Charles Atkins - Co-Occurring Disorders: Integrated Assessment and Treatment of Substance Use and Mental Disorders

Co-Occurring Disorders

Integrated Assessment and Treatment of
Substance Use and Mental Disorders

By Charles Atkins, MD

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 Womens 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 dont 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 educators and clinicians bookshelf.

--Eileen M. Russo, MA, LADC, Assistant Professor, Drug and Alcohol Recovery Counselor Program, Gateway Community College, New Haven, CT

Copyright 2014 by Charles Atkins, MD

Published by

PESI Publishing & Media

PESI, Inc

3839 White Ave

Eau Claire, WI 54703

Cover: Amy Rubenzer

Layout: Bookmasters

Edited by: Bookmasters

ISBN: 978-1-936128-54-9

All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, recording, or by any information storage and retrieval system without the written permission from the author (except for the inclusion of brief quotations in a review).

Printed in the United States of America

Library of Congress Cataloging-in-Publication Data

Atkins, Charles, author.

Co-occurring disorders : integrated assessment and treatment of substance use and mental disorders / by Charles Atkins.

p. ; cm.

Includes bibliographical references and index.

ISBN 978-1-936128-54-9 (pbk. : alk. paper) ISBN 1-936128-54-3 (pbk. : alk. paper)

I. Title.

[DNLM: 1. Substance-Related Disorderscomplications. 2. Substance-Related Disorderstherapy. 3. Mental Disorderscomplications. 4. Mental Disorderstherapy. 5. Psychotherapymethods. WM 270]

RC564

616.86dc23 2014036016

All rights reserved.

Books by Charles Atkins

The Bipolar Disorder Answer Book

The Alzheimers Answer Book

The Portrait

Risk Factor

Cadavers Ball

The Prodigy

Ashes Ashes

Mothers Milk

Go to Hell

Vultures at Twilight

Best Place to Die

Done to Death

Haffling

To librarians extraordinaire Linda Spadaccini and Lynn Sabol

I wish to express my gratitude for all of those who helped me develop this book. In particular Eileen Russo, Colette Anderson, Aili Arisco, Steve Jayson, Karen Kangas, Steven Southwick, Lauren Doninger, Martha Schmitz, Lynn Zinno, Carol Genova, Marie Johnston, Lori Sobel, Thomas Reinhardt, Doreen Elnitsky, Laura Nesta, Cheryl Planten, Sheila Zimmerman, Jason Schwarz, Pam Kieras, Karen Savage, Diane Passander, Bob Taylor, Susan Hayward, Elizabeth Fitzgerald, Linda Jackson, and Michael Olson. So much of this book originates in work I did with my wonderful colleagues and clients at Waterbury Hospitals West Main Behavioral Health and Community Mental Health Affiliates (CMHA) in New Britain, CT. We learn so much from each other, and experience is our greatest teacher.

About the Author

Charles Atkins, MD is a board-certified psychiatrist, published author, clinical trainer, and the Chief Medical Officer for Community Mental Health Affiliates, LLC (CMHA) in New Britain, Connecticut.

He has written both non-fiction and fiction, including books on Bipolar Disorder, and Alzheimers Disease. His recent novels include the Barrett Conyors forensic thriller series and The Strauss and Campbell Connecticut cozies. His first young adult novelHAFFLINGwas published in 2013 under the pen name, Caleb James.

Dr. Atkins has written hundreds of articles, columns, and shorts stories for professional and popular magazines, newspapers, and journals. He is a member of the Yale volunteer clinical faculty. Hes been a regular contributor to the American Medical Associations American Medical News, a consultant to the Readers Digest Medical Breakthrough series, and his work has appeared in publications ranging from The Journal of the American Medical Association (JAMA) to Writers Digest Magazine. Hes been twice featured in the New York Times, as well as many other publications.

More than 8 million Americans meet the criteria for having at least one co-occurring substance use and mental disorder. This represents a large and diverse group of people, from a top executive with obsessive-compulsive disorder, who drinks more than a pint of hard liquor a day to a homeless woman who smokes cannabis heavily and has been in and out of psychiatric hospitals with a diagnosis of schizophrenia. With this vast spectrum of people affected with co-occurring disorders, and the almost endless number of diagnostic combinations, it is easy to see how the assessment and overall treatment must be custom fit to the person and their real-life circumstances. Strategies to help the homeless woman with schizophrenia will totally miss the mark with the germ phobic executive who drinks heavily to quiet his intrusive obsessive thoughts, and vice versa.

Studies that look at particular pieces of this co-occurring matrix are still in their infancy. But on balance, the research shows that integrated treatment (i.e., treatment that addresses both the substance use and mental disorders) leads to better outcomes for both. For this reason, Ive undertaken to write this book to give clinicians an overview on how to both assess co-occurring disorders and to develop effective treatment with their specific clients.

The how and why someone develops co-occurring substance use and mental health disorders makes sense. We are the sum of our experiences and upbringing, genetics, epigenetics, family history, lifestyle, and temperament. Perhaps someone got into trouble with drugs as a way of medicating crippling anxiety and depression. For a person with attention deficit disorder, perhaps they began to abuse their prescribed stimulants (Ritalin, Adderall, etc.) or discovered cocaine helped them calm down and focus. Maybe someone got hooked on prescription pain pills following a medical problem, or maybe they just liked the high, or perhaps they were part of a social group where substance use was the norm and things got out of hand.