
abrupt cessation or significant reduction of intake
• Symptoms usually disappear in 14 days of cessation
• Symptoms relieved by further substance use
• Symptoms relieved by other substances of the same
pharmacological group
Detoxification
• “The removal of poisons” Concise Oxford
Dictionary
• Detoxification is a process of achieving a drug
free state, usually involving the prescription of a
drug to attenuate withdrawal symptoms
• The aim is to achieve this agreed objective with a
minimum of discomfort to the individual
• At the same time monitoring the individual for
coexisting or complicating conditions.
•
.
•Motivational work
•Needle Exchange
•Maintenance
prescription
•Safer injecting
advice
•Substance
information
•Housing
•Access healthcare
•Bibliotherapy
.
•Motivational work
•Feedback
•Self-Monitoring
Introduce
Conflict
Reduce Harm
Pre-contemplation
Contemplation
Determination
Increase
Motivation
Prepare for
Change
Maintenance
Action
Relapse
Prevention
Behaviour
Change
•Sensitising/Antagonist prescription
•Revisit motivation
•Compare and contrast lifestyles
•Cognitive behavioural coping skills
High risk situations
Coping skills
•Utilising network support
•Detoxification
•Stopping injecting
•Attenuated drinking
•Planning activities
•Detoxification
•Developing social
support
Assessment of
substance use
Slide 6
Introduction to Dual Diagnosis
Objectives
• To recognise own attitudes towards drugs and
alcohol
• To understand the reasons why people use drugs
and alcohol
• To be aware of the legality, effects, routes of use, and
risks of alcohol, cannabis and cocaine
• Begin to understand why people may use them
despite adverse effects on Mental Health and
Physical Health
Dual Diagnosis
Capabilities
• Non-Judgemental Attitude: Be aware of ones own
attitudes and values in relation to dual diagnosis
and be able to suspend judgement when working
with service users, and carers. Challenge others’
attitudes in an appropriate and useful manner.
[Dual Diagnosis Capability 4 level 2
• Education and Health Promotion: Be able to offer
basic but accurate and up to date information and
advice about effects of substances on mental and
physical health and vice versa. [Dual Diagnosis
Capability 8 level 2]
Definitions
• The term “dual diagnosis” is generally
applied to people who have two
disorders
• Combined mental health and substance
use problems
• More than “dual problems”- likely to have
complex health and social needs
• Wide range of people with varying
degrees of need - need individualised
treatment
DUAL DIAGNOSIS
• "Co-existent mental illness and substance
abuse or other disorders“
• Complex often very complex
• Pareto Principle 80/20 (DD in the 20)
• Time consuming
• Frequently undetected, (through fear?)
• Substance use / intoxication / withdrawal
• Precipitate / exacerbate condition
• Usual not exceptional
• DoH - Good Practice Guide 2002
“Mainstreaming”
• DH (2002) Good Practice Guide:
• Doesn’t advocate a separate specialist service for dual
diagnosis
• Mental health services should take primary responsibility
for those with serious mental health problems (like
schizophrenia) and substance use
• Substance use services should take primary responsibility
for those with primary substance problems and common
mental health problems (anxiety, depression)
• However mental health and substance use services
should work together and support each other
Potential or Real Management
Problems
•
Often undetected
•
Often poor compliance with medication
•
Violence and disruption is possible with
intoxication and withdrawal
•
Compromised treatment regimes interactions/selfharm / abuse
•
Is it not just another added complexity and so
should not be ignored or lessened
Mental Health Practitioner v
Substance Use Practitioner
•
•
•
•
Communication skills
Assessment skills
Relationship building and maintenance
Knowledge of health and well being
•
•
•
•
Positive outlook
Encouraging hope in recovery
Empathetic
Holistic view
Exercise 1
•
Ask yourself these questions:
• What attitudes do I have about people who use drugs and
people who use alcohol?
• Where did these attitudes come from? (Parents, school,
media, religious beliefs etc)
• How might these attitudes affect how I work with people
with substance use problems?
Effects etc
•
•
•
•
Effects people want
Ones they are not so keen about
The dreaded withdrawal
Effects they might have on Mental
Health
• Myths and legends about users!
Reasons for use
•
•
•
•
•
•
•
•
•
•
•
To feel euphoric or feel nothing
To feel more confident
To work longer hours or enhance performance
To belong to a social group (peer pressure)
To kill time (alleviate boredom)
To alleviate physical pain and other health
problems
Because it is a habit
To satisfy cravings and avoid withdrawal symptoms
For weight loss
To experience an altered state of consciousness
To unwind after a stressful day
Discussion 1
• What have been your experiences of
working with people with dual
diagnosis within your work setting?
•
Think about issues concerning:
– the individual
– the carer
– yourselves
– the service that you work for.
Withdrawal
Working Definition
• Symptoms absent prior to regular / heavy use
• Symptoms are most severe post periods of heavy intake
• Symptoms are usually experienced within one half life of
abrupt cessation or significant reduction of intake
• Symptoms usually disappear in 14 days of cessation
• Symptoms relieved by further substance use
• Symptoms relieved by other substances of the same
pharmacological group
Detoxification
• “The removal of poisons” Concise Oxford
Dictionary
• Detoxification is a process of achieving a drug
free state, usually involving the prescription of a
drug to attenuate withdrawal symptoms
• The aim is to achieve this agreed objective with a
minimum of discomfort to the individual
• At the same time monitoring the individual for
coexisting or complicating conditions.
•
.
•Motivational work
•Needle Exchange
•Maintenance
prescription
•Safer injecting
advice
•Substance
information
•Housing
•Access healthcare
•Bibliotherapy
.
•Motivational work
•Feedback
•Self-Monitoring
Introduce
Conflict
Reduce Harm
Pre-contemplation
Contemplation
Determination
Increase
Motivation
Prepare for
Change
Maintenance
Action
Relapse
Prevention
Behaviour
Change
•Sensitising/Antagonist prescription
•Revisit motivation
•Compare and contrast lifestyles
•Cognitive behavioural coping skills
High risk situations
Coping skills
•Utilising network support
•Detoxification
•Stopping injecting
•Attenuated drinking
•Planning activities
•Detoxification
•Developing social
support
Assessment of
substance use
Slide 7
Introduction to Dual Diagnosis
Objectives
• To recognise own attitudes towards drugs and
alcohol
• To understand the reasons why people use drugs
and alcohol
• To be aware of the legality, effects, routes of use, and
risks of alcohol, cannabis and cocaine
• Begin to understand why people may use them
despite adverse effects on Mental Health and
Physical Health
Dual Diagnosis
Capabilities
• Non-Judgemental Attitude: Be aware of ones own
attitudes and values in relation to dual diagnosis
and be able to suspend judgement when working
with service users, and carers. Challenge others’
attitudes in an appropriate and useful manner.
