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Subject Area:Clinical Psychology,Physiology
Publication Name:Substance Use Disorder Treatment for People With Co-Occurring
Publisher:SAMHSA
Item Length:8.5 in
Subject:Medicine,Psychiatry,Psychotherapy
Publication Year:2020
Series:SAMHSA
Type:Textbook
Format:Paperback
Unit Type:Unit
Language:English
Item Height:11 in
Author:U.S. Department of Health and Human Services,SAMHSA
Educational Level:Adult & Further Education
Personalized:No
Level:Advanced
Country/Region of Manufacture:United States
Unit Quantity:1
Number of Pages:345

This textbook is an advanced level resource for healthcare professionals seeking to provide effective substance use disorder treatment for people with co-occurring disorders. It covers a wide range of topics including clinical psychology, physiology, medicine, psychotherapy, and psychiatry. The book is authored by the U.S. Department of Health and Human Services and SAMHSA, and is a valuable resource for those in the field of addiction treatment. The book is a paperback format with a length of 8.5 inches and a height of 11 inches. It has 345 pages and is published in English. The book is suitable for adult and further education levels, and is a must-have for those seeking to gain a deeper understanding of substance use disorder treatment. Contents Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viiExecutive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ixOverall Key Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ixContent Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xConsensus Panel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xviiTIP Development Participants. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xviiKAP Expert Panel and Federal Government Participants . . . . . . . . . . . . . . . . . . . . . . . . xviiiPublication Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxviiChapter 1—Introduction to Substance Use Disorder Treatment forPeople With Co-Occurring Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1Scope of This TIP. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2Terminology in This TIP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3Important Developments That Led to This TIP Update . . . . . . . . . . . . . . . . . . . . . . . . . . . .6Why Do We Need a TIP on CODs? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7The Complex, Unstable, and Bidirectional Nature of CODs . . . . . . . . . . . . . . . . . . . . . . . .11Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12Chapter 2— Guiding Principles for Working With People Who HaveCo-Occurring Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13General Guiding Principles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14Guidelines for Counselors and Other Providers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16Guidelines for Administrators and Supervisors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29Chapter 3—Screening and Assessment of Co-Occurring Disorders . . . . . . . . . . . . .31Screening and Basic Assessment for CODs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32The Complete Screening and Assessment Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36Considerations in Treatment Matching. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .68Chapter 4—Mental and Substance-Related Disorders: Diagnosticand Cross-Cutting Topics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69Depressive Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .71Bipolar I Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .76Posttraumatic Stress Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .83Personality Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .89Anxiety Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .98Schizophrenia and Other Psychotic Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .104Attention Deficit Hyperactivity Disorder. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .110Feeding and Eating Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114Substance-Related Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .121Cross-Cutting Topics: Suicide and Trauma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .129Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .140Chapter 5—Strategies for Working With People Who HaveCo-Occurring Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .141Competencies for Working With Clients Who Have CODsGuidance for Working With Clients Who Have Specific. . . . . . . . . . . . . . . . . . . . . . . .142Guidelines for a Successful Therapeutic Relationship . . . . . . . . . . . . . . . . . . . . . . . . . . . .142Protect Confidentiality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .148Co-Occurring Mental Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .160Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .163Chapter 6—Co-Occurring Disorders Among Special Populations . . . . . . . . . . . . . .165People Experiencing Homelessness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .166People Involved in the Criminal Justice System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .170Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .172People of Diverse Racial/Ethnic Backgrounds. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .179Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .182Chapter 7—Treatment Models and Settings for People WithCo-Occurring Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .183Treatment Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .184Treatment Models . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .188Empirical Evidence for ACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .192Treatment Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203Pharmacotherapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 220Chapter 8—Workforce and Administrative Concerns in WorkingWith People Who Have Co-Occurring Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . 229Recruitment, Hiring, and Retention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 230Avoiding Burnout . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233Competency and Professional Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .243Appendix A—Bibliography. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .245Appendix B—Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 285Training for Providers and Administrators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 285Other Resources for Counselors, Providers, and Programs . . . . . . . . . . . . . . . . . . . . . . . .287Client and Family Resources. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293Appendix C—Provider Forms, Measures, and Tools. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .297Biopsychosocial Intake Forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .297Suicide and Safety Screening and Assessment Tools . . . . . . . . . . . . . . . . . . . . . . . . . . . . .297Mental Disorder Screening and Assessment Tools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .297Substance Use/Misuse Screening and Assessment Tools. . . . . . . . . . . . . . . . . . . . . . . . . .297Trauma Screening and Assessment Tools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299Levels of Care Tool . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299Functioning and Disability Tools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .310Stage of Change Tools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .310Additional Screening Tools for Common Mental Disorders. . . . . . . . . . . . . . . . . . . . . . . .313ExhibitsExhibit 1.1. Key Terms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3EXHIBIT 1.2. Co-Occurring Substance Misuse in Adults Ages 18 and OlderWith and Without any Mental Illness and SMI (in 2018). . . . . . . . . . . . . . . . . . . . . . . . . . . .7Exhibit 2.1. Six Guiding Principles in Treating Clients With CODs . . . . . . . . . . . . . . . . . . . . . .16Exhibit 2.2. Making “No Wrong Door” a Reality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19Exhibit 2.3. The Four Quadrants Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20Exhibit 2.4. SAMHSA Practice Principles of Integrated Treatment for CODs . . . . . . . . . . . . .21Exhibit 2.5. Levels of Program Capacity in CODs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31Exhibit 3.1. Assessment Considerations for Clients With CODs. . . . . . . . . . . . . . . . . . . . . . . .39Exhibit 3.2. Biopsychosocial Sources of Information in the Assessment of CODs . . . . . . . . .40Exhibit 3.3. Recommended Screening Tools To Help Detect CODs . . . . . . . . . . . . . . . . . . . 44Exhibit 3.4. The Suicide Behaviors Questionnaire-Revised (SBQ-R) – Overview . . . . . . . . . . .46Exhibit 3.5. SBQ-R-Scoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .46Exhibit 3.6. SBQ-R Suicide Behaviors Questionnaire – Revised. . . . . . . . . . . . . . . . . . . . . . . . .47Exhibit 3.7. Mental HSF-III . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .52Exhibit 3.8. Level of Care Quadrants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57Exhibit 3.9. Sample Treatment Plan for Case Example George T.. . . . . . . . . . . . . . . . . . . . . .68Exhibit 3.10. Considerations in Treatment Matching . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .68Exhibit 4.1. Diagnostic Criteria for MDD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .74Exhibit 4.2. Diagnostic Criteria for PDD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .76Exhibit 4.3. Diagnostic Criteria for Bipolar I Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .80Exhibit 4.4. Diagnostic Criteria for PTSD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .86Exhibit 4.5 Diagnostic Criteria for General PD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .92Exhibit 4.6 Diagnostic Criteria for BPD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .95

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