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Removing Barriers: Dual Diagnosis Treatment and Motivational Interviewing. Kathleen Sciacca

Removing Barriers: Dual Diagnosis Treatment and Motivational Interviewing. Kathleen Sciacca

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This article written by Kathleen Sciacca, provides an overview of co-occurring mental illness and substance disorders and the issues regarding services and treatment needs.
Dual diagnosis treatment, the Sciacca model is compared with Motivatinal interviewing (Miller & Rollnick). Both models are based upon similar premises for service provision;
each model represents clear departures from traditional substance abuse services; each model provides the practitioner with a different skill set.
An important element is that each of these models evolved from different service systems,
Dual Diagnosis treatment evolved from the mental health system and Motivational interviewing evolved from the chemical dependency system, yet they arrived at the same place. This is an important factor for cross-training mental health and substance abuse treatment providers.
Each model evolves around a process of incremental change.
The Stages of Change and the Sciacca readiness scales are included.
This article written by Kathleen Sciacca, provides an overview of co-occurring mental illness and substance disorders and the issues regarding services and treatment needs.
Dual diagnosis treatment, the Sciacca model is compared with Motivatinal interviewing (Miller & Rollnick). Both models are based upon similar premises for service provision;
each model represents clear departures from traditional substance abuse services; each model provides the practitioner with a different skill set.
An important element is that each of these models evolved from different service systems,
Dual Diagnosis treatment evolved from the mental health system and Motivational interviewing evolved from the chemical dependency system, yet they arrived at the same place. This is an important factor for cross-training mental health and substance abuse treatment providers.
Each model evolves around a process of incremental change.
The Stages of Change and the Sciacca readiness scales are included.

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05/10/2014

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Sciacca, K. 1997. Removing barriers: dual diagnosis and motivationalinterviewing.
Professional Counselor 
12(1): 41-6. Reprinted withpermission from Health Communications, publisher of
Counselor 
(formerly
Professional Counselor 
), www.counselormagazine.com. All rights reserved.
 
"Removing Barriers: Dual Diagnosis Treatment and MotivationalInterviewing"
 
In the past, traditional treatment methods for drug addiction and alcoholism have beencharacteristically intense and confrontational. They are designed to break down a client’s denial,defenses, and/or resistance to his or her addictive disorders, as they are perceived by the provider. Admissions criteria to substance abuse treatment programs usually require abstinencefrom all illicit substances. Potential clients are expected to have some awareness of the problemscaused by substance abuse and be motivated to receive treatment.In contrast, traditional treatment methods for mental illness have been supportive, benignand non-threatening. They are designed to maintain the client's already-fragile defenses. Clientsentering the mental health system are generally not seeking treatment for their substance abuse problems. Frequently clients within the mental health system who actively abuse drugs andalcohol are not formally identified. If they are, they do not admit to such substance use.As some attention began to focus on clients with both substance abuse problems andmental illnesses, it quickly became apparent that new methods and interventions were necessary.Working with dual disorder clients who deny substance abuse, who are unmotivated for substance abuse treatment, and who are unable to tolerate intense confrontation, required a newmodel, a non-confrontational approach to the engagement and treatment of this special population. I first developed such a treatment model in 1984, with the goal of providingnonjudgmental acceptance of all symptoms and experiences related to both mental illness andsubstance disorders.
A brief history
 
Such treatment interventions and integrated programs -- which truly adapted to the needsof severely mentally ill chemical abusers -- had their genesis in 1984 at a New York stateoutpatient psychiatric facility. In 1985, these integrated treatment programs were implementedacross multiple program sites. Concurrently, treatment and program elements were taughtthrough training seminars in New York as well as nationally.In September 1986, the New York State Commission on Quality of Care (CQC) releasedthe findings of 18 months of research. In their report, they described the detachment anddownward spiral of dually diagnosed consumers, who were bounced among different systemswith "no definitive locus of responsibility." As a result, New York’s governor designated thestate Office of Mental Health as the lead agency responsible for coordinating collective effortsfor this population. The commission visited the dual diagnosis programs developed in 1984, anddeclared the treatment interventions, the training, and integrated programs to be positivesolutions to the dilemma.
 
When a 1987
Time
magazine investigation of these programs revealed that at least 50 percent of the 1.5 million to 2 million Americans with severe mental illness abuse illicit drugs or alcohol -- as compared to 15 percent of the general population -- the "doubly troubled" were brought to the attention of the general public.A gubernatorial task force declared its vision for statewide program development and atraining site for program and staff development in the treatment of mentally ill chemical abuserswas created to attain that vision. Short-term and on-going training and program development was provided to hundreds of New York’s treatment providers at both state and local mental healthand substance abuse agencies. Consumer-led and family-support programs were also developed.The state produced a training video that demonstrated the integrated treatment model, however,the training site closed in 1990 due to budgetary considerations. Programs and groups that grewout of this model continue to be an important nucleus of current services in New York andnationally.These treatment interventions evolved in adaptation to the needs of the dual diagnosisclients. Methods and philosophies clearly differed from traditional substance abuse treatment.Consumers who were actively abusing substances, physically addicted, unstable, andunmotivated, were engaged through a "non-confrontational" approach to denial and resistance,and acceptance of all symptoms. Consumers participated in treatment groups without pressure toself-disclose, and explored topics from their own perspectives. Subsequent providers either learned from this model, or came upon similar processes through their own experimentation.
How it works
 
