Concurrent Disorders (Part 2)

In Canada, our system of care for concurrent disorders is fragmented and compartmentalized—with varying treatment approaches and programs developed on a model that treats either the addiction or mental health issue exclusively as the primary focus—creating a system that is not well equipped to treat both disorders concurrently and results in poor client outcomes and system inefficiency. When fielding questions from a caller who is living with concurrent disorders (CD), call responders don't have to be an expert, but being CD-informed assists you and the caller to establish a baseline of understanding and opens lines of communication. It would not be unusual for a caller to use statements like, “What (mental health) providers do is they'll look at me and say…’forget about the mental health issue, you've got a real substance abuse problem, and you've got to go get help for that’, and either they ignore the using or the fact that I have an addiction, or else they won’t even deal with the mental health aspect of it because I've been using." Having a positive and caring attitude can serve to successfully engage callers and assist them to continue to seek support and work toward recovery. In the video, Concurrent Disorders (Part 2), Andrea Tsanos, Advanced Practice Clinician for the Toronto Centre for Addiction and Mental Health continues (See Part 1) to inform the viewer about the challenges of obtaining effective treatment. Crisis and Distress Line professionals will benefit from the strategies for being supportive and resourceful. Questions for Further Consideration: What is your comfort level in opening a conversation about concurrent disorders? Are there aspects of the disorder that may impact on your effectiveness in supporting this type of call? Review the barriers to communication as stated in the video. ‘Don’t forget that it can be hard, shameful, and scary to talk about mental health or addiction issues, or think about changing it – these are often private behaviours’. If you feel that you have personal issues that may present as barriers, it might be a good idea to discuss this with your training coordinator. If you have further questions, further research on the topic (see links below) might answer your queries. Ms. Tsanos indicates that there is more than one type of treatment for concurrent disorders but the integrated approach seems to be the most effective. What types of treatment options does your community offer? You don’t need to be an expert on the topic of concurrent disorders but it might be helpful to become aware of what resources are available in your community. Ms. Tsanos reviews flexible treatment goal choices which include, abstinence, harm-reduction, and perhaps the most challenging for a loved one to support, the “no-change” goal (which seeks to engage the individual in at least looking at their behavior without the demand for change at the outset). How would you offer support to a family member who is frustrated with a loved one who chooses the no-change goal? It might be a challenge for the family member to not want to expedite treatment for their loved one. Call responders may just do as they always do – be compassionate, explore options, and provide an empathetic listening ear. The key messages are for the family member to continue to encourage their loved one to go for an assessment, but failing that option, the family member should be encouraged to obtain support that will assist them with strategies for their own self-care and learning how to set their own limits and boundaries.