Introduction to IDDT and Harm Reduction Trreatment, Susan Doig

Introduction to IDDT and Harm Reduction
Susan Doig, LCSW, CADC
Chief Clinical Officer
Trilogy, Inc
What are Dual Disorders?
• Mental Illness and Substance Use disorders
occurring together in one person
Risk Factors
• 50% of persons with serious mental illness also have
substance abuse issues
• Being dually diagnosed is associated with high rates of the
– Relapse
– Hospitalization
– Violence
– Incarceration
– Homelessness
– Serious Infection (HIV, hepatitis)
*as noted from “Implementing Dual Diagnosis Services for clients with severe
Mental Illness” Drake, et al. 2001
Traditional Treatment
Non-integrated approach
Treats each disorder separately
Requires navigation of two separate systems
Office based
Traditional Treatment
• 12 step approaches have not had positive
results with dually disordered individuals
• Cognitive impairment can detract from
understanding information
• Confrontational approaches used in SA
treatment are not well tolerated
• Frustration and dropout may result from
requirements of abstinence
What is Dual Disorders Tx?
• An integrated, multidisciplinary approach
– Assertive outreach
– Engagement (motivational interviewing)
– Skill building
– Building community supports
– Relapse prevention
What is Dual Disorders Tx?
• Provides wide array of services other than just
counseling such as: housing, medication
training, supported employment, etc.
• No wrong door
• Non-linear: people do not move smoothly
from one stage to the next.
Drake et. al. 2001
Effectiveness of Dual Disorders Tx
• It’s an Evidenced Based Practice (EPB)
• Increases abstinence and helps people to cut
down use
• Better health outcomes
• Helps to improve outcomes for treatment
which helps to motivate the client to set
additional goals
Effectiveness of Dual Disorders Tx
• Many people attain stable remission of
substance use disorders over time
• Recovery encompasses other areas of
• Health, work, housing, relationships
• Harm reduction: anything that reduces the
risk of injury whether or not the individual is
able to abstain from the risky behavior.
--- David Ostrow, M.D., Ph.D.
Challenges in working with people in
Gaps in health care coverage
Homelessness/housing upon release
Access to medications
Continuity with providers
Increase service use and cost
Non-integrated systems of care
Court and provider collaboration
• Court order treatment can increase
motivation to participate in tx
• Relapse can be difficult to manage
• Effective Communication is key
• Planned release