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Common Issues & Interventions
in the Treatment of
Co-Occurring Disorders
Objectives
~What are Co-occurring Disorders
~Chicken and Egg Dilemma
~Awareness and Mindfulness
~Self-Esteem
~Sleep
~Nutrition
~Depressed and/or Anxious Mood
in the Treatment of
Co-Occurring Disorders
Objectives
~What are Co-occurring Disorders
~Chicken and Egg Dilemma
~Awareness and Mindfulness
~Self-Esteem
~Sleep
~Nutrition
~Depressed and/or Anxious Mood
What are Co-Occurring Disorders
~Any physical or mental health disorder that
~Occurs at the same time as an addiction
~Can cause clinically significant impairment on its own
~Creates a hurdle in the recovery process
~Any physical or mental health disorder that
~Occurs at the same time as an addiction
~Can cause clinically significant impairment on its own
~Creates a hurdle in the recovery process
Chicken and the Egg
~Which to address first—Mental Health or Addiction
~Both! (assuming motivation)
~Addiction (Goal is progress not perfection)
~What are your triggers for use?
~What have you done in the past that has helped you not use?
~What can you do to help yourself stay clean/not use now?
~How can you do that? / How can I help?
~Mental and/or Physical Health Issues
~What MH/PH issues do you have that contribute to your use?
~What can you do that helps make those things less distressing?
~How can you do that? / How can I help?
Awareness
~Most people in early recovery are on autopilot
~The powerlessness to change the situation often prompts disconnection emotionally, mentally, physically and spiritually
~Part of the definition of addiction is experiencing difficulties in multiple areas of life as a result of use which often results in guilt, resentment, depression, grief, negative self-image
~Life is about survival avoiding the intolerable pain
~Which to address first—Mental Health or Addiction
~Both! (assuming motivation)
~Addiction (Goal is progress not perfection)
~What are your triggers for use?
~What have you done in the past that has helped you not use?
~What can you do to help yourself stay clean/not use now?
~How can you do that? / How can I help?
~Mental and/or Physical Health Issues
~What MH/PH issues do you have that contribute to your use?
~What can you do that helps make those things less distressing?
~How can you do that? / How can I help?
Awareness
~Most people in early recovery are on autopilot
~The powerlessness to change the situation often prompts disconnection emotionally, mentally, physically and spiritually
~Part of the definition of addiction is experiencing difficulties in multiple areas of life as a result of use which often results in guilt, resentment, depression, grief, negative self-image
~Life is about survival avoiding the intolerable pain
Awareness –Interventions
~Turn off Autopilot
~Mindfulness
~How I feel right now
~Meeting my needs
~Thoughts Feelings, Urges and Behaviors that keep me unhappy
~Thoughts Feelings, Urges and Behaviors that will help me start changing
Awareness –Interventions
~Purposeful Action Continuum
Awareness –Interventions
~Deal with thoughts and feelings that prevent self awareness
~Guilt (I need to ignore my needs and make up for…)
~Fear (If I tune in, I might get overwhelmed)
~Apathy (What’s the point?)
~Self-Hatred/Negative Internal Voice (Suck it up!)
Self-Esteem
~Low Self Esteem
~Powerless
~Walk the middle path, identifying what you do and do not have control over
~Learn from prior failures
~Create a Success Mantra
~Turn off Autopilot
~Mindfulness
~How I feel right now
~Meeting my needs
~Thoughts Feelings, Urges and Behaviors that keep me unhappy
~Thoughts Feelings, Urges and Behaviors that will help me start changing
Awareness –Interventions
~Purposeful Action Continuum
Awareness –Interventions
~Deal with thoughts and feelings that prevent self awareness
~Guilt (I need to ignore my needs and make up for…)
~Fear (If I tune in, I might get overwhelmed)
~Apathy (What’s the point?)
~Self-Hatred/Negative Internal Voice (Suck it up!)
Self-Esteem
~Low Self Esteem
~Powerless
~Walk the middle path, identifying what you do and do not have control over
~Learn from prior failures
~Create a Success Mantra
Quotes About Success and Failure
~”Failure isn't fatal, but failure to change might be” – John Wooden
~“I have not failed. I've just found 10,000 ways that won't work.” – Thomas A. Edison
~“Success is stumbling from failure to failure with no loss of enthusiasm.” – Winston Churchill
~The only real mistake is the one from which we learn nothing.” – Henry Ford
~“Success is the result of perfection, hard work, learning from failure, loyalty, and persistence.” Colin Powell
~”Failure isn't fatal, but failure to change might be” – John Wooden
~“I have not failed. I've just found 10,000 ways that won't work.” – Thomas A. Edison
~“Success is stumbling from failure to failure with no loss of enthusiasm.” – Winston Churchill
~The only real mistake is the one from which we learn nothing.” – Henry Ford
~“Success is the result of perfection, hard work, learning from failure, loyalty, and persistence.” Colin Powell
Self-Esteem
~Low Self Esteem
~If people do not feel worthy of recovery/happiness, they will not stay motivated for it
~Change the Dialogue
~Undeserving of happiness (refusal to forgive self)
~What would it mean if you forgave yourself?
~What are you afraid will happen?
~What makes someone deserving of happiness?
Self-Esteem
~Low Self Esteem
~If people do not feel worthy of recovery/happiness, they will not stay motivated for it
~Change the Dialogue
~Unlovable or fallible?
~What makes someone lovable?
~Useless/purposeless or undirected?
~What skills/qualities/attributes do you have?
~How can you use those?
Sleep
~Sleep is disrupted by
~Addictions
~Stress/Depression/Anxiety
~Physical Pain
~Poor Nutrition
~Sufficient quality sleep improves
~Focus/Concentration
~Energy
~Hormone levels
~Appetite
~Mood
~Low Self Esteem
~If people do not feel worthy of recovery/happiness, they will not stay motivated for it
~Change the Dialogue
~Undeserving of happiness (refusal to forgive self)
~What would it mean if you forgave yourself?
~What are you afraid will happen?
~What makes someone deserving of happiness?
Self-Esteem
~Low Self Esteem
~If people do not feel worthy of recovery/happiness, they will not stay motivated for it
~Change the Dialogue
~Unlovable or fallible?
~What makes someone lovable?
~Useless/purposeless or undirected?
~What skills/qualities/attributes do you have?
~How can you use those?
Sleep
~Sleep is disrupted by
~Addictions
~Stress/Depression/Anxiety
~Physical Pain
~Poor Nutrition
~Sufficient quality sleep improves
~Focus/Concentration
~Energy
~Hormone levels
~Appetite
~Mood
Sleep
~Interventions
~3-Step sleep routine
~Eliminate caffeine, nicotine and alcohol before bed
~Avoid sleep aids when possible (Medications for the treatment of sleep disorders) as they reduce deep sleep.
~Try guided imagery or at least thinking about something non-stressful
~Address pain, allergy and apnea issues that wake you up
~Interventions
~3-Step sleep routine
~Eliminate caffeine, nicotine and alcohol before bed
~Avoid sleep aids when possible (Medications for the treatment of sleep disorders) as they reduce deep sleep.
~Try guided imagery or at least thinking about something non-stressful
~Address pain, allergy and apnea issues that wake you up
Nutrition
~More than half of the population is meeting or exceeding total grain and total protein foods recommendations
~Grains are refined and not “whole” greatly reducing nutrient value
~Fortified grains do not provide vitamins and minerals in the “natural” most bioavailable ratio
~About three-fourths of the population has an eating pattern that is low in vegetables, fruits, dairy, and oils.
~Potentially causing deficiencies in Vitamin C, calcium and magnesium
~More than half of the population is meeting or exceeding total grain and total protein foods recommendations
~Grains are refined and not “whole” greatly reducing nutrient value
~Fortified grains do not provide vitamins and minerals in the “natural” most bioavailable ratio
~About three-fourths of the population has an eating pattern that is low in vegetables, fruits, dairy, and oils.
~Potentially causing deficiencies in Vitamin C, calcium and magnesium
Nutrition– Water
~Aids on digestion which makes minerals and nutrients more accessible to the body
~Enables your body to excrete waste.
~The brain is approximately 85% water
~Water gives the brain the electrical energy for all brain functions, including thought and memory processes. (Dr. Corinne Allen)
~Water delivers nutrients to the brain and removes toxins.
~If you are 1% dehydrated 5% decrease in cognitive function.
~2 percent% dehydration fuzzy short-term memory, problems with focusing
~Aids on digestion which makes minerals and nutrients more accessible to the body
~Enables your body to excrete waste.
~The brain is approximately 85% water
~Water gives the brain the electrical energy for all brain functions, including thought and memory processes. (Dr. Corinne Allen)
~Water delivers nutrients to the brain and removes toxins.
~If you are 1% dehydrated 5% decrease in cognitive function.
~2 percent% dehydration fuzzy short-term memory, problems with focusing
Mood
~Depression
~Hopelessness
~Complete the sentence… I don’t think there is any hope that…
~For each sentence identify why the person believes there is no hope.
