Practice in Mental Health-Substance Use

David B. Cooper

• Publisher: CRC Press
• Year: 2018
• ISBN:
  9781315346601
• Edition: 1
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

The Mental Health-Substance Use series provides clear guidance for professionals on this complex and increasingly recognised field. It concentrates on the concerns, dilemmas and concepts that impact on the life and well-being of affected individuals and those close to them, as well as the future direction of practice, education, research, services, intervention, and treatment. This final book in the series provides the basis of best practice for offering effective interventions to affected individuals and their families, exploring the effects of various substances, both controlled and proscribed, and the impact of substance use in schizophrenia. Therapeutic interventions such as Eye Movement Desensitisation and Reprocessing (EMDR) and dialectical behaviour therapy are discussed, as are relapse prevention and the specific needs of groups such as older people and young adults. Associated topics such as individuals within the criminal justice system, and brain injury (the symptoms of which often mimic mental health-substance use) complete this highly comprehensive guide. The volumes in this series are designed to challenge concepts and stimulate debate, exploring all aspects of the development in treatment, intervention and care response, and the adoption of research-led best practice. They are essential reading for mental health and substance use professionals, students and educators.

CHAPTER 1

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Setting the scene

David B Cooper

Listening itself is an art. When we listen with a still and concentrated mind, it’s possible to actually be responsive to what the words are saying. Sometimes deep insights come in a flash, unexpectedly.¹

INTRODUCTION

The difficulties encountered by people who experience mental health– substance use problems are not new. The individual using substances presenting to the mental health professional can often encounter annoyance and suspicion. Likewise, the person experiencing mental health problems presenting to the substance use services can encounter hostility and hopelessness. ‘We cannot do anything for the substance use problem until the mental health problem is dealt with!’ The referral to the mental health team is returned: ‘We cannot do anything for this person until the substance use problem is dealt with!’ Thus, the individual is in the middle of two professional worlds and neither is willing to move, and yet, both professional worlds are involved in ‘caring’ for the individual.

For many years, it has been acknowledged that the two parts of the caring system need to work as one. However, this desire has not developed into practice. Over recent years, this impetus has changed. There is now a drive towards meeting the needs of the individual experiencing mental health– substance use problems, pooling expertise from both sides. Moreover, there is an international political will to bring about change, often driven forward by a small group of dedicated professionals at practice level.

Some healthcare environments have merely paid lip service, ensuring the correct terminology is included within the policy and procedure documentation, while at the same time doing nothing, or little, to bring about the changes needed at the practice level to meet the needs of the individual. Others have grasped the drive forward and have spearheaded developments at local and national level within their country to meet such needs. It appears that the latter are now succeeding. There is a concerted international effort to improve the services provided for the individual, and a determination to pool knowledge and expertise. In addition, there is the ability of these professional groups to link into government policy and bring about the political will to support such change. However, this cannot happen overnight. There are major attitudinal changes needed — not least at management and practice level. One consultant commented that to work together with mental health– substance use problems would be too costly. Furthermore, the consultant believed it would create ‘too much work’! Consequently, there is a long way to go — but a driving force to succeed exists.

Obtaining in-depth and knowledgeable text is difficult in new areas of change. One needs to be motivated to trawl a broad spectrum of work to develop a sound grounding — the background detail that is needed to build good professional practice. This is a big request of the hard-worked and pressured professional. There are a few excellent mental health– substance use books available. However, this series of six books is groundbreaking, in that each presents a much needed text that will introduce the first, but vital, step to the interventions and treatments available for the individual experiencing mental health– substance use concerns and dilemmas.

These books are educational. However, they will make no one an expert! In mental health– substance use, there is a need to initiate, and maintain, education and training. There are key principles and factors we need to bring out and explore. Some we will use — others we will adapt — while others we will reject. Each book is complete. Conversely, each aims to build on the preceding book. However, books do not hold all the answers. Nothing does. What is hoped is that the professional will participate in, and collaborate with, each book, progressing through each to the other. Along the way, hopefully, the professional will enhance existing knowledge or develop new concepts to benefit the individual.

The books offer a first step, relevant to the needs of professionals — at practice level or senior service development — in a clear, concise and understandable format. Each book has made full use of boxes, graphs, tables, figures, interactive exercises, self-assessment tools and case studies — where appropriate — to examine and demonstrate the effect mental health– substance use can have on the individual, family, carers and society as a whole.

A deliberate attempt has been made to avoid jargon, and where terminology is used, to offer a clear explanation and understanding. The terminology used in this book is fully explained at the beginning of the book, before the reader commences with the chapters. By placing it there the reader will be able to reference it quickly, if needed. Specific gender is used, as the author feels appropriate. However, unless stated, the use of the male/female gender is interchangeable.

Patience and perseverance have magical effects before which difficulties disappear and obstacles vanish.²

BOOK 6: PRACTICE IN MENTAL HEALTH–SUBSTANCE USE

The professional’s role is to see where the individual is in his/her life, to support and steer that individual to a level of stability that is acceptable to him/her. You may not be able to ‘fix it’, but you can encourage acceptance and bring hope. To achieve this we must use the best evidence-based practice and ensure quality in that practice.

For the individual and family it is important that we achieve an intervention that is right — what works for one person may not work for another. Matching the intervention to the person leads to a more effective outcome. The individual, working with others experiencing similar problems and experiences, in a supportive environment, should not be overlooked as an effective intervention.

