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Addiction Treating mental health and substance abuse

Portsmouth Herald - 7/9/2017

PORTSMOUTH - The establishment of a link between people who have a mental health diagnosis and a substance abuse disorder is something those in the field recognize. Because of the link, a different approach may be needed for treatment.

Patty Driscoll, a licensed social worker at Seacoast Mental Health, based in Portsmouth and Exeter, said they have a method of treatment called ITCOD (Integrated treatment for co-occurring disorders) that they use when both conditions are present.

According to SAMHSA (Substance Abuse and Mental Health Services Administration, www.samsha.gov), any combination of mental health disorders and substance abuse or addiction qualifies for this diagnosis (sometimes referred to as a dual diagnosis), such as alcoholism and depression, anorexia and cocaine dependence, post-traumatic stress disorder and heroin addiction, prescription drug dependence and anxiety and others.

The existence of a dual diagnosis makes it difficult to separate them in terms of treatment.

'The ITCOD is a model created by SAMSHA based on co-occurring diagnosis," said Driscoll. "We need to recognize that both conditions are problematic, and that they play against each other."

Driscoll said the model is based on a dual diagnosis that is significant.

"By that, I mean we are not talking about a person who is depressed and occasionally smokes pot," said Driscoll. "This is more. This is when each of the two conditions are directly affecting the other."

The basic tenet of ITCOD is that the client should be treated by a single provider, one who is qualified in both mental health and in substance abuse, rather than having a different therapist for each condition.

"The person really needs someone who understands how the two conditions work together," said Driscoll. "We embrace the 'no wrong door' premise, meaning that it doesn't matter if the person came to us for treatment of a mental health issue, or for substance abuse.

We will approach the problems head on, and together. We are trained in this and approach their treatment in a different way than if we were treating one or the other. The treatment is also co-occurring."

Everyone who comes for treatment is at a different place in their journey. Driscoll said they base treatment on the person's state of change.

"Are they just contemplating giving up the addictive substance and if yes, that's where we start," said Driscoll. "We work with them to understand what barriers will be there to overcome. If they are an action stage and have decided to get sober, we work from there. Eventually we want to be at the recovery stage, and teach them how to avoid relapses."

The goal is to get the person to where they need to be to move on to the next step. Driscoll said the ITCOD model is heavy on group support.

Many people with a co-occurring disorder began their SUD because they were self-medicating to cope with feelings they felt unable to handle.

"Maybe they had an anxiety disorder so started with a substance that momentarily helped them to relax, to feel better," said Driscoll. "The more you do that, the more likely you are to develop a problem. We do a lot of teaching in this model."

Driscoll doesn't have all the answers, but she did have a thought to offer.

"I think there needs to be more collaboration between the primary care doctors and the therapy side of a person in treatment for a mental health or substance abuse disorder before opioids are routinely prescribed.

"I am not pointing fingers at anyone," said Driscoll. "I just think with better communication, maybe less opioids could be prescribed."