~What would have to change to give him or her hope?
~How can you start to make that happen
~Hope Chest…
~Each day add a card with something that indicates things are going better
Mood
~Depression
~Helplessness
~Nothing I do will change it
~What have other people done?
~What has worked in the past?
~What is keeping that from working now?
~Validate steps already taken
~Identify next steps
~Create successes to increase self-efficacy and empowerment.
Mood
~Depression
~Apathy
~Exhaustion “Sick and tired of being sick and tired”
~Learned helplessness
~Identify bad events
~Determine which parts were uncontrollable
~Explore which parts are, in the present, controllable
Mood
~Anxiety/Worry
~Loss of control
~What do you most worry about being out of control of, and why?
~What parts of that situation are in your control?
~When you have lost control of that before, what happened?
~Inability to cope
~How do you cope
~What are some of the most difficult things you have coped with and how?
Emotional Dysregulation
~Inability to tolerate/handle any more stress
~Prevention
~What stressors can you eliminate
~Who can handle other stressors (bills, picking up kids)
~What are the current stressors you are dealing with
~Put each on an index card (add cards as needed)
~Prioritize (urgency then stressfulness)
~Address one to 3 each week
~Depression
~Hopelessness
~Complete the sentence… I don’t think there is any hope that…
~For each sentence identify why the person believes there is no hope.
~What would have to change to give him or her hope?
~How can you start to make that happen
~Hope Chest…
~Each day add a card with something that indicates things are going better
Mood
~Depression
~Helplessness
~Nothing I do will change it
~What have other people done?
~What has worked in the past?
~What is keeping that from working now?
~Validate steps already taken
~Identify next steps
~Create successes to increase self-efficacy and empowerment.
Mood
~Depression
~Apathy
~Exhaustion “Sick and tired of being sick and tired”
~Learned helplessness
~Identify bad events
~Determine which parts were uncontrollable
~Explore which parts are, in the present, controllable
Mood
~Anxiety/Worry
~Loss of control
~What do you most worry about being out of control of, and why?
~What parts of that situation are in your control?
~When you have lost control of that before, what happened?
~Inability to cope
~How do you cope
~What are some of the most difficult things you have coped with and how?
Emotional Dysregulation
~Inability to tolerate/handle any more stress
~Prevention
~What stressors can you eliminate
~Who can handle other stressors (bills, picking up kids)
~What are the current stressors you are dealing with
~Put each on an index card (add cards as needed)
~Prioritize (urgency then stressfulness)
~Address one to 3 each week
Emotional Dysregulation
~Intervention
~4 things you can do when you get stressed out/angry
~Practice the pause by…
~Distract don’t react by…
~Improve the moment by…
~Turning your attention by…
~What are 3 helpful problem solving skills
~Create a win/win
~Brainstorming
~Focus on the parts in my control
~Intervention
~4 things you can do when you get stressed out/angry
~Practice the pause by…
~Distract don’t react by…
~Improve the moment by…
~Turning your attention by…
~What are 3 helpful problem solving skills
~Create a win/win
~Brainstorming
~Focus on the parts in my control
Interpersonal Issues
~What have this person’s relationships been like?
~What does he/she think a healthy relationship look like?
~What has caused prior relationships to end?
~What can be learned from those relationships?
~What does he/she most need in a best friend and why?
~Which of those characteristics does he/she bring?
Cookie Metaphor
Medications
~Psychotropics for depression or anxiety
~Muscle relaxants or pain medications for pain
~Antagonist or partial agonist medications for addiction
Summary
~People with addictions should be expected to have mood issues
~Addiction isn’t diagnosed until there are multiple problems (which can cause mood issues)
~There are many common themes that can be identified and addressed in early recovery to
~Enhance self esteem
~Empower the client
~Begin creating a resiliency narrative.
~What have this person’s relationships been like?
~What does he/she think a healthy relationship look like?
~What has caused prior relationships to end?
~What can be learned from those relationships?
~What does he/she most need in a best friend and why?
~Which of those characteristics does he/she bring?
Cookie Metaphor
Medications
~Psychotropics for depression or anxiety
~Muscle relaxants or pain medications for pain
~Antagonist or partial agonist medications for addiction
Summary
~People with addictions should be expected to have mood issues
~Addiction isn’t diagnosed until there are multiple problems (which can cause mood issues)
~There are many common themes that can be identified and addressed in early recovery to
~Enhance self esteem
~Empower the client
~Begin creating a resiliency narrative.