We listen to the individual and take action to work alongside the move towards his/her goals. Sometimes, one way does not work, and an alternative is tried. However, the good professional never gives up on the individual and family members — no one ‘deserves it’. The door should always be open; accepting of the individual and family members at whatever point she/he enters our care (see Book 1, Chapter 7).

To achieve this, we need an understanding of what is available to aid the individual and family member to achieve his/her own goals: where he/she wants to be — what is acceptable to him/her — not what is acceptable to us! To do this, we need the basics — then we develop that knowledge to practise and utilise skills.

As mentioned in the Preface, the ability to learn and gain new knowledge is the way forward. As professionals, we must start with knowledge, and from there we can begin to understand. We commence using our new-found skills, progressing to develop the ability to examine practice, to put concepts together and to make valid judgements.³ This knowledge is gained through education, training and experience, sometimes enhanced by our own life experiences.

However, we must always remember that those we offer care to, and their family members, bring their own knowledge, skills and life experiences, some developed from dealing with ill health. Therefore, in order to turn our clinical practice to effective outcomes for the individual and family, we must demonstrate a mutual understanding and respect of that expertise.

We need to appreciate and understand the concerns and dilemmas that face the person. We have to adapt our practice to respond to those individual needs. It is important to remember that each person is unique. Yes, there may be similarities in symptoms, and specific needs addressed for sexuality, spirituality and age, etc. However, we must accept and acknowledge that each person will have variations and specific needs that have to be considered when offering appropriate practices, and when interacting with the individual. Moreover, we must be aware of the needs of the family and carers who have their own specific requirements.

To get to this level of skill we need a grounding — a sound knowledge of the theories behind the practices — how they work, who may benefit, and the principles behind the interventions. This must be research led and be fluid in that we take on board the updates and modifications to the intervention as knowledge and skills progress. These are the philosophies from which effective practice and interventions are offered. Taking all we have understood and learned from the previous books in the series, this book offers some practical examples of interventions offered by the professional in specific circumstances to the individual and family. To provide effective care there is a need for a ‘starting point’ of intervention — then an understanding of the types of interventions that may improve the quality of life for the person and family. Thus, Book 6 provides the basis of best practice when offering effective interventions and treatment.

Chapters 2–6 look at practice in relation to alcohol, cannabis, stimulants, prescription drug and tobacco use in relation to mental health. David Kavanagh and Dawn Procter (Chapter 7) explore the impact of substance use in schizophrenia and offer some evidence-based practice examples through case studies, etc. that will enhance interventions for the individual and family.

Fran Miller (Chapter 8) looks at how eye movement desensitisation and reprocessing (EMDR) offers a way forward as an effective intervention for mental health–substance use problems. EMDR is a continuing theme when Walter Busuttil from Combat Stress examines current practice with post-traumatic stress disorder and substance use (Chapter 9), and Art O’Malley looks at practice in relation to attention deficit hyperactivity disorder and substance use in children (Chapter 10).

We acknowledge that all practice intervention cannot be the same; in Chapters 11 and 12 the authors look specifically at the complex needs of the older adult (Chapter 11) and the young adult (Chapter 12), both requiring changes in intervention to meet these needs. In Chapter 13, Lorne Korman and Kyle Burns examine how dialectical behaviour therapy can be helpful when working alongside the young adult and how this is best achieved at a practice level.

When the individual is within the judicial system the process of effective intervention produces some specific areas for consideration. Such intervention is not as easy as we would like to believe in terms of facilities, skills, low staffing levels and expertise. In Chapter 14, Dave Marteau offers some guidance on how such concerns and dilemmas might be approached, and what could be the way forward for effective practice interventions.

SELF-ASSESSMENT EXERCISE 1.1

Time: 7 days

• Before reading Chapters 15 and 16 think of something you really like to eat...

Table of contents

• Cover Page
• Half Title
• Title Page
• Copyright Page
• Contents
• Preface
• About the Mental Health–Substance Use series
• About the editor
• List of contributors
• Terminology
• Cautionary note
• Acknowledgements
• Dedication
• 1 Setting the scene—David B Cooper
• 2 Alcohol and mental health—May Baker and Dave Buckley
• 3 Cannabis and mental health—Zain Sadiq and Paul D Morrison
• 4 Stimulants and mental health—Richard Orr McLeod and Philip D Cooper
• 5 Prescription drugs and mental health—Suzanne Nielsen and Nicole Lee
• 6 Tobacco and mental health—David Jones
• 7 Substance use and schizophrenia—David J Kavanagh and Dawn Proctor
• 8 Eye movement desensitisation and reprocessing (EMDR)—Francesca Miller
• 9 Post-traumatic stress disorder and substance use—Walter Busuttil
• 10 Attention deficit hyperactivity disorder and substance use—Arthur G O’Malley
• 11 The older adult—Marilyn White-Campbell
• 12 The young person—Christina KME Sonneborn
• 13 The young person and dialectical behaviour therapy—Lorne M Korman and Kyle Burns
• 14 Prison, crime and active intervention—David Marteau
• 15 Relapse prevention in mental health—Rami T Jumnoodoo and Patrick Coyne
• 16 Relapse prevention in substance use—Sharon H Hsu and G Alan Marlatt
• 17 Neuropsychiatry: brain injury, mental health–substance use—John R Ashcroft
• Useful chapters
• Useful contacts—Collated by Jo Cooper
• Index