Chapter 8 discusses substance misuse with a co-occurring mental disorder or disability. I found an article that investigates the difficulty of integrating mental health and addiction services. However, it theorizes that the ASAM (American Society for Addiction Medicine) and its criteria can help alleviate this mind-numbing issue.ASAM believes that the easiest way to treat co-occurring disorders is the "seamless integration of
psychiatric and substance abuse interventions in order to form a cohesive, unitary system of care" (Mee-Lee, 2012). In regards to the clinicians that are dealing with the cases, the ASAM believe that both mental illness and the treatment of addiction need to be dealt with hand in hand. Furthermore, they advise that it be done by the same clinician in the same organization as an attempt to eliminate any gaps in treatment, medication, or counseling (Mee-Lee, 2012).
With this, though, there are numerous methods and ideologies in theory and treatment methodologies. The article outlines fives:
1. Addiction System vs. Mental Health System
2. Integrated Treatment vs. Parallel Treatment
3. Care vs. Confrontation
4. Abstinence-oriented vs. Abstinence-mandated
5. Deinstitutionalization vs. Recovery and Rehabilitation
These provide different methodologies and ideologies in regards to the different theories on how to effectively treat a patient. However, the ASAM has come up with six assessment dimensions that are used to focus assessment and treatment.
1. Acute Intoxication and/or Withdrawal Potential
- This assesses for intoxication and/or withdrawal management. It helps to create a treatment plan to detox the patient.
2. Biomedical Conditions and Complications
- This looks to assess any other biological conditions that could hinder treatment.
3. Emotional, Behavioral, or Cognitive Conditions and Complications
- Just as the biomedical assessment does, this assesses emotional, behavioral or cognitive issues that could hinder treatment.
4. Readiness to Change
- This assesses the clients readiness to change and be re-integrated into a functioning member of society.
5. Relapse, Continued Use or Continued Problem Potential
- Assesses the probability that the client ends up back where they started.
6. Recovery Environment
- Assesses the clients needs for a good recovery environment. Includes financial, family and social factors.
The goals of the ASAM is boiled down to the five M's. They want to motivate, manage, medicate, meet, and monitor their clients to better help them in the ongoing struggle with their multiple disorders.
While the article also discusses programs that cannot help co-occurring disorders like the AOS and MHOS, they give examples of programs that are set up for dual-disorders like DDC (Dual Diagnosis Capable) programs and the DDE (Dual Diagnosis Enhanced) programs. These programs look to attack all disorders in a manner in which that can get the client back to a healthy lifestyle. These have began to gain more popularity as increased percentages of co-occurring disorders have risen.
I believe this ties in heavily to the reading we had to do for Chapter 8. It provides a face to the literature. It's good to see that there are programs out there (like the DDC and DDE) that are structured in such a way that can help people with co-occurring disorders integrate back into society. I believe the ASAM provides a strong and feasible way to treat co-occurring disorders and provide an effective way to integrate people back into society.
The strongest portion of this article I thought was the six dimensions. It provides a well-rounded plan. I believe it covers all the bases and allows the clinician to stay on top of a rather difficult and mind-boggling issue. Overall, I really enjoyed this article and was pleased to see that help is out there for people struggling with co-occurring disorders.
REFERENCES:
Mee-Lee, D. Why integrating mental health and addiction services is hard to do and how the ASAM criteria help. The Change Companies. Yakima, WA. 8 October, 2012.
