Triple Threat: Beyond Mental Health and Substance Abuse Issues

Triple ThreatTriple Threat
Beyond Dual DiagnosisBeyond Dual Diagnosis
• Dr. Louise Stanger
Ed.D. LCSW, CIP
• Director All About
Interventions
• Member NII and AIS
• Faculty SDSU
Interwork Institute
Copyright © Dr. Louise StangerCopyright © Dr. Louise Stanger

Getting To Know YouGetting To Know You
• Hello! Tell your neighbor
about yourself
• What brings you here
today ?
• What do you want to get
out of our time together?

ObjectivesObjectives
• Learn to Identify
multiple issues-
Ecological approach
• Learn how to prioritize
intervention strategies
• Identify therapeutic
interventions

ObjectivesObjectives
• Understand while one
disorder may be
acting out another
one is off in a different
direction
• Discuss triangulation
of data
• Picking the right
treatment center

Which Came First ?Which Came First ?
Substance Abuse
Mental Health
Other –Legal, Physical, Family History

Importance of Family MappingImportance of Family Mapping

Doing a Correct AssessmentDoing a Correct Assessment
for Co-Occurringfor Co-Occurring
• Family History with Triangulation of Data
• Establish period of abstinence (4-6 weeks)
• Establish SA as Primary or Secondary
which came first
• Obtain Longitudinal History

PortraiturePortraiture
• Qualitative evidenced
based research
method
• Assumes we are co-
collaborators
• Use snowball sample
which means we
interview many
people to gain data

Unique Factors for Triple ThreatUnique Factors for Triple Threat
InterventionsInterventions
• Often do not end up in a group meeting
• Can take more then one gathering- can go on
for hours or days even months
• Require an active facilitator
• Can be volatile, may involve courts
• May involve law enforcement
• May involve medical facilities
• Must support family or accountability team
• MUST KNOW TREATMENT CENTERS

Importance of KnowingImportance of Knowing
Mental Health DisordersMental Health Disorders

Personality Disorders +Personality Disorders +
• Avoid Power
Struggles
• Be Direct
• Support Family –
Strong Boundaries
• Compliment
Narcissists
• Confront Boarderline
• MI,CBT, SFT, DBT
,PAUSE

SA-Bipolar and OtherSA-Bipolar and Other
• Mania
• Hypo-Mania
• Depressive Episode
--------------------------------
• Join with client
• Nonthreatening
• Over empathize
• Instill hope go flat as
client escalates
• Educate

Obsessive Compulsive Disorder-Obsessive Compulsive Disorder-
Borderline ++Borderline ++

• Have Patience
• Be Consistent
• Be Understanding
• Indulge OCD
• Direct
• Firm
• Invitational Distract
When Stuck

PTSD and TBIPTSD and TBI’s and other hidden’s and other hidden
—WHAT?—WHAT?

Traumatic Brain InjuryTraumatic Brain Injury

Intervention with Trauma HistoryIntervention with Trauma History
• Be upfront and honest
• No surprises
• Understanding-Attunement-Empathetic
• Educate all about PTSD, TBI etc
• Match client to interventionists or therapist
• Match treatment facility

During InterventionDuring Intervention
• If perpetrator is family member assume others
maybe victims
• Have perpetraor leave intervention or not be
present –this is where individual prescreening
interviews is so important
• Do not let abuse become focus of intervention,
focus on getting help
• Manage anger
• Track all members and ground when necessary

Psychotic-SA and LegalPsychotic-SA and Legal
• Schizophrenia
• Delusional
• Drug Induced
Psychosis
• Paranoia
• Marijuana –Budder
• Methamphetamines
• Alcohol
• Ecstasy
• Hallucinogenic

Intervention strategiesIntervention strategies
• Low stimulation
• May not use group setting
• Monotone voice
• May enter delusional system (need to be
skilled to decide to or not)
• May involve commitment through that is
very hard

Legal CasesLegal Cases
• Make sure to partner with a
knowledgeable attorney
• Use legal as a motivator for long term
change
• Do not use treatment as an escape plan
• Form a straegic partnership
• Role of Admissions Team, Court Liason<
Case Managers impt.

Case StudiesCase Studies
20 somethings -FTL20 somethings -FTL

Intervention StrategiesIntervention Strategies
• Time and More Time
• Create a Firm Fence
• Use the Legal System to Help
• Do not be afraid to invite team members
that are saboteurs to leave
• Patience-Perseverance-Determination
• Flexibility in Approaches

ProfessionalsProfessionals
Drs. ,Lawyers, Nurses, TeachersDrs. ,Lawyers, Nurses, Teachers
Pilots , Fireman , Police OfficersPilots , Fireman , Police Officers

Public FiguresPublic Figures

• Require a different sort of Team
• Employers, Business agents, Personal
Assistants, Fellow Performers,
Administrative Assistants , Hair Dressers,
Stylists
• Treatment Center Confidentiality
• Follow up Care
• At What Price

Older AdultsOlder Adults
• Physical Difficulties
• Loss of Spouse or Partner
• Retirement or Loss of Job
• Loss of Friends
• Isolation
• Change of Environments
• Family Systems
• Spirtuality
• Have you ever checked out the
check out line at CVS, RITE
AID Etc.

• Family Participation-Oh Dad or mom are just too
old to change
• Putting Together the right Team-All the Drs,
clinicians, treatment centers
• Clinicians knowing about normal , non
pathological depression following the death of a
spouse and about aging
• Clinicians knowing about the difference between
divorce and widowers and widows
• Can be effective with team and with one on one

Physical LimitationsPhysical Limitations

It Takes a VillageIt Takes a Village

Evidenced Based ModalitiesEvidenced Based Modalities
• Motivational Interviewing
• 12 Step Facilitation
• CBT
• DBT
• Solution Focused (SFT)
• Acceptance and Attunement
• Being honest and transparent

ResourcesResources
• DSM V
• NAMI
• The Art and Science of Portraiture,
Lawrence-Lightfoot and Davis
• Talking to Strangers, Weiss
• Stop Walking on Egg Shells Workbook ,
Kruger
• Aging and Addiction, Colleran & Jay

ResourcesResources
• Get Your Loved One Sober, Meyers and
Wolfe
• The Object of My Affection is My
Reflection, Coping with Narcissists, Lerner
• Interviewing for Solutions, Dejong & Berg
• Is it Love or is it Addiction, Schaeffer
• The Clinicians Guide to 12 Step, Parker &
Guest

ResourcesResources
• The Psychology of Wealth, Richards, PHD
• Roadmap to Resilience; A Guide for
Military, Trauma Victims and Their
Families, Meichenbaun PHD.
• Crucial Conversations , Patterson,
Grenny, McMillian,Switzler
• Thanks to Jeffrey Merrick Esq. and
Heather Hayes

Triple Threat: Beyond Mental Health and Substance Abuse Issues

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Triple Threat: Beyond Mental Health and Substance Abuse Issues