3. • Overview of Workwise Series
• IntroductionsWelcome
• Need for this Knowledge
• Overview of Co-Occurring DisordersPresentation
• Preview of next week
• Assign Learning Activity
• Questions
Summary
Agenda
4. Workwise is an online learning series that provides
interactive training and consultation to professionals
delivering behavioral health services on topics essential
to increasing knowledge, building skills, and changing
practice through the adoption of evidence-based and
promising practices.
Workwise uses:
Virtual interactive training through real-time skill-
based learning and practice
Group and self- study activities
Reading assignments
Discussions
Workwise
5. Week Agenda/Topic Assignments DATE
Orientation to Technology Session COMPLETED!
One Welcome/Overview of Workwise Series and of Co-
Occurring Disorders
6/1/19
Two Overview of DEPRESSIVE Disorders 6/12/19
Three A Closer Look at ANXIETY Disorders and TRAUMA 6/19/19
Four Starting to understand PERSONALITY Disorders 6/29/19
Five Integration of BH into SUD treatment 7/3/19
Six Cultural Intelligence and Wrap up 7/101/19
Co-Occurring DO Series
9. The
coexistence of
both a mental
health and a
substance use
disorder is
referred to as a
Co-Occurring
Disorder.
Co-Occurring Disorders
10. Among the 20.2 million adults in the U.S.
who experienced a substance use disorder,
50.5%—10.2 million adults—had a co-
occurring mental illness, according to
Results from the 2014 National Survey on
Drug Use and Health: Mental Health
Findings, NSDUH Series published by
Substance Abuse and Mental Health
Services Administration (SAMHSA).
(Center 2015)
Co-Occurring Stats
12. • New information related to
Special Populations:
• Older adults
• Parents with children
• Those working in safety
sensitive occupations
• Criminal justice settings
• AS WELL AS:
“Incorporation of
the latest
understanding of
Co-Occurring
Disorders
Capability”What’s New in ASAM
Criteria?
13. • Are there current psychiatric illnesses or
psychological, behavioral, emotional or cognitive
problems that need to be addressed?
• Are there chronic conditions that affect treatment
such as bipolar or anxiety?
• Do any emotional, behavioral, or cognitive signs
or symptoms appear to be an expected part of the
addictive disorder?
EMOTIONAL, BEHAVIORAL, OR COGNITIVE
CONDITIONS AND COMPLICATIONS
Dimension 3
14. • Are they severe enough to warrant specific
mental health treatment, even if symptoms
are caused by substance use?
• Is the patient able to manage the activities
of daily living?
• Can he or she cope with any emotional,
behavioral or cognitive problems?
ASAM-Dimension 3 Continued
15. • Dangerousness/Lethality
• Interference with Addiction Recovery
Efforts
• Social Functioning
• Ability for Self-Care
• Course of Illness
Dimension 3 Risk Domains
16. • Is the patient in immediate danger of continued
severe mental health distress and/or alcohol,
tobacco and/or drug use?
• Does the patient have any recognition or
understanding of, or skills in coping with his or
her addictive, co-occurring, or mental disorder?
• Have addiction and/or psychotropic medications
assisted in recovery before?
• What are the person’s skills in coping with
protracted withdrawal, cravings, or impulses?
RELAPSE, CONTINUED USE OR CONTINUED PROBLEM
POTENTIAL
Dimension 5
17. • How well can the patient cope with negative
effects, peer pressure, and stress without
recurrence of addictive thinking and behavior?
• How severe are the problems and further
distress that may continue or reappear if the
patient is not successfully engaged in
treatment?
• How aware is the patient of relapse triggers and
skills to control addiction impulses or impulses
to harm self or others?
Dimension 5 Continued
19. of all deaths in the US
are attributable to
Addictive Substances.-
National Institutes of Health
1/4
20. …of people with a
substance use disorder,
have or have had a
psychiatric disorder.
-Co-occurring disorders program: integrating
combined therapies.-2008 , Hazelden
60-70%
21. …of adults with a
Mental Illness also have
a chronic health
condition
-National Council for Behavioral Health-2013
68%
22. Individuals with addiction and co-
occurring mental illness die, on
average, 37 years earlier than
Americans without severe
addictions and mental health
problems.
(Oregon, 2008)
37 Years…
23. Public program leaders,
health professionals,
advocates and stakeholders
continue to be concerned
with the disproportionately
high loss of life of those with
substance use and/or
mental health disorders.
Efforts are under way to
reduce observed disparities
in mortality.
Initial interventions to modify
behavioral and other risks
have increased life
expectancy by up to five
years.
(Wright, et. All, 1998)
…increased Life Expectancy
by up to 5 years…
24. According to SAMHSA,
the most effective dual
diagnosis regimen treats both
the mental illness and
substance issues
at the same time.
(SAMHSA 2009)
Treatment needs to
go hand in hand…
27. • 47 Years Old
• Involvement in the legal system
• Had children involved in Child
Protection Services in the past
• Diagnosed with Diabetes
• No Primary Care Physician
• Goes to the ER for medical care
• Has had treatment in the past
(MH/SUD/Inpatient and
Outpatient)
• Works as a receptionist currently
and had multiple jobs in the past
10 years
• No Insurance
• Currently no transportationMEET MOLLY
Accessing care for opioid use
28. What Have YOU seen Work?
What is
happening in your
agency,
community or
state that is
moving in a
positive direction
to address co-
occurring
disorders?
29. Depression
Mood Disorders (Bi-Polar DO)
Anxiety and Trauma
Personality Disorders
Suicide Prevention
OTHER DISORDERS OF NOTE:
ADHD
Schizophrenia and other Psychotic DO
LEARN MORE!
Common Mental Health Conditions and
Issues we will be discussing in this series:
37. Read the Article
“Co-Occurring substance use
and mental disorders among
adults with opioid use
disorder”
-
Consider Questions to
Discuss Next Week.
Learning Activity-Week #1
39. • Center for Behavioral Health Statistics and Quality. (2015). Behavioral health trends in the United States:
Results from the 2014 National Survey on Drug Use and Health (HHS Publication No. SMA 15-4927, NSDUH
Series H-50). Retrieved from http://www.samhsa.gov/ data/
• http://www.integration.samhsa.gov/integrated-care-models/integration-infographic
• http://www.drugabuse.gov/related-topics/medical-consequences-drug-abuse/mortality
• http://www.thenationalcouncil.org/topics/addictions
• http://www.integration.samhsa.gov/integrated-care-models/integration-infographic
• https://www.nami.org/NAMI/media/NAMI-Media/Infographics/GeneralMHFacts.pdf
• The ASAM Criteria, Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions, Third
Edition, 2013.
• Oregon Department of Human Services Addiction and Mental Health Division. Measuring premature mortality
among Oregonians. June 2008.
• Strosahl, 1998; Fries, et. al., 1993; Shapiro, et. al., 1985
• Substance Abuse and Mental Health Services Administration. Integrated Treatment for Co-Occurring
Disorders: The Evidence. DHHS Pub. No. SMA-08-4366, Rockville, MD: Center for Mental Health Services,
Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human
Services, 2009.
• Wright, Janice C. and Weinstein, Milton C. Gains in Life Expectancy from Medical Interventions –
Standardizing Data on Outcomes. The New England Journal of Medicine, 339(6):380-386, August 6, 1998.
References:
