Intervention in Mental Health-Substance Use

David B. Cooper

• Publisher: CRC Press
• Year: 2016
• ISBN:
  9781315346618
• 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, and the future direction of practice, education, research, services, intervention, and treatment. Mental health-substance use is a complex and varied phenomenon, and this volume stresses an appreciation that interventions that work for one individual or family may prove ineffective for another. It therefore explores the needs of individuals and carers, the nature of the therapeutic relationship, and the theory and application of a variety of interventional techniques; these include group therapy, cognitive behaviour therapy (CBT), motivational interviewing (MI), brief interventions and many more. 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

Setting the scene

David B Cooper

It seems that when problems arise our outlook becomes narrow.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.

BOOK 4: INTERVENTION IN MENTAL HEALTH AND SUBSTANCE USE

Case study

My life was good, a home, family, work. I lived for work because that provided me with the money to keep my family – my responsibility. But things were going wrong; I lost control of my perceived destiny. Ill health took control. Initially, I coped, I had hope, it will get better – no need to adapt. However, the system was slow – stepped care meant that I could not get back my usual good health.I had to try this before I could try that – even though I knew ‘that’ would help me! Then I entered my ‘abyss’. The darkness as I call it took over. This may take days, weeks, months, years, maybe never – at that time I did not know! ‘Eventually you will find a way to cope and accept.’ At this stage this was just a myth put about by ‘them’. Just something your family and friends tell you. Slowly, they stepped back, unable to cope with my behaviour and actions. I was angry, sad, despaired, happy, unreasonable and obnoxious! I built a brick wall around me. Each meeting with the specialist brought initial hope – then hopelessness. I tried to recreate what I had – cocoon myself in my own safe world. My income dropped – disappeared altogether – but the bills did not! But society and state perceive people like me as a scrounger – work dodgers – a burden. In my mind I was begging for money. But my income was not as it was. I needed money to keep things as they were. I created my own empire – borrowed money I could not pay back in the misguided belief that this would bring normality back to my life, and I would then pay my debts. My debtors were after me, my family wanted me to change – but there was no way out or so I believed. I felt ashamed. I hid things – my feelings – my life was a lie, because no one would understand. I sank into a hole, maybe sought thrills; I would buy something that I believed would make me happy. I did not need it, and the happiness passed as soon as I bought the expensive ‘treat’! Nobody cared – or that is how I felt – I will die. Indeed, I wanted to die. I acted in ways I did not understand – and again the shame, the despair – no way out, so what, who cares! Some sort of self-harm, self-gratification – all was doomed, I would get the punishment I deserved for being ill – not like normal hard-working people. I wanted to be punished – needed to be punished – punished for being weak and ill – not normal. At some point I accepted that I needed to change – to adapt – to take control of ‘it’. It cannot be in charge of me. I accepted my position in life – the illness – its potential route. Slowly, I came out of my abyss. I looked around and saw the damage I had done. I was aware of the destruction, but helpless. I tried to make amends and build bridges with those I had hurt along the way. Some may forgive – others may accept – while others will never forgive or accept. It lives alongside my illness. But I saw a light – my own light of acceptance. I accepted the progression of my illness. Of course, many people have helped me along the way, but that goes unacknowledged. I needed to do this for myself. Now I accept the good days – and the bad. I know the damage to me is progressive – and the damage to others cannot be corrected, but I can only accept my future. Yes, there are down days – black, cold and empty days. But I look for hope. Hang on to the hope – for that is my way forward – my way out. Until the end! Of course, this is my story – my life. We are all different – I suppose we handle things differently. But that is how it was for me – then and now.

The case study above offers a glance inside the life of the individual experiencing mental health–substance use problems. We do not know how it is for him/her but we listen to the individual’s story. 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’, but maybe encourage acceptance and bring hope.

The professional listens to the individual and takes action to work alongside the movement towards his/her goals. Sometimes one way does not work and so the professional will try another way. However, the good professional never gives up on the individual – no one ‘deserves it’. The door should always be open, accepting of the individual at whatever point she/he enters your care (see Book 1, Chapter 7).

To achieve this, the professional needs an understanding of what is available to aid the individual to attain his/her own goals: where he/she wants to be, what is acceptable to him/her – not what is acceptable to the professional! To do this we need the basics, then we develop that knowledge into practice and skill.

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.² This knowledge is gained through education, training and experience, sometimes enhanced by own life experiences.

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, making interventions and treatment outcome effective requires mutual understanding and respect.

We need to appreciate and understand the concerns and dilemmas that face the person before she/he comes to the service, and professional, for intervention and treatment. We have to adapt the service 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 sex and age. However, we must accept and acknowledge that each will have variations and specific needs that have to be considered when developing appropriate services, and when interacting with the individual. Moreover, we must be aware of the needs of the family and carers who have their own specific needs.

To get to this level of skills we need a grounding: a sound knowledge of the theories behind the treatment, how they work, who may benefit, the principles behind the interventions. This must be research-led practice and be fluid in that we take onboard the updates and modifications to the intervention as knowledge and skills progress. These are the philosophies, ethics – the grounding – from which effective interventions are introduced and developed. This book describes the various models that can be used to address the concerns and dilemma faced by 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 4 provides the theoretical basis of current practice. In Chapter 2, Jo Cooper looks at how imperative the therapeutic relationship is between the individual and professional. This is the starting point of all good practice. If we get this right, we are commencing the journey alongside the individual to his/her chosen goals.

Chapter 3, the Tidal Model, builds on this chapter and offers a humanistic model of care. In Chapters 4 and 5, Larry Purnell offers an insight into the Purnell Model for cultural competence and the application of transcultural theory in mental health–substance use. Like the preceding chapters, they highlight the importance of the individual as the centre of our interventions and treatments – each unique. Carlo DiClemente and colleagues (Chapter 6) ‘describes how to use the principles and concepts of the Transtheoretical Model to address multiple diagnoses and problems and adaptations or limitations when using it’ with the individual experiencing mental health–substance use problems. Chapter 7 builds upon this by examining the role of motivational interviewing (MI) when working with people experiencing mental health–substance use problems. ‘Motivational Interviewing is a therapeutic technique with specific and teachable skills’; these are discussed throughout the chapter. ‘The chapter focuses on general techniques for working alongside’ the individual experiencing mental health–substance use problems rather than ‘providing specific details about the application of MI to all possible combinations of problems’.

Chapter 8 (Catherine Lock and colleagues) charts the development of brief interventions ‘both empirically and in terms of their theory base’. The chapter looks at the effects of brief interventions on substance use and the evidence of the effect of brief interventions on mental health–substance use concerns.

The book then examines specific interventions that may aid the individual experiencing mental health–substance use concerns and dilemmas. Kathleen Sciacca (Chapter 9) draws on her vast consultancy experience across systems of care, programme models and state-wide initiatives. Her chapter covers theme-centred interaction, stages of change, and person-centred reflective listening to explore the role of integrated group treatment.

Anne Garland (Chapter 10) looks at the role of cognitive behavioural therapy (CBT). The chapter aims to describe the fundamental principles of cognitive behaviour therapy, the theory, and the basic treatment rationale and process for making psychological sense of a person’s problems.

Alexander Chapman and colleagues (Chapter 11) describe the role of dialectical behaviour therapy (DBT). This chapter offers practical guidance on the evidence for DBT in the treatment of substance use problems and offer suggestions on how to incorporate DBT into the treatment of people experiencing such prob...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Preface
• About the Mental Health–Substance Use series
• About the editor
• List of contributors
• Terminology
• Cautionary note
• Acknowledgements
• Dedication
• 1 Setting the scene
• 2 The therapeutic relationship
• 3 The Tidal Model
• 4 The Purnell Model for Cultural Competence
• 5 Application of transcultural theory to mental health–substance use in an international context
• 6 A Transtheoretical Model perspective on change: process-focused intervention in mental health–substance use
• 7 Motivational interviewing: mental health–substance use
• 8 Brief interventions: mental health–substance use
• 9 Integrated group treatment for people experiencing mental health–substance use problems
• 10 Cognitive behavioural therapy: mental health–substance use
• 11 Dialectical behaviour therapy: mental health–substance use
• 12 Eye movement desensitisation and reprocessing (EMDR): mental health–substance use
• 13 Cue reactivity: working with cues and triggers to craving
• 14 Mutual aid groups
• 15 Empowering life choices
• Useful chapters
• Useful contacts
• Index