Co-Occurring Disorder Treatment with People Involved in the Criminal Justice

SystemPresented byCenter for Evidence Based Practices at Case/Ohio Substance Abuse and Mental IllnessCoordinating Center of Excellencethe Ohio SAMI CCOE is a partnership between the Mandel School of Applied Social Sciences and the Department of Psychiatry, CWRU School of Medicine, Case Western Reserve University in collaboration with the Ohio Departments of Mental Health and Alcohol Dependence and Addiction Services

www.centerforebp.case.edu

Why focus on Co-Occurring Disorders?

• Substance use disorders are common in people with severe mental illness

• Mental illness is common in people with substance use disorders

• Co-occurring disorders lead to worse outcomes and higher costs than single disorders

Co-Occurring Disorders lead to worse outcomes than single disorders

• Relapse of mental illness• Treatment problems and hospitalization • Violence, victimization, and suicidal behavior• Homelessness and Incarceration• Medical problems, HIV & Hepatitis risk behaviors

and infection• Family problems• Increase service use and cost

Traditional Co-Occurring Disorders Treatment

• Treat each disorder separately– May be parallel or sequential

• Separate treatment is less effective

Integrated Dual Disorders Treatment (IDDT): What is it?

• Treatment of substance use disorder and mental illness together– Same team– Same location– Same time– Other characteristics to be described later

• ACT (Assertive Community Treatment)• DD-CAT and DD-CMHT

Abstinence after Integrated Dual Disorder Treatment

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Abstinence leads to improvements in other outcomes

• Reduce institutionalization• Reduce symptoms, suicide• Reduce violence, victimization, legal problems• Better physical health • Improve function, work• Improve relationships and family

Now What…

• Treatment Works

• How To Get and Keep People in Treatment

• Rapport and Relationship

• Stage-Wise and Motivational Implications

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Introduction of Panelists:Organizational Missions and History

• Nikki Bisig: Greater Cincinnati Behavioral Health (GCB)

• John Scalish and Lou LaMarca, Community Assessment and Treatment Services, Inc. (CATS)

The Benefits

• Why did your organization endeavor to provide co-occurring treatment?

• Why did your organization seek to work with the criminal justice system?

The Challenges and Solutions

• Differing cultures between the criminal justice system and the mental health and substance abuse treatment systems

• Compliance vs. Adherence and Risk Management

• What is “Treatment”? What is “Success” in Treatment?

Lessons Learned

• Training implications• Communication and developing trust between

treatment providers and criminal justice staff• A range of treatment services (case management,

groups, meds, etc)• Stagewise treatment and motivational interventions

Questions?

www.centerforebp.case.edu

Scott Gerhard, MA, LSWConsultant and TrainerCenter for Evidence-Based Practices (CEBP)Case Western Reserve Universityscott.gerhard@case.edu216-268-0808

www.centerforepb.case.edu

www.centerforebp.case.edu