This Treatment Improvement Protocol (TIP) update is intended to provide addiction counselors and other providers, supervisors, and administrators with the latest science in the screening, assessment, diagnosis, and management of co-occurring disorders (CODs). For purposes of this TIP, CODs refer to co-occurring substance use disorders (SUDs) and mental disorders. Clients with CODs have one or more disorders relating to the use of alcohol or other substances with misuse potential as well as one or more mental disorders. A diagnosis of CODs occurs when at least one disorder of each type can be established independent of the other and is not simply a cluster of symptoms resulting from the one disorder. Many may think of the typical person with CODs as having a serious mental illness (SMI) combined with a severe SUD, such as schizophrenia combined with alcohol use disorder (AUD).

This book includes a compilation of papers published in 2020 and 2021 focused on dual disorders, which are found in significant and growing numbers in both substance addiction and mental health clinics. These contributions assume a broad perspective ranging from exposure to genetic and neurobiological elements to factors such as personality and quality of life. In all cases, these papers aimed to be transferred to and to benefit clinical practice.

Motivation is key to substance use behavior change. Counselors can support clients' movement toward positive changes in their substance use by identifying and enhancing motivation that already exists. Motivational approaches are based on the principles of person-centered counseling. Counselors' use of empathy, not authority and power, is key to enhancing clients' motivation to change. Clients are experts in their own recovery from SUDs. Counselors should engage them in collaborative partnerships. Ambivalence about change is normal. Resistance to change is an expression of ambivalence about change, not a client trait or characteristic. Confrontational approaches increase client resistance and discord in the counseling relationship. Motivational approaches explore ambivalence in a nonjudgmental and compassionate way.

To practice psychotherapy in a correctional setting is to encounter a range of cultural issues reflecting the various ethnic, class, gender, and physical subgroups of the prison population--as well as to navigate the culture of the prison, staff, and justice system that underpins the patients' circumstances. Drawing on the authors' extensive professional experience, Psychotherapy in Corrections offers mental health professionals a comprehensive look at the most common situations they are likely to face and provides practical advice on dealing with them. Diagnostically oriented chapters cover core issues that include self-harm and substance use disorders, as well as mood and personality disorders. Specific supportive therapy techniques for addressing these issues, as well as special situations--including the experience of women in prison, behaviors that can disrupt care, and efforts to reduce recidivism--are illustrated by clinical vignettes. In tackling the social and developmental conditions that lead individuals to interact with the correctional system, Psychotherapy in Corrections also acknowledges the effects of the COVID-19 pandemic and the movement for social justice in society. Anyone who conducts psychotherapy in a prison setting will benefit from an approach centered on treating the human in front of them, regardless of the setting or their crime.

Case management has been variously classified as a skill group, a core function, service coordination, or a network of "friendly neighbors." Although it defies precise definition, case management generally can be described as a coordinated approach to the delivery of health, substance abuse, mental health, and social services, linking clients with appropriate services to address specific needs and achieve stated goals. The Consensus Panel that developed this TIP believes that case management lends itself to the treatment of substance abuse, particularly for clients with other disorders and conditions who require multiple services over extended periods of time and who face difficulty in gaining access to those services. This document details the factors that programs should consider as they decide to implement case management or modify their current case management activities. This summary is excerpted from the main text, in which references to the research appear.

Despite an increased awareness of co-occurring disorders, most current treatment paradigms still focus on one problem or the other, leaving much unassessed, unaddressed, or ignored. Until now - a revolutionary new book from Dr. Charles Atkins that can break the cycles of relapse for those intertwined with substance use and mental illness. Co-Occurring Disorders is a guide to practical assessment and effective treatment approaches for working work with any number of co-occurring disorders. This step-by-step approach, demonstrated through diverse case studies, gives you the tools you need to improve and track your clinical outcomes. This is a must-have resource for both the rubber-meets-the-road clinician, who wants effective strategies and a clear direction for treatment and recovery, and the administrator who creates interventions at the system level with attention to regulatory and reimbursement demands. Also included is a comprehensive state-by-state Guide to Mental Health and Substance Abuse Agencies and Prescription Monitoring Programs Evidence-Based Integrated Treatment, finding the right tool for the job: • Motivational Interviewing • Cognitive-Behavioral Therapy and Strategies • Skills Training • Mindfulness Training • Mutual Self-Help & Peer-Based interventions • Wellness interventions • Recovery based • Family interventions • Assertive Community Treatment and Targeted Case Management • Psychopharmacology including opioid and nicotine replacement strategies Diagnosis-Specific Issues in Co-Occurring Disorders: • ADHD • Depression and Bipolar Disorders • Anxiety and PTSD • Schizophrenia and other Psychotic Disorders • Personality Disorders Substance-Specific Issues in Co-Occurring Disorders: • Alcohol • Opioids • Tobacco • Cocaine and other Stimulants, including "Bath Salts" • Cannabis & Synthetic Cannabis • The Internet and other sources of Drugs Reviews: "A comprehensive, user-friendly compilation of assessment and intervention strategies to be used for clients. It includes a number of worksheets for both clinicians and clients, and is a valuable tool for treatment decision-making." -- Donald Meichenbaum, PhD, noted author and speaker, a CBT founder, and voted one of the 10 most influential psychotherapists of the 20th century "This book is wonderful. I plan to adopt it as a textbook for my MSW Co-Occurring Disorder Program." -- Jaak Rakfeldt, Ph.D., Co-Occurring Disorder Cohort Program, MSW Coordinator, Southern Connecticut State Unviersity Professor "So much valuable information in a user friendly manner, clinicians as well as others will find this book useful in their practice. This resource is a powerful tool and I am especially proud of the way he connects issues related to gender and trauma." -- Colette Anderson, LCSW, CEO The Connecticut Women's Consortium "A clear, concise and straightforward and up to date text on co-occurring disorders has been glaringly lacking in the Behavioral Health Field. Co-Occurring Disorders: The Integrated Assessment and Treatment of Substance Use and Mental Disorders offers students and clinicians at all levels a comprehensive view of the challenges of treating those with a co-occurring mental health and substance use disorder. Written in plain language, Atkins provides a clinical road map beginning with an outline of key issues and ending with treatment planning. Atkins also does what most don’t and that is to stress the importance of peer support, natural supports and self-help. Co-Occurring Disorders: The Integrated Assessment and Treatment of Substance Use and Mental Disorders is an important addition to any educator’s and clinician’s bookshelf." --Eileen M. Russo, MA, LADC, Assistant Professor, Drug and Alcohol Recovery Counselor Program, Gateway Community College, New Haven, CT "As a person that has lived with bipolar disorder for many years and has proudly disclosed my personal journey of recovery, I know there are many people who would greatly benefit from the treatments suggested in this powerful book-co-occurring services are rarely done in such a comprehensive way." -- Dr. Karen A. Kangas, Director of Operations, Advocacy Unlimited, Inc.

Psychiatric Mental Health Nursing: An Interpersonal Approach, Third Edition is a foundational resource that weaves both the psychodynamic and neurobiological theories into the strategies for nursing interventions.