Interventions
(written by Helen Sheppard, DipSW)

Working with clients with dual diagnosis is long-term work and different interventions can be used at different stages of the process.   There is limited research evidence in the UK about ‘what works’ in terms of effective interventions for people with substance use problems and mental ill health.

Mueser (2003) identified four stages of intervention:

1. Engagement: This is concerned with the development and maintenance of a therapeutic alliance between social worker and service user. The worker’s style should be non-confrontational and should not focus solely on the substance use. There will probably be more immediate practical needs that need to be met such as finances, housing, daytime activity.
2. Motivation for Change: Building motivation draws upon the principles of Motivational Interviewing. Its purpose is to strengthen a client’s motivation to change whilst avoiding confrontation and resistance. This can be done with education about substances and how they impact on mental health, decisional balance sheets that look at the pros and cons of continuing to use substances, and the reframing of past experiences, gently emphasising the negative influence of substance use.
3. Active Treatment:  It is important at the start of the intervention to agree the anticipated substance related goal. Abstinence may not be realistic and the goal may be harm reduction.
4. Relapse Prevention: This approach identifies high-risk situations for increasing the substance use and rehearses coping strategies.

In the UK, there is the Cognitive-Behavioural Integrated Treatment Approach (C-BIT) developed by the COMPASS project team in Birmingham.  This approach combines standard techniques used in cognitive therapy with the key cognitive elements from a number of psychosocial approaches, in order to facilitate change in the management of drug/alcohol use behaviour and psychosis. (For further reading on this approach see Graham et al. (eds.) (2004) Cognitive-Behavioural Integrated Treatment (C-BIT).  A Treatment Manual for Substance Misuse in People with Severe Mental Health Problems.  Chichester: John Wiley and Sons)

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