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Dual Diagnosis Treatment and Motivational Interviewing for Co-occurring Disorders" Kathleen Sciacca

Dual Diagnosis Treatment and Motivational Interviewing for Co-occurring Disorders" Kathleen Sciacca

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This article details the implementation of integrated treatment for dual diagnosis into existing programs. It reviews a state-wide program development initiative that included both program implementation and refining infrastructure simultaneously. The article then goes on to detail treatment interventions that include and integration of dual diagnosis best practices, motivational interviewing and the stages of change.
The treatment approach is relevant to both individual and group work.
This article details the implementation of integrated treatment for dual diagnosis into existing programs. It reviews a state-wide program development initiative that included both program implementation and refining infrastructure simultaneously. The article then goes on to detail treatment interventions that include and integration of dual diagnosis best practices, motivational interviewing and the stages of change.
The treatment approach is relevant to both individual and group work.

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05/11/2014

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2007, Volume 2
Treating AddictionDisorders
 A quarterly publication from the National Council forCommunity Behavioral Healthcare 
www.TheNationalCouncil.org 
 AddictionsTreatment:Still Limited AfterAll These Years AddictionsTreatmentPays
Linda Rosenberg sayswe can win the fightforparityonlyif theaddictionsand mental health advocacycommunitiesfighttogether.
 page 1
Steve Belenko demonstrateshowaddictionstreatment  yieldsneteconomicbenefitsto society 
 page 3
Healthy Minds.StrongCommunities.
Dual DiagnosisTreatmentandMotivational Interviewing
Kathleen Sciacca explorescollaborative treatmentinterventionsthat concurwith the client’sreadinesslevel.
 page 22
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A G A Z I N E
 
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/
NATIONALCOUNCILMAGAZINE
2007
VOLUME 2
Precontemplation Contemplation Preparation Action
A“simultaneousapproach” thataddressesthe “how to do it” elementsconcurrentlywith the systemicguidelines, ismosteffective in implement-ing integrated servicesforco-occurring mental illnessand addictiondisorders. Thisapproachhelpsparticipation branch outbeyond smallpilotgroupsinto broadercommunitiesand statewide arenas.The simultaneousapproach isquite differentfrom the traditionalsequential approach, which focuseson systemsorinfrastructure elementswhile program implementation, staffdevelopment, and serviceprovisionelementsare hardlyaddressed. Service implementation frequentlygetscouched in discussionsofchartersand guidelinesand isoftenexperienced ascomplex, laborious, and abstract. Thisapproach can betime-consuming, wasteful, and delaytreatmentand services. Itisusuallylimited to a small numberofparticipants.
Implementing a SimultaneousApproach
To successfullyimplementa co-occurring program track, the following elementsare necessary• Ascreening tool.An empathicengagementstrategythatrecognizesclient’sreadiness.• Interventionsthatare stage and phase specific.• Aco-occurring clinical assessment.• Outcome measure.• Program implementation tracking.
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• Staffdevelopmentand training thatresultsin participant’slearning “how to” provide servicesand intervention.
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The materialsand protocolsforimplementing integrated, co-occurrinservicesare readilyavailable and include effective approachessuch asbestpracticesdual diagnosistreatmentand evidence-based motiva-tional interviewing interventionsthatare clear, learnable, and have beenpracticed formore than 20 years.An outstanding example isthe State ofGeorgia, which, forthe pastfiveyears, hasimplemented dual diagnosisprogramsacrosssystemsin aclear, concise waywhile continuing to refine itsinfrastructure.
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The state’sgoal isto make everystate-affiliated program capable ofaddressinco-occurring disorders. Everyyear, a seriesoftraining seminarsandintensive program implementation groupsare offered atnumeroustimesformanagersand directcare providers. Each intensive training and tech-nical supportgroup focuseson program implementation acrosssystemsand programs, includesdual diagnosistreatmentand motivational inter-viewing, and yieldsatleast16 new dual diagnosisprograms.
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Dual Diagnosisand Motivational Interviewing Interventions
The dual diagnosismodel described here originated in 1984 in the mentalhealth field
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and setprecedentsforinterventionsthatfollowed.Motivational interviewing also evolved in the 1980s, butfrom theaddictionsfield.
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Both modelsemploysimilarapproachesyetofferseparate setsofskills.Dual diagnosisand motivational interviewing 
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employacceptance,nonconfrontation, and recognition ofclient’sreadinesslevels, andassesschange incrementally. Building rapport, respect, trust, and safetyin groupsand individual interactionsisparamount. In contrastto thesymptom-focused medical model, these modelsemployinterventionsthatconnectto individualsand strive to understand theirthoughts,feelings, struggles, aspirations, and disappointments. Providersserve asempathicallieswhile working toward facilitating thorough exploration of an issue.These modelsdepartfrom traditional mental health and addictionsprogramsthatview clientswho enterservicesas“action” readyandquicklyforge an action plan. Dual diagnosisand motivational interview-ing engage clientsattheirvariouslevelsofreadinessto change. Eachmodel initiallyemployed a wayto determine clients’ level ofreadinesstochange. Motivational interviewing cited the StagesofChange
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asanincremental processofchange. Dual diagnosisdeveloped a ReadinessScale,
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which isdescriptive, numerical, and a phase-by-phase treatmentmodel thatdefinesa client’smovementalong the continuum ofchange.The stages, phases, and numerical descriptorscorrelate and provide acrosscheckwhen theyare used in combination. These stage and phasemodelsare recommended asbestpracticesforco-occurring disordersbythe Substance Abuse and Mental Health ServicesAdministration.
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Combined InterventionsAlong the Continuum ofChange 
Clients’ readinesslevel providesthe explanation fortheirattitudetoward change and ridsprovidersofnegative interpretationssuch asthe“uncooperative” or“resistant” client. Interventionsconcurwith theclient’sreadinesslevel. Dual diagnosisand motivational interviewing modelsare empathic, collaborative, and strategic. Providersremainconnected and follow along with the client(client-centered) whilesimultaneouslyemploying directive strategiesto facilitate clients’movementalong the continuum ofchange. The processofmovementthrough stagesand phasesisnonlinear; clientsmaymove backtoearlierstagesand stagesmayoverlap.
Dual DiagnosisTreatmentand Motivational Interviewing forCo-occurring Disorders
Kathleen Sciacca, MA, Consultant, Executive Director, Sciacca Comprehensive Service DevelopmentforMental Illness, Drug Addiction and Alcoholism
Dual diagnosisand motivational interviewing interventionsmatch stagesin the client’sreadiness
Continued on page 23

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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: 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 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 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.
Rescheduled. Motivational Interviewing, Preparing People for Change: Theory and Skill Building Training Seminar - NEW DATES: December 3, 4 & 5, 2012, NYC. Complete Details: http://users.erols.com/ksciacca/MIann... There are spaces available and registration is open for the December dates. The October MI training seminar has been rescheduled due to the hurricane.
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