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Triple Threat: Beyond Mental Health and Substance Abuse Issues

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As a seasoned interventionist, I’ve seen clients from both sides of the mental illness/substance abuse spectrum as well as clients with an avalanche of additional problems that I describe as the TRIPLE THREAT, those who suffer from a tertiary issue either as a result of a prior condition (i.e. disorder or illness) or that one that is exacerbated by additional factors (i.e. physical, legal, traumatic, etc.). These folks and their families present a diagnostic quandary with their kaleidoscope of competing and equally important issues.

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Triple Threat: Beyond Mental Health and Substance Abuse Issues

  1. 1. 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
  2. 2. 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? Copyright © Dr. Louise StangerCopyright © Dr. Louise Stanger
  3. 3. ObjectivesObjectives • Learn to Identify multiple issues- Ecological approach • Learn how to prioritize intervention strategies • Identify therapeutic interventions Copyright © Dr. Louise StangerCopyright © Dr. Louise Stanger
  4. 4. 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 Copyright © Dr. Louise StangerCopyright © Dr. Louise Stanger
  5. 5. Which Came First ?Which Came First ? Substance Abuse Mental Health Other –Legal, Physical, Family History Copyright © Dr. Louise StangerCopyright © Dr. Louise Stanger
  6. 6. Importance of Family MappingImportance of Family Mapping Copyright © Dr. Louise StangerCopyright © Dr. Louise Stanger
  7. 7. 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 Copyright © Dr. Louise StangerCopyright © Dr. Louise Stanger
  8. 8. PortraiturePortraiture • Qualitative evidenced based research method • Assumes we are co- collaborators • Use snowball sample which means we interview many people to gain data Copyright © Dr. Louise StangerCopyright © Dr. Louise Stanger
  9. 9. 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 Copyright © Dr. Louise StangerCopyright © Dr. Louise Stanger
  10. 10. Importance of KnowingImportance of Knowing Mental Health DisordersMental Health Disorders Copyright © Dr. Louise StangerCopyright © Dr. Louise Stanger
  11. 11. InterventionsInterventions Personality Disorders +Personality Disorders + • Avoid Power Struggles • Be Direct • Support Family – Strong Boundaries • Compliment Narcissists • Confront Boarderline • MI,CBT, SFT, DBT ,PAUSE Copyright © Dr. Louise StangerCopyright © Dr. Louise Stanger
  12. 12. 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 Copyright © Dr. Louise StangerCopyright © Dr. Louise Stanger
  13. 13. Obsessive Compulsive Disorder-Obsessive Compulsive Disorder- Borderline ++Borderline ++ Copyright © Dr. Louise StangerCopyright © Dr. Louise Stanger
  14. 14. InterventionsInterventions • Have Patience • Be Consistent • Be Understanding • Indulge OCD • Direct • Firm • Invitational Distract When Stuck Copyright © Dr. Louise StangerCopyright © Dr. Louise Stanger
  15. 15. PTSD and TBIPTSD and TBI’s and other hidden’s and other hidden —WHAT?—WHAT? Copyright © Dr. Louise StangerCopyright © Dr. Louise Stanger
  16. 16. Traumatic Brain InjuryTraumatic Brain Injury Copyright © Dr. Louise StangerCopyright © Dr. Louise Stanger
  17. 17. 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 Copyright © Dr. Louise StangerCopyright © Dr. Louise Stanger
  18. 18. 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 Copyright © Dr. Louise StangerCopyright © Dr. Louise Stanger
  19. 19. Psychotic-SA and LegalPsychotic-SA and Legal • Schizophrenia • Delusional • Drug Induced Psychosis • Paranoia • Marijuana –Budder • Methamphetamines • Alcohol • Ecstasy • Hallucinogenic Copyright © Dr. Louise StangerCopyright © Dr. Louise Stanger
  20. 20. 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 Copyright © Dr. Louise StangerCopyright © Dr. Louise Stanger
  21. 21. 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. Copyright © Dr. Louise StangerCopyright © Dr. Louise Stanger
  22. 22. Case StudiesCase Studies 20 somethings -FTL20 somethings -FTL Copyright © Dr. Louise StangerCopyright © Dr. Louise Stanger
  23. 23. 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 Copyright © Dr. Louise StangerCopyright © Dr. Louise Stanger
  24. 24. ProfessionalsProfessionals Drs. ,Lawyers, Nurses, TeachersDrs. ,Lawyers, Nurses, Teachers Pilots , Fireman , Police OfficersPilots , Fireman , Police Officers Copyright © Dr. Louise StangerCopyright © Dr. Louise Stanger
  25. 25. Public FiguresPublic Figures Copyright © Dr. Louise StangerCopyright © Dr. Louise Stanger
  26. 26. Intervention StrategiesIntervention Strategies • 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 Copyright © Dr. Louise StangerCopyright © Dr. Louise Stanger
  27. 27. 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. Copyright © Dr. Louise StangerCopyright © Dr. Louise Stanger
  28. 28. Intervention StrategiesIntervention Strategies • 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 Copyright © Dr. Louise StangerCopyright © Dr. Louise Stanger
  29. 29. Physical LimitationsPhysical Limitations Copyright © Dr. Louise StangerCopyright © Dr. Louise Stanger
  30. 30. It Takes a VillageIt Takes a Village Copyright © Dr. Louise StangerCopyright © Dr. Louise Stanger
  31. 31. Evidenced Based ModalitiesEvidenced Based Modalities • Motivational Interviewing • 12 Step Facilitation • CBT • DBT • Solution Focused (SFT) • Acceptance and Attunement • Being honest and transparent Copyright © Dr. Louise StangerCopyright © Dr. Louise Stanger
  32. 32. 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 Copyright © Dr. Louise StangerCopyright © Dr. Louise Stanger
  33. 33. 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 Copyright © Dr. Louise StangerCopyright © Dr. Louise Stanger
  34. 34. 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 Copyright © Dr. Louise StangerCopyright © Dr. Louise Stanger

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