[Dual Diagnosis Capability 4 level 2
• Education and Health Promotion: Be able to offer
basic but accurate and up to date information and
advice about effects of substances on mental and
physical health and vice versa. [Dual Diagnosis
Capability 8 level 2]
Definitions
• The term “dual diagnosis” is generally
applied to people who have two
disorders
• Combined mental health and substance
use problems
• More than “dual problems”- likely to have
complex health and social needs
• Wide range of people with varying
degrees of need - need individualised
treatment
DUAL DIAGNOSIS
• "Co-existent mental illness and substance
abuse or other disorders“
• Complex often very complex
• Pareto Principle 80/20 (DD in the 20)
• Time consuming
• Frequently undetected, (through fear?)
• Substance use / intoxication / withdrawal
• Precipitate / exacerbate condition
• Usual not exceptional
• DoH - Good Practice Guide 2002
“Mainstreaming”
• DH (2002) Good Practice Guide:
• Doesn’t advocate a separate specialist service for dual
diagnosis
• Mental health services should take primary responsibility
for those with serious mental health problems (like
schizophrenia) and substance use
• Substance use services should take primary responsibility
for those with primary substance problems and common
mental health problems (anxiety, depression)
• However mental health and substance use services
should work together and support each other
Potential or Real Management
Problems
•
Often undetected
•
Often poor compliance with medication
•
Violence and disruption is possible with
intoxication and withdrawal
•
Compromised treatment regimes interactions/selfharm / abuse
•
Is it not just another added complexity and so
should not be ignored or lessened
Mental Health Practitioner v
Substance Use Practitioner
•
•
•
•
Communication skills
Assessment skills
Relationship building and maintenance
Knowledge of health and well being
•
•
•
•
Positive outlook
Encouraging hope in recovery
Empathetic
Holistic view
Exercise 1
•
Ask yourself these questions:
• What attitudes do I have about people who use drugs and
people who use alcohol?
• Where did these attitudes come from? (Parents, school,
media, religious beliefs etc)
• How might these attitudes affect how I work with people
with substance use problems?
Effects etc
•
•
•
•
Effects people want
Ones they are not so keen about
The dreaded withdrawal
Effects they might have on Mental
Health
• Myths and legends about users!
Reasons for use
•
•
•
•
•
•
•
•
•
•
•
To feel euphoric or feel nothing
To feel more confident
To work longer hours or enhance performance
To belong to a social group (peer pressure)
To kill time (alleviate boredom)
To alleviate physical pain and other health
problems
Because it is a habit
To satisfy cravings and avoid withdrawal symptoms
For weight loss
To experience an altered state of consciousness
To unwind after a stressful day
Discussion 1
• What have been your experiences of
working with people with dual
diagnosis within your work setting?
•
Think about issues concerning:
– the individual
– the carer
– yourselves
– the service that you work for.
Withdrawal
Working Definition
• Symptoms absent prior to regular / heavy use
• Symptoms are most severe post periods of heavy intake
• Symptoms are usually experienced within one half life of
abrupt cessation or significant reduction of intake
• Symptoms usually disappear in 14 days of cessation
• Symptoms relieved by further substance use
• Symptoms relieved by other substances of the same
pharmacological group
Detoxification
• “The removal of poisons” Concise Oxford
Dictionary
• Detoxification is a process of achieving a drug
free state, usually involving the prescription of a
drug to attenuate withdrawal symptoms
• The aim is to achieve this agreed objective with a
minimum of discomfort to the individual
• At the same time monitoring the individual for
coexisting or complicating conditions.
•
.
•Motivational work
•Needle Exchange
•Maintenance
prescription
•Safer injecting
advice
•Substance
information
•Housing
•Access healthcare
•Bibliotherapy
.
•Motivational work
•Feedback
•Self-Monitoring
Introduce
Conflict
Reduce Harm
Pre-contemplation
Contemplation
Determination
Increase
Motivation
Prepare for
Change
Maintenance
Action
Relapse
Prevention
Behaviour
Change
•Sensitising/Antagonist prescription
•Revisit motivation
•Compare and contrast lifestyles
•Cognitive behavioural coping skills
High risk situations
Coping skills
•Utilising network support
•Detoxification
•Stopping injecting
•Attenuated drinking
•Planning activities
•Detoxification
•Developing social
support
Assessment of
substance use
Slide 8
Introduction to Dual Diagnosis
Objectives
• To recognise own attitudes towards drugs and
alcohol
• To understand the reasons why people use drugs
and alcohol
• To be aware of the legality, effects, routes of use, and
risks of alcohol, cannabis and cocaine
• Begin to understand why people may use them
despite adverse effects on Mental Health and
Physical Health
Dual Diagnosis
Capabilities
• Non-Judgemental Attitude: Be aware of ones own
attitudes and values in relation to dual diagnosis
and be able to suspend judgement when working
with service users, and carers. Challenge others’
attitudes in an appropriate and useful manner.
[Dual Diagnosis Capability 4 level 2
• Education and Health Promotion: Be able to offer
basic but accurate and up to date information and
advice about effects of substances on mental and
physical health and vice versa. [Dual Diagnosis
Capability 8 level 2]
Definitions
• The term “dual diagnosis” is generally
applied to people who have two
disorders
• Combined mental health and substance
use problems
• More than “dual problems”- likely to have
complex health and social needs
• Wide range of people with varying
degrees of need - need individualised
treatment
DUAL DIAGNOSIS
• "Co-existent mental illness and substance
abuse or other disorders“
• Complex often very complex
• Pareto Principle 80/20 (DD in the 20)
• Time consuming
• Frequently undetected, (through fear?)
• Substance use / intoxication / withdrawal
• Precipitate / exacerbate condition
• Usual not exceptional
• DoH - Good Practice Guide 2002
“Mainstreaming”
• DH (2002) Good Practice Guide:
• Doesn’t advocate a separate specialist service for dual
diagnosis
• Mental health services should take primary responsibility
for those with serious mental health problems (like
schizophrenia) and substance use
• Substance use services should take primary responsibility
for those with primary substance problems and common
mental health problems (anxiety, depression)
• However mental health and substance use services
should work together and support each other
Potential or Real Management
Problems
•
Often undetected
•
Often poor compliance with medication
•
Violence and disruption is possible with
intoxication and withdrawal
•
Compromised treatment regimes interactions/selfharm / abuse
•
Is it not just another added complexity and so
should not be ignored or lessened
Mental Health Practitioner v
Substance Use Practitioner
•
•
•
•
Communication skills
Assessment skills
Relationship building and maintenance
Knowledge of health and well being
•
•
•
•
Positive outlook
Encouraging hope in recovery
Empathetic
Holistic view
Exercise 1
•
Ask yourself these questions:
• What attitudes do I have about people who use drugs and
people who use alcohol?
• Where did these attitudes come from? (Parents, school,
media, religious beliefs etc)
• How might these attitudes affect how I work with people
with substance use problems?
Effects etc
•
•
•
•
Effects people want
Ones they are not so keen about
The dreaded withdrawal
Effects they might have on Mental
Health
• Myths and legends about users!
Reasons for use
•
•
•
•
•
•
•
•
•
•
•
To feel euphoric or feel nothing
To feel more confident
To work longer hours or enhance performance
To belong to a social group (peer pressure)
To kill time (alleviate boredom)
To alleviate physical pain and other health
problems
Because it is a habit
To satisfy cravings and avoid withdrawal symptoms
For weight loss
To experience an altered state of consciousness
To unwind after a stressful day
Discussion 1
• What have been your experiences of
working with people with dual
diagnosis within your work setting?
•
Think about issues concerning:
– the individual
– the carer
– yourselves
– the service that you work for.
Withdrawal
Working Definition
• Symptoms absent prior to regular / heavy use
• Symptoms are most severe post periods of heavy intake
• Symptoms are usually experienced within one half life of
abrupt cessation or significant reduction of intake
• Symptoms usually disappear in 14 days of cessation
• Symptoms relieved by further substance use
• Symptoms relieved by other substances of the same
pharmacological group
Detoxification
• “The removal of poisons” Concise Oxford
Dictionary
• Detoxification is a process of achieving a drug
free state, usually involving the prescription of a
drug to attenuate withdrawal symptoms
• The aim is to achieve this agreed objective with a
minimum of discomfort to the individual
• At the same time monitoring the individual for
coexisting or complicating conditions.
•
.
•Motivational work
•Needle Exchange
•Maintenance
prescription
•Safer injecting
advice
•Substance
information
•Housing
•Access healthcare
•Bibliotherapy
.
•Motivational work
•Feedback
•Self-Monitoring
Introduce
Conflict
Reduce Harm
Pre-contemplation
Contemplation
Determination
Increase
Motivation
Prepare for
Change
Maintenance
Action
Relapse
Prevention
Behaviour
Change
•Sensitising/Antagonist prescription
•Revisit motivation
•Compare and contrast lifestyles
•Cognitive behavioural coping skills
High risk situations
Coping skills
•Utilising network support
•Detoxification
•Stopping injecting
•Attenuated drinking
•Planning activities
•Detoxification
•Developing social
support
Assessment of
substance use
Slide 9
Introduction to Dual Diagnosis
Objectives
• To recognise own attitudes towards drugs and
alcohol
• To understand the reasons why people use drugs
and alcohol
• To be aware of the legality, effects, routes of use, and
risks of alcohol, cannabis and cocaine
• Begin to understand why people may use them
despite adverse effects on Mental Health and
Physical Health
Dual Diagnosis
Capabilities
• Non-Judgemental Attitude: Be aware of ones own
attitudes and values in relation to dual diagnosis
and be able to suspend judgement when working
with service users, and carers. Challenge others’
attitudes in an appropriate and useful manner.
[Dual Diagnosis Capability 4 level 2
• Education and Health Promotion: Be able to offer
basic but accurate and up to date information and
advice about effects of substances on mental and
physical health and vice versa. [Dual Diagnosis
Capability 8 level 2]
Definitions
• The term “dual diagnosis” is generally
applied to people who have two
disorders
• Combined mental health and substance
use problems
• More than “dual problems”- likely to have
complex health and social needs
• Wide range of people with varying
degrees of need - need individualised
treatment
DUAL DIAGNOSIS
• "Co-existent mental illness and substance
abuse or other disorders“
• Complex often very complex
• Pareto Principle 80/20 (DD in the 20)
• Time consuming
• Frequently undetected, (through fear?)
• Substance use / intoxication / withdrawal
• Precipitate / exacerbate condition
• Usual not exceptional
• DoH - Good Practice Guide 2002
“Mainstreaming”
• DH (2002) Good Practice Guide:
• Doesn’t advocate a separate specialist service for dual
diagnosis
• Mental health services should take primary responsibility
for those with serious mental health problems (like
schizophrenia) and substance use
• Substance use services should take primary responsibility
for those with primary substance problems and common
mental health problems (anxiety, depression)
• However mental health and substance use services
should work together and support each other
Potential or Real Management
Problems
•
Often undetected
•
Often poor compliance with medication
•
Violence and disruption is possible with
intoxication and withdrawal
•
Compromised treatment regimes interactions/selfharm / abuse
•
Is it not just another added complexity and so
should not be ignored or lessened
Mental Health Practitioner v
Substance Use Practitioner
•
•
•
•
Communication skills
Assessment skills
Relationship building and maintenance
Knowledge of health and well being
•
•
•
•
Positive outlook
Encouraging hope in recovery
Empathetic
Holistic view
Exercise 1
•
Ask yourself these questions:
• What attitudes do I have about people who use drugs and
people who use alcohol?
• Where did these attitudes come from? (Parents, school,
media, religious beliefs etc)
• How might these attitudes affect how I work with people
with substance use problems?
Effects etc
•
•
•
•
Effects people want
Ones they are not so keen about
The dreaded withdrawal
Effects they might have on Mental
Health
• Myths and legends about users!
Reasons for use
•
•
•
•
•
•
•
•
•
•
•
To feel euphoric or feel nothing
To feel more confident
To work longer hours or enhance performance
To belong to a social group (peer pressure)
To kill time (alleviate boredom)
To alleviate physical pain and other health
problems
Because it is a habit
To satisfy cravings and avoid withdrawal symptoms
For weight loss
To experience an altered state of consciousness
To unwind after a stressful day
Discussion 1
• What have been your experiences of
working with people with dual
diagnosis within your work setting?
•
Think about issues concerning:
– the individual
– the carer
– yourselves
– the service that you work for.
Withdrawal
Working Definition
• Symptoms absent prior to regular / heavy use
• Symptoms are most severe post periods of heavy intake
• Symptoms are usually experienced within one half life of
abrupt cessation or significant reduction of intake
• Symptoms usually disappear in 14 days of cessation
• Symptoms relieved by further substance use
• Symptoms relieved by other substances of the same
pharmacological group
Detoxification
• “The removal of poisons” Concise Oxford
Dictionary
• Detoxification is a process of achieving a drug
free state, usually involving the prescription of a
drug to attenuate withdrawal symptoms
• The aim is to achieve this agreed objective with a
minimum of discomfort to the individual
• At the same time monitoring the individual for
coexisting or complicating conditions.
•
.
•Motivational work
•Needle Exchange
•Maintenance
prescription
•Safer injecting
advice
•Substance
information
•Housing
•Access healthcare
•Bibliotherapy
.
•Motivational work
•Feedback
•Self-Monitoring
Introduce
Conflict
Reduce Harm
Pre-contemplation
Contemplation
Determination
Increase
Motivation
Prepare for
Change
Maintenance
Action
Relapse
Prevention
Behaviour
Change
•Sensitising/Antagonist prescription
•Revisit motivation
•Compare and contrast lifestyles
•Cognitive behavioural coping skills
High risk situations
Coping skills
•Utilising network support
•Detoxification
•Stopping injecting
•Attenuated drinking
•Planning activities
•Detoxification
•Developing social
support
Assessment of
substance use
Slide 10
Introduction to Dual Diagnosis
Objectives
• To recognise own attitudes towards drugs and
alcohol
• To understand the reasons why people use drugs
and alcohol
• To be aware of the legality, effects, routes of use, and
risks of alcohol, cannabis and cocaine
• Begin to understand why people may use them
despite adverse effects on Mental Health and
Physical Health
Dual Diagnosis
Capabilities
• Non-Judgemental Attitude: Be aware of ones own
attitudes and values in relation to dual diagnosis
and be able to suspend judgement when working
with service users, and carers. Challenge others’
attitudes in an appropriate and useful manner.
[Dual Diagnosis Capability 4 level 2
• Education and Health Promotion: Be able to offer
basic but accurate and up to date information and
advice about effects of substances on mental and
physical health and vice versa. [Dual Diagnosis
Capability 8 level 2]
Definitions
• The term “dual diagnosis” is generally
applied to people who have two
disorders
• Combined mental health and substance
use problems
• More than “dual problems”- likely to have
complex health and social needs
• Wide range of people with varying
degrees of need - need individualised
treatment
DUAL DIAGNOSIS
• "Co-existent mental illness and substance
abuse or other disorders“
• Complex often very complex
• Pareto Principle 80/20 (DD in the 20)
• Time consuming
• Frequently undetected, (through fear?)
• Substance use / intoxication / withdrawal
• Precipitate / exacerbate condition
• Usual not exceptional
• DoH - Good Practice Guide 2002
“Mainstreaming”
• DH (2002) Good Practice Guide:
• Doesn’t advocate a separate specialist service for dual
diagnosis
• Mental health services should take primary responsibility
for those with serious mental health problems (like
schizophrenia) and substance use
• Substance use services should take primary responsibility
for those with primary substance problems and common
mental health problems (anxiety, depression)
• However mental health and substance use services
should work together and support each other
Potential or Real Management
Problems
•
Often undetected
•
Often poor compliance with medication
•
Violence and disruption is possible with
intoxication and withdrawal
•
Compromised treatment regimes interactions/selfharm / abuse
•
Is it not just another added complexity and so
should not be ignored or lessened
Mental Health Practitioner v
Substance Use Practitioner
•
•
•
•
Communication skills
Assessment skills
Relationship building and maintenance
Knowledge of health and well being
•
•
•
•
Positive outlook
Encouraging hope in recovery
Empathetic
Holistic view
Exercise 1
•
Ask yourself these questions:
• What attitudes do I have about people who use drugs and
people who use alcohol?
• Where did these attitudes come from? (Parents, school,
media, religious beliefs etc)
• How might these attitudes affect how I work with people
with substance use problems?
Effects etc
•
•
•
•
Effects people want
Ones they are not so keen about
The dreaded withdrawal
Effects they might have on Mental
Health
• Myths and legends about users!
Reasons for use
•
•
•
•
•
•
•
•
•
•
•
To feel euphoric or feel nothing
To feel more confident
To work longer hours or enhance performance
To belong to a social group (peer pressure)
To kill time (alleviate boredom)
To alleviate physical pain and other health
problems
Because it is a habit
To satisfy cravings and avoid withdrawal symptoms
For weight loss
To experience an altered state of consciousness
To unwind after a stressful day
Discussion 1
• What have been your experiences of
working with people with dual
diagnosis within your work setting?
•
Think about issues concerning:
– the individual
– the carer
– yourselves
– the service that you work for.
Withdrawal
Working Definition
• Symptoms absent prior to regular / heavy use
• Symptoms are most severe post periods of heavy intake
• Symptoms are usually experienced within one half life of
abrupt cessation or significant reduction of intake
• Symptoms usually disappear in 14 days of cessation
• Symptoms relieved by further substance use
• Symptoms relieved by other substances of the same
pharmacological group
Detoxification
• “The removal of poisons” Concise Oxford
Dictionary
• Detoxification is a process of achieving a drug
free state, usually involving the prescription of a
drug to attenuate withdrawal symptoms
• The aim is to achieve this agreed objective with a
minimum of discomfort to the individual
• At the same time monitoring the individual for
coexisting or complicating conditions.
•
.
•Motivational work
•Needle Exchange
•Maintenance
prescription
•Safer injecting
advice
•Substance
information
•Housing
•Access healthcare
•Bibliotherapy
.
•Motivational work
•Feedback
•Self-Monitoring
Introduce
Conflict
Reduce Harm
Pre-contemplation
Contemplation
Determination
Increase
Motivation
Prepare for
Change
Maintenance
Action
Relapse
Prevention
Behaviour
Change
•Sensitising/Antagonist prescription
•Revisit motivation
•Compare and contrast lifestyles
•Cognitive behavioural coping skills
High risk situations
Coping skills
•Utilising network support
•Detoxification
•Stopping injecting
•Attenuated drinking
•Planning activities
•Detoxification
•Developing social
support
Assessment of
substance use
Slide 11
Introduction to Dual Diagnosis
Objectives
• To recognise own attitudes towards drugs and
alcohol
• To understand the reasons why people use drugs
and alcohol
• To be aware of the legality, effects, routes of use, and
risks of alcohol, cannabis and cocaine
• Begin to understand why people may use them
despite adverse effects on Mental Health and
Physical Health
Dual Diagnosis
Capabilities
• Non-Judgemental Attitude: Be aware of ones own
attitudes and values in relation to dual diagnosis
and be able to suspend judgement when working
with service users, and carers. Challenge others’
attitudes in an appropriate and useful manner.
[Dual Diagnosis Capability 4 level 2
• Education and Health Promotion: Be able to offer
basic but accurate and up to date information and
advice about effects of substances on mental and
physical health and vice versa. [Dual Diagnosis
Capability 8 level 2]
Definitions
• The term “dual diagnosis” is generally
applied to people who have two
disorders
• Combined mental health and substance
use problems
• More than “dual problems”- likely to have
complex health and social needs
• Wide range of people with varying
degrees of need - need individualised
treatment
DUAL DIAGNOSIS
• "Co-existent mental illness and substance
abuse or other disorders“
• Complex often very complex
• Pareto Principle 80/20 (DD in the 20)
• Time consuming
• Frequently undetected, (through fear?)
