Journey

💡 Understanding the Process: Treatment for individuals with co-occurring mental health and substance use disorders follows a structured, long-term approach. Progress is non-linear, and clients may move back and forth between stages.

🟢 Engagement (Building the Relationship)

Goal: Establish a therapeutic alliance and build trust.

• Key Challenges:
  • Difficulty acknowledging substance misuse and/or mental health problems.
  • Stigma, fear of disclosure, and confidentiality concerns.
  • Past negative experiences with services, mistrust of professionals.
  • Barriers such as housing instability, financial struggles, or legal issues.
• Best Practices:
  • Adopt a non-confrontational, empathetic approach.
  • Help meet immediate needs (food, shelter, benefits).
  • Offer flexible engagement methods (outreach, home visits).
  • Work with families/carers where possible.
  • Build motivation by exploring ambivalence and personal goals.

🟡 Persuasion (Working Towards Change)

Goal: Increase motivation for treatment by highlighting the benefits of change.

• Key Techniques:
  • Motivational Interviewing (MI): Strengths-based approach to reduce resistance.
  • Psychoeducation: Discuss the impact of substances on mental health.
  • Cycle of Change Model: Identify where the person is in their journey.
  • Decisional Balance Exercises: Explore pros and cons of continued substance use.
• Best Practices:
  • Normalise ambivalence and reinforce autonomy.
  • Use collaborative, non-judgemental conversations.
  • Ensure the person has access to support networks.
  • Offer structured, low-demand interventions (e.g., harm reduction strategies).

🔵 Active Treatment (Structured Intervention)

Goal: Actively support recovery and stabilisation.

• Interventions May Include:
  • Medication Management (e.g., antipsychotics, antidepressants, OST for opioid use).
  • Structured Psychosocial Interventions (e.g., CBT, DBT, relapse prevention therapy).
  • Integrated Substance Use & Mental Health Care (coordinated treatment plans).
  • Housing & Social Support (stable accommodation, peer groups).
• Best Practices:
  • Ensure multi-disciplinary collaboration (MH teams, GPs, social workers).
  • Address physical health issues (BBVs, nutrition, sleep, chronic conditions).
  • Develop a relapse prevention plan alongside harm reduction strategies.
  • Consider peer support and lived-experience interventions.

🟣 Relapse Prevention (Maintaining Recovery)

Goal: Support long-term stability and prevent return to harmful behaviours.

• Key Strategies:
  • Crisis Planning (managing triggers, recognising early warning signs).
  • Cognitive-Behavioural Techniques (identifying and restructuring thoughts).
  • Social & Community Integration (work, relationships, meaningful activities).
  • Ongoing Peer & Professional Support.
• Best Practices:
  • Help clients develop self-management skills and coping mechanisms.
  • Ensure regular review meetings to adapt the care plan.
  • Encourage gradual independence while maintaining structured support.
  • Recognise relapse as a learning opportunity, not failure.

🔹 Final Thoughts

Dual diagnosis treatment requires patience, flexibility, and a multi-agency approach. Engagement is the foundation, and ongoing support is crucial to sustaining recovery. Tailor interventions to each individual, ensuring person-centred, trauma-informed care.