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01. Common terms used in concurrent disorders
This section describes three major types of substances:
People who abuse substances regularly and who may experience ongoing serious problems without being dependent on the substance.
Some of these problems are:
• inability to fulfil responsibilities
• dangerous use
• legal problems
• social and family problems
People who are dependent on substances have major physical, mental and behaviour problems that can have serious effects on their lives.
Some of the signs of substance dependence are:
• tolerance
• withdrawal
• time investment
• retreat from usual activities
• ongoing use
If three or more of these problems are ongoing during a 12-month period
Diagnostic criteria involve:
psychological dependence
physical dependence
Most people use the term more broadly to refer to compulsive behaviours, including substance use, that cause problems. People persist with these behaviours in spite of strong negative consequences.
Characterized by:
Co-occurring disorders is another way of describing a situation where someone has one or more mental health disorders and one or more substance use disorders.
Researchers have suggested four types of interaction:
• substance use and mental health problems may be triggered by the same factor
• mental health problems may influence the development of substance use problems
• substance use problems may influence the development of mental health problems
• substance use and mental health problems may not interact
Mental health problems
Substance use problem
Common factor
As the biopsychosoical model suggests, the causes of addictive behaviours are complex, and can include the following:
BIOLOGICAL FACTORS
SOCIAL
FACTORS
Psychological
FACTORS
Most integrated programs have been developed for clients who have severe mental health problems. They have common features including:
The treatment provider investigates how the substance use and mental health problems interact.
During an assessment, people are often asked to discuss things such as:
• why they have come for help, what kind of help they are looking for and what has helped in the past
• general life problems, troubling thoughts or feelings, substance use problems, as well as how long problems have lasted
• whether they have experienced or seen violence (e.g., physical or sexual assault, war), even if it occurred years before
• whether there is a history of substance use or mental health problems in their family
• what their life is like (e.g., how they feel, what they think, how they sleep, if they exercise
and socialize, how they do at school or work, how their relationships with friends and family are)
Group and individual sessions guided by the Stages of Change model and Health Canada Best Practices for the treatment of Concurrent Disorders interventions operate within a harm reduction approach and trauma informed care perspective.
Treatment approaches includ:
cognitive behavioural therapy
dialectical behavioural therapy strategies
structured relapse prevention
motivational interviewing
Cognitive-behavioural therapy (CBT) is based on the theory that thoughts have an
important influence on how people behave. Therapists help people to identify unhelpful
thoughts and behaviours and learn healthier skills and habits.
In DBT, people look at how their background and their life experience affect how they control their emotions. It teaches clients how to:
• become more aware of their thoughts and actions (“mindfulness”
• tolerate distres
• manage their emotion
• get better at communicating with other
• improve their relationships with other peopl
Structured Relapse Prevention (SRP) uses a cognitive-behavioural approach to help
people with moderate to severe problems gain more control over their use of alcohol
and other drugs.
Motivational approaches are also useful in encouraging people to identify their goals, and in building hope and commitment to change and recovery.
Motivational approaches use the client’s perspective on his or her mental health and substance use problems as the starting point for treatment.
The long-term objective is to help the client set goals and recognize that his or her current lifestyle interferes with achieving these goals.
Psychoeducation
Development of Coping Skills and Strategies
Goal planning
Relapse Prevention
Referral to community agencies
Family education
Treatment strategies include:
• withdrawal management
• substitution therapy
• antagonist therapy
• aversive therapy
The main objective in the pharmacological treatment of drug withdrawal is to prevent severe complications, particularly seizures in the case of some drugs (e.g., alcohol, barbiturates, benzodiazepines) that can happen when people stop using substances.
In substitution therapy, the substance of abuse is replaced with a medication that is less likely to be abused.
Substituting methadone, a synthetic opioid, for heroin is one example of substitution therapy.
Antagonist therapy blocks the effects of opioids. For example, naltrexone (ReVia) is sometimes used to block the effects of alcohol and opioids. It is used to help maintain abstinence following withdrawal from these substances.
A medication is prescribed that will cause unpleasant side-effects if substances are also used and
discourages use of the substance.
Disulfiram (formerly marketed under the trade name Antabuse) is an example of aversive therapy to discourage alcohol use.
The symptoms that result when disulfiram is combined with alcohol include:
• nausea and dry mouth
• flushing, sweating, throbbing head and palpitations.
A relapse occurs when a person in recovery re-experiences problems or symptoms associated
with his or her disorders.
With substance use disorders, a relapse means a return to problem substance use after a period of abstinence or controlled use.
With mental health disorders, a relapse is a flare-up of symptoms that are associated with the disorder.
A relapse of one disorder can sometimes trigger relapse of the other.
“Relapse means failure”
“Relapse can’t be prevented”