• Substance use / intoxication / withdrawal
• Precipitate / exacerbate condition
• Usual not exceptional
• DoH - Good Practice Guide 2002
“Mainstreaming”
• DH (2002) Good Practice Guide:
• Doesn’t advocate a separate specialist service for dual
diagnosis
• Mental health services should take primary responsibility
for those with serious mental health problems (like
schizophrenia) and substance use
• Substance use services should take primary responsibility
for those with primary substance problems and common
mental health problems (anxiety, depression)
• However mental health and substance use services
should work together and support each other
Potential or Real Management
Problems
•
Often undetected
•
Often poor compliance with medication
•
Violence and disruption is possible with
intoxication and withdrawal
•
Compromised treatment regimes interactions/selfharm / abuse
•
Is it not just another added complexity and so
should not be ignored or lessened
Mental Health Practitioner v
Substance Use Practitioner
•
•
•
•
Communication skills
Assessment skills
Relationship building and maintenance
Knowledge of health and well being
•
•
•
•
Positive outlook
Encouraging hope in recovery
Empathetic
Holistic view
Exercise 1
•
Ask yourself these questions:
• What attitudes do I have about people who use drugs and
people who use alcohol?
• Where did these attitudes come from? (Parents, school,
media, religious beliefs etc)
• How might these attitudes affect how I work with people
with substance use problems?
Effects etc
•
•
•
•
Effects people want
Ones they are not so keen about
The dreaded withdrawal
Effects they might have on Mental
Health
• Myths and legends about users!
Reasons for use
•
•
•
•
•
•
•
•
•
•
•
To feel euphoric or feel nothing
To feel more confident
To work longer hours or enhance performance
To belong to a social group (peer pressure)
To kill time (alleviate boredom)
To alleviate physical pain and other health
problems
Because it is a habit
To satisfy cravings and avoid withdrawal symptoms
For weight loss
To experience an altered state of consciousness
To unwind after a stressful day
Discussion 1
• What have been your experiences of
working with people with dual
diagnosis within your work setting?
•
Think about issues concerning:
– the individual
– the carer
– yourselves
– the service that you work for.
Withdrawal
Working Definition
• Symptoms absent prior to regular / heavy use
• Symptoms are most severe post periods of heavy intake
• Symptoms are usually experienced within one half life of
abrupt cessation or significant reduction of intake
• Symptoms usually disappear in 14 days of cessation
• Symptoms relieved by further substance use
• Symptoms relieved by other substances of the same
pharmacological group
Detoxification
• “The removal of poisons” Concise Oxford
Dictionary
• Detoxification is a process of achieving a drug
free state, usually involving the prescription of a
drug to attenuate withdrawal symptoms
• The aim is to achieve this agreed objective with a
minimum of discomfort to the individual
• At the same time monitoring the individual for
coexisting or complicating conditions.
•
.
•Motivational work
•Needle Exchange
•Maintenance
prescription
•Safer injecting
advice
•Substance
information
•Housing
•Access healthcare
•Bibliotherapy
.
•Motivational work
•Feedback
•Self-Monitoring
Introduce
Conflict
Reduce Harm
Pre-contemplation
Contemplation
Determination
Increase
Motivation
Prepare for
Change
Maintenance
Action
Relapse
Prevention
Behaviour
Change
•Sensitising/Antagonist prescription
•Revisit motivation
•Compare and contrast lifestyles
•Cognitive behavioural coping skills
High risk situations
Coping skills
•Utilising network support
•Detoxification
•Stopping injecting
•Attenuated drinking
•Planning activities
•Detoxification
•Developing social
support
Assessment of
substance use
Slide 12
Introduction to Dual Diagnosis
Objectives
• To recognise own attitudes towards drugs and
alcohol
• To understand the reasons why people use drugs
and alcohol
• To be aware of the legality, effects, routes of use, and
risks of alcohol, cannabis and cocaine
• Begin to understand why people may use them
despite adverse effects on Mental Health and
Physical Health
Dual Diagnosis
Capabilities
• Non-Judgemental Attitude: Be aware of ones own
attitudes and values in relation to dual diagnosis
and be able to suspend judgement when working
with service users, and carers. Challenge others’
attitudes in an appropriate and useful manner.
[Dual Diagnosis Capability 4 level 2
• Education and Health Promotion: Be able to offer
basic but accurate and up to date information and
advice about effects of substances on mental and
physical health and vice versa. [Dual Diagnosis
Capability 8 level 2]
Definitions
• The term “dual diagnosis” is generally
applied to people who have two
disorders
• Combined mental health and substance
use problems
• More than “dual problems”- likely to have
complex health and social needs
• Wide range of people with varying
degrees of need - need individualised
treatment
DUAL DIAGNOSIS
• "Co-existent mental illness and substance
abuse or other disorders“
• Complex often very complex
• Pareto Principle 80/20 (DD in the 20)
• Time consuming
• Frequently undetected, (through fear?)
• Substance use / intoxication / withdrawal
• Precipitate / exacerbate condition
• Usual not exceptional
• DoH - Good Practice Guide 2002
“Mainstreaming”
• DH (2002) Good Practice Guide:
• Doesn’t advocate a separate specialist service for dual
diagnosis
• Mental health services should take primary responsibility
for those with serious mental health problems (like
schizophrenia) and substance use
• Substance use services should take primary responsibility
for those with primary substance problems and common
mental health problems (anxiety, depression)
• However mental health and substance use services
should work together and support each other
Potential or Real Management
Problems
•
Often undetected
•
Often poor compliance with medication
•
Violence and disruption is possible with
intoxication and withdrawal
•
Compromised treatment regimes interactions/selfharm / abuse
•
Is it not just another added complexity and so
should not be ignored or lessened
Mental Health Practitioner v
Substance Use Practitioner
•
•
•
•
Communication skills
Assessment skills
Relationship building and maintenance
Knowledge of health and well being
•
•
•
•
Positive outlook
Encouraging hope in recovery
Empathetic
Holistic view
Exercise 1
•
Ask yourself these questions:
• What attitudes do I have about people who use drugs and
people who use alcohol?
• Where did these attitudes come from? (Parents, school,
media, religious beliefs etc)
• How might these attitudes affect how I work with people
with substance use problems?
Effects etc
•
•
•
•
Effects people want
Ones they are not so keen about
The dreaded withdrawal
Effects they might have on Mental
Health
• Myths and legends about users!
Reasons for use
•
•
•
•
•
•
•
•
•
•
•
To feel euphoric or feel nothing
To feel more confident
To work longer hours or enhance performance
To belong to a social group (peer pressure)
To kill time (alleviate boredom)
To alleviate physical pain and other health
problems
Because it is a habit
To satisfy cravings and avoid withdrawal symptoms
For weight loss
To experience an altered state of consciousness
To unwind after a stressful day
Discussion 1
• What have been your experiences of
working with people with dual
diagnosis within your work setting?
•
Think about issues concerning:
– the individual
– the carer
– yourselves
– the service that you work for.
Withdrawal
Working Definition
• Symptoms absent prior to regular / heavy use
• Symptoms are most severe post periods of heavy intake
• Symptoms are usually experienced within one half life of
abrupt cessation or significant reduction of intake
• Symptoms usually disappear in 14 days of cessation
• Symptoms relieved by further substance use
• Symptoms relieved by other substances of the same
pharmacological group
Detoxification
• “The removal of poisons” Concise Oxford
Dictionary
• Detoxification is a process of achieving a drug
free state, usually involving the prescription of a
drug to attenuate withdrawal symptoms
• The aim is to achieve this agreed objective with a
minimum of discomfort to the individual
• At the same time monitoring the individual for
coexisting or complicating conditions.
