Download Concurrent three Samar Zakaria

Working with young people who
have mental health and substance
use issues.
Samar Zakaria
Main points…
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Challenges faced while treating young
adults in a dual diagnosis rehab unit
◦ Define dual diagnosis in this context
◦ Describe the dual diagnosis rehab service
◦ Name the challenges currently faced
Objectives
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Describe the challenges faced by young
adults with a dual diagnosis
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Explore the potential complications of
substance use
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Discuss harm reduction approaches to
supporting young adults in their recovery
journey
Co occurring Disorders

Dual diagnosis is a term used to refer to coexisting conditions.
◦ This is also sometimes referred to
comorbidity.
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Today we are specifically referring to the
existence of a mental disorder or illness
and a substance use disorder (licit and /or
illicit drugs).
Definition of comorbidity

Comorbidity refers to : Situations where people
have problems related both to their use of
substances (from hazardous through to harmful
use and/or dependence) and to their mental health
(from problematic symptoms through to highly
prevalent conditions, such as, depression and
anxiety, to the low prevalence disorders such as
psychosis).
◦
The NSW Clinical Guidelines for the Care of Persons with Comorbid Mental Illness and Substance Use Disorders in
Acute Care Settings 2009 pg7
Dual Diagnosis Service
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Inpatient service – patients are admitted under the
Mental Health Act; usually referred from community
mental health services or other inpatient acute
mental health services.
18-35 years of age
Rehabilitation – inpatient rehabilitation offered
during assessment (even though patients will be
under the Mental Health Act). Willingness to attend
program activities is an important stage of
treatment.
Dual Diagnosis Service cont.

“Treatment resistant” Schizophrenia –
usually about to work up for Clozapine or
may be in early days of treatment. Or may
require review of current treatment.

Substance abuse or dependence – history
of continued substance use/ abuse/
dependence complicating management /
treatment
Harms associated with a Dual Diagnosis
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Poorer physical health
Poorer social and occupational functioning
Greater drug use severity
Increased risk of self harm and suicide
Poorer mental health
Increased homelessness
Increased risk of violence
Increased stress on relationships
◦
One person, diverse needs: living with mental health and alcohol and drug difficulties. National Mental Health
Commission’s report card on mental health and suicide prevention. A review of best practice produced by the NHMRC
Centre of Research Excellence in Mental Health and Substance Use
We see
Greater symptom severity and polydrug use, repeated hospital
admissions.
 As well as poorer social and
interpersonal functioning.
 Greater instability with
accommodation and homelessness.
 Increased risk of relapse.

Main points

Providing a safe and therapeutic
environment for young adults with a
dual diagnosis to continue along their
recovery journey
◦
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Mental Health Act
Mental Health Review Tribunal
Drug and alcohol philosophy
The individual recovery journey
Main points

Information on the use of harm
reduction strategies to support the
recovery journey
◦ Define recovery
◦ Describe harm reduction strategies
currently used
◦ Name the challenges faced
Harm Reduction/Minimisation

Harm reduction is a set of practical
strategies that reduce negative
consequences of substance use and
mental illness
◦ This includes methods of safer use to
managed use to abstinence
◦ Offer of pharmacotherapy / assist through
pharmacology
Recovery as a concept
Personal view
 Individual experience
 A journey
 Gaining hope
 Self determination
 Social identity
 Self management
 Living a meaningful life

Main Points
Challenges
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Inpatient, locked/contained environment
Continued substance use
Active psychosis
No smoking policy
Risk of aggression
Continued Substance Use
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Complicates treatment
Medication compliance
Prolonged active psychosis
Lower level of engagement in offered
activities
Higher level of risk of aggression
Case Example

Young man aged 23 with a history of
psychosis (not well managed),
substance abuse, self harm attempts,
isolated, poor engagement with
services (repeated admissions). Poor
compliance with treatment/meds,
continued substance use.
Case Example cont.
Offer of rehab (locked unit); following is
what we saw:
 Poor engagement
 Withdrawal
 “liked his psychosis”
 Absconding
 Further attempts to self harm
 Craving for substances
Challenges
Abstinence is the expectation or the
goal that everyone needs to strive for.
 Rudimentary harm reduction
strategies.
 Community engagement
 Risk aversion

◦ Transition into the community
◦ Community services as hurdles
Opportunity
Our young man
 Opportunity to continue on to a
cottage (open) based environment
 Transition into the community
 Connection with community based
services
 Employment opportunity

Progression
Long term residential treatment
opportunity
 Rehab setting
 Allied health input
 Pharmacology review
 MI
 CBT
 An integrated approach…
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