The phase-by-phase interventions from "denial" to "abstinence" begin by assessing theclient's readiness to engage in treatment. Readiness levels are accepted as starting points for treatment, rather than points of confrontation or criteria for elimination. Mental health andsubstance abuse programs who integrate these programs, implement screening forms to identifyclients who have dual disorders.Identified clients are followed up for engagement and assessment of readiness. Clientsare encouraged to participate in dual diagnosis treatment even if they do not accept or agree tothe presence of a substance disorder. Clients may participate on the basis of their interest inlearning more about mental health and substance disorders, or with the belief that they may beable to lend support to others who are seeking help, among other reasons. The process then proceeds from identification to the engagement phase.The objective in the engagement phase is to develop comfortable and trustingrelationships and, if possible, to expose the client to information about the etiology and processesof these illnesses in an empathic and educational manner. The client is given the opportunity tocritique the information presented, rather than being told about any particular fact. Interactioneffects between symptoms of mental illness and substance disorders are also included in thisexploration. Clients at this phase are not required to disclose personal experiences or to admitthey use or abuse substances until they are comfortable doing so.The inclusion of educational materials and discussion topics allows for discussion of theissues and impersonal participation. Clients are encouraged to move along a continuum from“exploration” to “acknowledgment” of their symptoms. This includes:
*
attaining a level of trust necessary to discuss their own use of substances and/or symptoms of mental illness;
*
the exploration and subsequent discovery of any problems or interaction affects that
 
result from substance use and mental health symptoms;* considerations and motivation for addressing these problems;
*
active engagement in a process of treatment that seeks to eliminate symptoms;
*
attainment of partial or full remission;
*
and participation in an individualized maintenance regime for relapse prevention.These programs are implemented as components of existing mental health, and substanceabuse programs, and thereby provide integrated treatment.Materials developed for the implementation of this treatment process includescreening instruments, with separate instruments used for detecting substance abuse among persons who are known to have a mental illness, and detecting mental illness among those persons who are known to have substance abuse/dependence.The pre-group interview provides engagement strategies and a scale to indicate theclient's level of readiness or motivation to participate in treatment. The comprehensiveassessment reviews past and present mental illness, substance abuse, and interaction effects.Forms for progress reviews and updates include criteria necessary to measure change throughoutthe phases of movement toward readiness for treatment, active treatment, and relapse prevention.Forms for data collection include programmatic information regarding statistics, client participation, and outcome. See Figure one.
Figure 1: Sciacca Treatment Model for Dual Diagnosis* 
 
Program Form/Intervention
 
 
Process and Outcome
1. Screening: Mental health,dual disorders, DD CAGE,substance abuse, MISF.Identification of potentialdual diagnosis clients.2. Pre-group interview andreadiness scale. Engagement.a. Engagement into grouptreatment;b. Assessment of readinesslevel (1-5).3. Continuation of engagement(when applicable).Client requires engagementbeyond pre-group interview.4. Provide group treatment. Phase 1: Client does notdisclose personal situation,participates in discussions oreducational materials/topics,develops trust.5. Complete monthly data formfor each group.6. Administer comprehensiveassessment (phase two):Phase 2:a. Client discusses own

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The next "Motivational Interviewing, Preparing People for Change: Theory & Skill Building Training Seminar" will be held on October 27, 28 & 29, 2014, in New York City. Details: http://users.erols.com/ksciacca/MIann... Includes Stages of Change, CBT and ample experiential practice in MI core skills and strategies. Registration is open to 30 participants. Please announce.
The next "Motivational Interviewing, Preparing People for Change: Theory and Skill Building Training Seminar" will be held on March 17, 18 & 19, 2014, in New York City. Details: http://users.erols.com/ksciacca/MIann... Course includes the Stages of Change, pertinent CBT interventions and ample experiential practice. Registration is open to 30 participants. Please announce.
The next "Motivational Interviewing, Preparing People for Change: Theory and Skill Building Training Seminar" will be held on October 28, 29 & 30, 2013, in New York City. Details: http://users.erols.com/ksciacca/MIann... Course includes the Stages of Change, pertinent Cognitive Behavioral Therapy interventions and ample experiential practice. Registration is open to 30 participants. Please announc
Learn more about the practice of client-centered - motivational interviewing communication skills. Free training videos - 5 video clips Motivational Interviewing in Psychiatry and Mental health: https://www.youtube.com/user/expand17 Include skills, strategy, technique, examples and more. Also 6 video clips Motivational Interviewing in Primary Health Care. Please pass this link along to others
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The next "Motivational Interviewing, Preparing People for Change: Theory and Skills Building Training Seminar" will be held on March 18, 19 & 20, 2013 in NYC. Registration is open - Complete details at: http://users.erols.com/ksciacca/MIann... Please announce.
The next "Motivational Interviewing, Preparing People for Change: Theory and Skills Building Training Seminar" will be held on March 18, 19 & 20, 2013 in NYC. Registration is open - Complete details at: http://users.erols.com/ksciacca/MIann... Please announce.
The next Motivational Interviewing, Preparing People for Change: Theory and Skill Building Training Seminar - will be held on October 29, 30 & 31, 2012 in New York City. Complete details at: http://users.erols.com/ksciacca/MIann...
For six video clips on Introduction to Motivational Interviewing in Health Care go to: https://www.youtube.com/user/expand17 Please pass this link along to others who may be interested.

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