•
.
•Motivational work
•Needle Exchange
•Maintenance
prescription
•Safer injecting
advice
•Substance
information
•Housing
•Access healthcare
•Bibliotherapy
.
•Motivational work
•Feedback
•Self-Monitoring
Introduce
Conflict
Reduce Harm
Pre-contemplation
Contemplation
Determination
Increase
Motivation
Prepare for
Change
Maintenance
Action
Relapse
Prevention
Behaviour
Change
•Sensitising/Antagonist prescription
•Revisit motivation
•Compare and contrast lifestyles
•Cognitive behavioural coping skills
High risk situations
Coping skills
•Utilising network support
•Detoxification
•Stopping injecting
•Attenuated drinking
•Planning activities
•Detoxification
•Developing social
support
Assessment of
substance use
Slide 13
Introduction to Dual Diagnosis
Objectives
• To recognise own attitudes towards drugs and
alcohol
• To understand the reasons why people use drugs
and alcohol
• To be aware of the legality, effects, routes of use, and
risks of alcohol, cannabis and cocaine
• Begin to understand why people may use them
despite adverse effects on Mental Health and
Physical Health
Dual Diagnosis
Capabilities
• Non-Judgemental Attitude: Be aware of ones own
attitudes and values in relation to dual diagnosis
and be able to suspend judgement when working
with service users, and carers. Challenge others’
attitudes in an appropriate and useful manner.
[Dual Diagnosis Capability 4 level 2
• Education and Health Promotion: Be able to offer
basic but accurate and up to date information and
advice about effects of substances on mental and
physical health and vice versa. [Dual Diagnosis
Capability 8 level 2]
Definitions
• The term “dual diagnosis” is generally
applied to people who have two
disorders
• Combined mental health and substance
use problems
• More than “dual problems”- likely to have
complex health and social needs
• Wide range of people with varying
degrees of need - need individualised
treatment
DUAL DIAGNOSIS
• "Co-existent mental illness and substance
abuse or other disorders“
• Complex often very complex
• Pareto Principle 80/20 (DD in the 20)
• Time consuming
• Frequently undetected, (through fear?)
• Substance use / intoxication / withdrawal
• Precipitate / exacerbate condition
• Usual not exceptional
• DoH - Good Practice Guide 2002
“Mainstreaming”
• DH (2002) Good Practice Guide:
• Doesn’t advocate a separate specialist service for dual
diagnosis
• Mental health services should take primary responsibility
for those with serious mental health problems (like
schizophrenia) and substance use
• Substance use services should take primary responsibility
for those with primary substance problems and common
mental health problems (anxiety, depression)
• However mental health and substance use services
should work together and support each other
Potential or Real Management
Problems
•
Often undetected
•
Often poor compliance with medication
•
Violence and disruption is possible with
intoxication and withdrawal
•
Compromised treatment regimes interactions/selfharm / abuse
•
Is it not just another added complexity and so
should not be ignored or lessened
Mental Health Practitioner v
Substance Use Practitioner
•
•
•
•
Communication skills
Assessment skills
Relationship building and maintenance
Knowledge of health and well being
•
•
•
•
Positive outlook
Encouraging hope in recovery
Empathetic
Holistic view
Exercise 1
•
Ask yourself these questions:
• What attitudes do I have about people who use drugs and
people who use alcohol?
• Where did these attitudes come from? (Parents, school,
media, religious beliefs etc)
• How might these attitudes affect how I work with people
with substance use problems?
Effects etc
•
•
•
•
Effects people want
Ones they are not so keen about
The dreaded withdrawal
Effects they might have on Mental
Health
• Myths and legends about users!
Reasons for use
•
•
•
•
•
•
•
•
•
•
•
To feel euphoric or feel nothing
To feel more confident
To work longer hours or enhance performance
To belong to a social group (peer pressure)
To kill time (alleviate boredom)
To alleviate physical pain and other health
problems
Because it is a habit
To satisfy cravings and avoid withdrawal symptoms
For weight loss
To experience an altered state of consciousness
To unwind after a stressful day
Discussion 1
• What have been your experiences of
working with people with dual
diagnosis within your work setting?
•
Think about issues concerning:
– the individual
– the carer
– yourselves
– the service that you work for.
Withdrawal
Working Definition
• Symptoms absent prior to regular / heavy use
• Symptoms are most severe post periods of heavy intake
• Symptoms are usually experienced within one half life of
abrupt cessation or significant reduction of intake
• Symptoms usually disappear in 14 days of cessation
• Symptoms relieved by further substance use
• Symptoms relieved by other substances of the same
pharmacological group
Detoxification
• “The removal of poisons” Concise Oxford
Dictionary
• Detoxification is a process of achieving a drug
free state, usually involving the prescription of a
drug to attenuate withdrawal symptoms
• The aim is to achieve this agreed objective with a
minimum of discomfort to the individual
• At the same time monitoring the individual for
coexisting or complicating conditions.
•
.
•Motivational work
•Needle Exchange
•Maintenance
prescription
•Safer injecting
advice
•Substance
information
•Housing
•Access healthcare
•Bibliotherapy
.
•Motivational work
•Feedback
•Self-Monitoring
Introduce
Conflict
Reduce Harm
Pre-contemplation
Contemplation
Determination
Increase
Motivation
Prepare for
Change
Maintenance
Action
Relapse
Prevention
Behaviour
Change
•Sensitising/Antagonist prescription
•Revisit motivation
•Compare and contrast lifestyles
•Cognitive behavioural coping skills
High risk situations
Coping skills
•Utilising network support
•Detoxification
•Stopping injecting
•Attenuated drinking
•Planning activities
•Detoxification
•Developing social
support
Assessment of
substance use
Slide 14
Introduction to Dual Diagnosis
Objectives
• To recognise own attitudes towards drugs and
alcohol
• To understand the reasons why people use drugs
and alcohol
• To be aware of the legality, effects, routes of use, and
risks of alcohol, cannabis and cocaine
• Begin to understand why people may use them
despite adverse effects on Mental Health and
Physical Health
Dual Diagnosis
Capabilities
• Non-Judgemental Attitude: Be aware of ones own
attitudes and values in relation to dual diagnosis
and be able to suspend judgement when working
with service users, and carers. Challenge others’
attitudes in an appropriate and useful manner.
