Strategies For Working With People Who Have Co-Occurring Disorders

Key Concepts

• Building a positive therapeutic alliance is a cornerstone of effective, high-quality, person-centered care for all clients, especially those with co-occurring disorders (CODs). Clients with CODs often experience stigma, mistrust, and low treatment engagement.

• CODs are complex and are associated with certain clinical challenges that, if unaddressed, can compromise the counselor-client relationship and impinge on quality of care, potentially leading to suboptimal outcomes.

• Strategies and approaches like empathic support, motivational enhancement, relapse prevention techniques, and skill building help strengthen clients’ ability to succeed and make long-term recovery more likely.

• Certain mental disorders are complex, chronic, and difficult to treat, including major depressive disorder (MDD), anxiety disorders, posttraumatic stress disorder (PTSD), and serious mental illness (SMI*). Clients with these disorders may have unique symptoms and limitations in function.

  
  

Empirically based substance use disorder (SUD) treatment approaches can help counselors address these unique symptoms and functional limitations in ways that will minimize their potential to disrupt the therapeutic relationship and impede positive treatment outcomes.

* Serious Mental Illness (SMI): A diagnosable mental, behavioral, or emotional disorder (other than developmental disorders or SUDs) that persists long enough to meet diagnostic criteria and that causes functional impairment sufficient to substantially disrupt major life activities (Substance Abuse and Mental Health Services Administration [SAMHSA], 2017).

Other Treatment Considerations

Opioid agonist treatment has been shown to be an effective treatment for heroin and opioid addiction. Suboxone, Naltrexone, or a formulation that requires only monthly administration by injection has helped address the problem of patients with major urges to use opioids. Other treatments, such as Vivitrol, are available to assist patients withdrawing from alcohol use.

Based on previous results of studies concerning treatment dropout, practice guidelines recommend offering a variety of psychosocial treatment services to patients entering opioid agonist treatment.

Examples of other treatment services include intensive group outpatient treatment, group outpatient treatment, and individual outpatient services. As with many patients, they may need case management services to assist them with gaining resources helpful in stabilizing their home and family life.

Treatment Interventions For Co-Occurring Disorders

• Cognitive-Behavioral Therapy assists patients in finding new pathways to understand their negative thinking patterns and begin replacing them with positive thinking skills.

• Mindfulness Meditation helps patients focus fully on their breathing. The patient can notice their thoughts without judgment or frustration. This facilitates their ability to make negative thinking less impactful, reducing stress and heart rate.

• Stress management skill building empowers patients to calm themselves, decompress from a stressful day, and improve their overall health.

• Accentuating positive thinking skills assists patients in healing from negative emotions, generating positive emotions, cultivating a positive attitude, and gaining self-awareness without judgment.

In Summary

The thought-mood connection underlies psychological stress, anxiety, mood disorders, substance use disorders, challenging interpersonal relationships, and the experience of gaining peace and positive emotions without having to use substances to cope with everyday life experiences.

If you suspect you may be struggling with co-occurring disorders or any substance or mental health challenges, remember you’re not alone. Prompt intervention is key, and with the right support, all people can develop healthy living and build fulfilling relationships. Consider scheduling an assessment with a qualified substance use and mental health professional today. They can help you understand your unique needs and develop a treatment plan to promote healing and growth.