[Dual Diagnosis Capability 4 level 2
• Education and Health Promotion: Be able to offer
basic but accurate and up to date information and
advice about effects of substances on mental and
physical health and vice versa. [Dual Diagnosis
Capability 8 level 2]
Definitions
• The term “dual diagnosis” is generally
applied to people who have two
disorders
• Combined mental health and substance
use problems
• More than “dual problems”- likely to have
complex health and social needs
• Wide range of people with varying
degrees of need - need individualised
treatment
DUAL DIAGNOSIS
• "Co-existent mental illness and substance
abuse or other disorders“
• Complex often very complex
• Pareto Principle 80/20 (DD in the 20)
• Time consuming
• Frequently undetected, (through fear?)
• Substance use / intoxication / withdrawal
• Precipitate / exacerbate condition
• Usual not exceptional
• DoH - Good Practice Guide 2002
“Mainstreaming”
• DH (2002) Good Practice Guide:
• Doesn’t advocate a separate specialist service for dual
diagnosis
• Mental health services should take primary responsibility
for those with serious mental health problems (like
schizophrenia) and substance use
• Substance use services should take primary responsibility
for those with primary substance problems and common
mental health problems (anxiety, depression)
• However mental health and substance use services
should work together and support each other
Potential or Real Management
Problems
•
Often undetected
•
Often poor compliance with medication
•
Violence and disruption is possible with
intoxication and withdrawal
•
Compromised treatment regimes interactions/selfharm / abuse
•
Is it not just another added complexity and so
should not be ignored or lessened
Mental Health Practitioner v
Substance Use Practitioner
•
•
•
•
Communication skills
Assessment skills
Relationship building and maintenance
Knowledge of health and well being
•
•
•
•
Positive outlook
Encouraging hope in recovery
Empathetic
Holistic view
Exercise 1
•
Ask yourself these questions:
• What attitudes do I have about people who use drugs and
people who use alcohol?
• Where did these attitudes come from? (Parents, school,
media, religious beliefs etc)
• How might these attitudes affect how I work with people
with substance use problems?
Effects etc
•
•
•
•
Effects people want
Ones they are not so keen about
The dreaded withdrawal
Effects they might have on Mental
Health
• Myths and legends about users!
Reasons for use
•
•
•
•
•
•
•
•
•
•
•
To feel euphoric or feel nothing
To feel more confident
To work longer hours or enhance performance
To belong to a social group (peer pressure)
To kill time (alleviate boredom)
To alleviate physical pain and other health
problems
Because it is a habit
To satisfy cravings and avoid withdrawal symptoms
For weight loss
To experience an altered state of consciousness
To unwind after a stressful day
Discussion 1
• What have been your experiences of
working with people with dual
diagnosis within your work setting?
•
Think about issues concerning:
– the individual
– the carer
– yourselves
– the service that you work for.
Withdrawal
Working Definition
• Symptoms absent prior to regular / heavy use
• Symptoms are most severe post periods of heavy intake
• Symptoms are usually experienced within one half life of
abrupt cessation or significant reduction of intake
• Symptoms usually disappear in 14 days of cessation
• Symptoms relieved by further substance use
• Symptoms relieved by other substances of the same
pharmacological group
Detoxification
• “The removal of poisons” Concise Oxford
Dictionary
• Detoxification is a process of achieving a drug
free state, usually involving the prescription of a
drug to attenuate withdrawal symptoms
• The aim is to achieve this agreed objective with a
minimum of discomfort to the individual
• At the same time monitoring the individual for
coexisting or complicating conditions.
•
.
•Motivational work
•Needle Exchange
•Maintenance
prescription
•Safer injecting
advice
•Substance
information
•Housing
•Access healthcare
•Bibliotherapy
.
•Motivational work
•Feedback
•Self-Monitoring
Introduce
Conflict
Reduce Harm
Pre-contemplation
Contemplation
Determination
Increase
Motivation
Prepare for
Change
Maintenance
Action
Relapse
Prevention
Behaviour
Change
•Sensitising/Antagonist prescription
•Revisit motivation
•Compare and contrast lifestyles
•Cognitive behavioural coping skills
High risk situations
Coping skills
•Utilising network support
•Detoxification
•Stopping injecting
•Attenuated drinking
•Planning activities
•Detoxification
•Developing social
support
Assessment of
substance use
Slide 15
Introduction to Dual Diagnosis
Objectives
• To recognise own attitudes towards drugs and
alcohol
• To understand the reasons why people use drugs
and alcohol
• To be aware of the legality, effects, routes of use, and
risks of alcohol, cannabis and cocaine
• Begin to understand why people may use them
despite adverse effects on Mental Health and
Physical Health
Dual Diagnosis
Capabilities
• Non-Judgemental Attitude: Be aware of ones own
attitudes and values in relation to dual diagnosis
and be able to suspend judgement when working
with service users, and carers. Challenge others’
attitudes in an appropriate and useful manner.
[Dual Diagnosis Capability 4 level 2
• Education and Health Promotion: Be able to offer
basic but accurate and up to date information and
advice about effects of substances on mental and
physical health and vice versa. [Dual Diagnosis
Capability 8 level 2]
Definitions
• The term “dual diagnosis” is generally
applied to people who have two
disorders
• Combined mental health and substance
use problems
• More than “dual problems”- likely to have
complex health and social needs
• Wide range of people with varying
degrees of need - need individualised
treatment
DUAL DIAGNOSIS
• "Co-existent mental illness and substance
abuse or other disorders“
• Complex often very complex
• Pareto Principle 80/20 (DD in the 20)
• Time consuming
• Frequently undetected, (through fear?)
• Substance use / intoxication / withdrawal
• Precipitate / exacerbate condition
• Usual not exceptional
• DoH - Good Practice Guide 2002
“Mainstreaming”
• DH (2002) Good Practice Guide:
• Doesn’t advocate a separate specialist service for dual
diagnosis
• Mental health services should take primary responsibility
for those with serious mental health problems (like
schizophrenia) and substance use
• Substance use services should take primary responsibility
for those with primary substance problems and common
mental health problems (anxiety, depression)
• However mental health and substance use services
should work together and support each other
Potential or Real Management
Problems
•
Often undetected
•
Often poor compliance with medication
•
Violence and disruption is possible with
intoxication and withdrawal
•
Compromised treatment regimes interactions/selfharm / abuse
•
Is it not just another added complexity and so
should not be ignored or lessened
Mental Health Practitioner v
Substance Use Practitioner
•
•
•
•
Communication skills
Assessment skills
Relationship building and maintenance
Knowledge of health and well being
•
•
•
•
Positive outlook
Encouraging hope in recovery
Empathetic
Holistic view
Exercise 1
•
Ask yourself these questions:
• What attitudes do I have about people who use drugs and
people who use alcohol?
• Where did these attitudes come from? (Parents, school,
media, religious beliefs etc)
• How might these attitudes affect how I work with people
with substance use problems?
Effects etc
•
•
•
•
Effects people want
Ones they are not so keen about
The dreaded withdrawal
Effects they might have on Mental
Health
• Myths and legends about users!
Reasons for use
•
•
•
•
•
•
•
•
•
•
•
To feel euphoric or feel nothing
To feel more confident
To work longer hours or enhance performance
To belong to a social group (peer pressure)
To kill time (alleviate boredom)
To alleviate physical pain and other health
problems
Because it is a habit
To satisfy cravings and avoid withdrawal symptoms
For weight loss
To experience an altered state of consciousness
To unwind after a stressful day
Discussion 1
• What have been your experiences of
working with people with dual
diagnosis within your work setting?
•
Think about issues concerning:
– the individual
– the carer
– yourselves
– the service that you work for.
Withdrawal
Working Definition
• Symptoms absent prior to regular / heavy use
• Symptoms are most severe post periods of heavy intake
• Symptoms are usually experienced within one half life of
abrupt cessation or significant reduction of intake
• Symptoms usually disappear in 14 days of cessation
• Symptoms relieved by further substance use
• Symptoms relieved by other substances of the same
pharmacological group
Detoxification
• “The removal of poisons” Concise Oxford
Dictionary
• Detoxification is a process of achieving a drug
free state, usually involving the prescription of a
drug to attenuate withdrawal symptoms
• The aim is to achieve this agreed objective with a
minimum of discomfort to the individual
• At the same time monitoring the individual for
coexisting or complicating conditions.
•
.
•Motivational work
•Needle Exchange
•Maintenance
prescription
•Safer injecting
advice
•Substance
information
•Housing
•Access healthcare
•Bibliotherapy
.
•Motivational work
•Feedback
•Self-Monitoring
Introduce
Conflict
Reduce Harm
Pre-contemplation
Contemplation
Determination
Increase
Motivation
Prepare for
Change
Maintenance
Action
Relapse
Prevention
Behaviour
Change
•Sensitising/Antagonist prescription
•Revisit motivation
•Compare and contrast lifestyles
•Cognitive behavioural coping skills
High risk situations
Coping skills
•Utilising network support
•Detoxification
•Stopping injecting
•Attenuated drinking
•Planning activities
•Detoxification
•Developing social
support
Assessment of
substance use
Slide 16
Introduction to Dual Diagnosis
Objectives
• To recognise own attitudes towards drugs and
alcohol
• To understand the reasons why people use drugs
and alcohol
• To be aware of the legality, effects, routes of use, and
risks of alcohol, cannabis and cocaine
• Begin to understand why people may use them
despite adverse effects on Mental Health and
Physical Health
Dual Diagnosis
Capabilities
• Non-Judgemental Attitude: Be aware of ones own
attitudes and values in relation to dual diagnosis
and be able to suspend judgement when working
with service users, and carers. Challenge others’
attitudes in an appropriate and useful manner.
[Dual Diagnosis Capability 4 level 2
• Education and Health Promotion: Be able to offer
basic but accurate and up to date information and
advice about effects of substances on mental and
physical health and vice versa. [Dual Diagnosis
Capability 8 level 2]
Definitions
• The term “dual diagnosis” is generally
applied to people who have two
disorders
• Combined mental health and substance
use problems
• More than “dual problems”- likely to have
complex health and social needs
• Wide range of people with varying
degrees of need - need individualised
treatment
DUAL DIAGNOSIS
• "Co-existent mental illness and substance
abuse or other disorders“
• Complex often very complex
• Pareto Principle 80/20 (DD in the 20)
• Time consuming
• Frequently undetected, (through fear?)
• Substance use / intoxication / withdrawal
• Precipitate / exacerbate condition
• Usual not exceptional
• DoH - Good Practice Guide 2002
“Mainstreaming”
• DH (2002) Good Practice Guide:
• Doesn’t advocate a separate specialist service for dual
diagnosis
• Mental health services should take primary responsibility
for those with serious mental health problems (like
schizophrenia) and substance use
• Substance use services should take primary responsibility
for those with primary substance problems and common
mental health problems (anxiety, depression)
• However mental health and substance use services
should work together and support each other
Potential or Real Management
Problems
•
Often undetected
•
Often poor compliance with medication
•
Violence and disruption is possible with
intoxication and withdrawal
•
Compromised treatment regimes interactions/selfharm / abuse
•
Is it not just another added complexity and so
should not be ignored or lessened
Mental Health Practitioner v
Substance Use Practitioner
•
•
•
•
Communication skills
Assessment skills
Relationship building and maintenance
Knowledge of health and well being
•
•
•
•
Positive outlook
Encouraging hope in recovery
Empathetic
Holistic view
Exercise 1
•
Ask yourself these questions:
• What attitudes do I have about people who use drugs and
people who use alcohol?
• Where did these attitudes come from? (Parents, school,
media, religious beliefs etc)
• How might these attitudes affect how I work with people
with substance use problems?
Effects etc
•
•
•
•
Effects people want
Ones they are not so keen about
The dreaded withdrawal
Effects they might have on Mental
Health
• Myths and legends about users!
Reasons for use
•
•
•
•
•
•
•
•
•
•
•
To feel euphoric or feel nothing
To feel more confident
To work longer hours or enhance performance
To belong to a social group (peer pressure)
To kill time (alleviate boredom)
To alleviate physical pain and other health
problems
Because it is a habit
To satisfy cravings and avoid withdrawal symptoms
For weight loss
To experience an altered state of consciousness
To unwind after a stressful day
Discussion 1
• What have been your experiences of
working with people with dual
diagnosis within your work setting?
•
Think about issues concerning:
– the individual
– the carer
– yourselves
– the service that you work for.
Withdrawal
Working Definition
• Symptoms absent prior to regular / heavy use
• Symptoms are most severe post periods of heavy intake
• Symptoms are usually experienced within one half life of
abrupt cessation or significant reduction of intake
• Symptoms usually disappear in 14 days of cessation
• Symptoms relieved by further substance use
• Symptoms relieved by other substances of the same
pharmacological group
Detoxification
• “The removal of poisons” Concise Oxford
Dictionary
• Detoxification is a process of achieving a drug
free state, usually involving the prescription of a
drug to attenuate withdrawal symptoms
• The aim is to achieve this agreed objective with a
minimum of discomfort to the individual
• At the same time monitoring the individual for
coexisting or complicating conditions.
•
.
•Motivational work
•Needle Exchange
•Maintenance
prescription
•Safer injecting
advice
•Substance
information
•Housing
•Access healthcare
•Bibliotherapy
.
•Motivational work
•Feedback
•Self-Monitoring
Introduce
Conflict
Reduce Harm
Pre-contemplation
Contemplation
Determination
Increase
Motivation
Prepare for
Change
Maintenance
Action
Relapse
Prevention
Behaviour
Change
•Sensitising/Antagonist prescription
•Revisit motivation
•Compare and contrast lifestyles
•Cognitive behavioural coping skills
High risk situations
Coping skills
•Utilising network support
•Detoxification
•Stopping injecting
•Attenuated drinking
•Planning activities
•Detoxification
•Developing social
support
Assessment of
substance use