First, when working with a population with co-occurring disorders it is vital they are able to be accurately assessed quickly so they will be able to be placed into treatment which meets their needs as quickly as possible. Diagnosing clients with depression and substance abuse/dependence, needs to meet the criteria with the current DSM. Substance abuse and dependence in the DSM tends to be confusing due to the clinician making the diagnosis based out of their limited “snap shot” of information and context. The daunting task of assessing as accurately as possible is vital to address the placement criteria.
Working with those with co-occurring diagnosis may require the clinician to have specific training due to the nature of having varying complications. The training may require for those to have a multi-problem view point to cover the multidimensional problems which may or have occurred. Client’s with the diagnosis of depression and substance abuse/dependence need to have a treatment plan which is client-centered. “A client-centered treatment plan is based on a careful assessment inclusive of immediate needs, motivation for change, and readiness to change.” (p 23).
Creating the therapeutic alliance and sustaining it is vital for the client to be able to trust and rely on the clinician for help. “An early and strong therapeutic alliance is critical to successful treatment.”...
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...ossible adverse interactions between an antidepressant medication and the substances a patient is abusing (such as the potential for increased sedation or intoxication).” (p 29).
Working with any type of disorder can be challenging, let alone working with co-occurring disorders. It takes a skilled clinician to separate the symptoms of the diagnoses to best treat them. One way to assist the client in managing these symptoms is to educate the client on the slow process of repairing the brain, the post-acute withdrawal symptoms, and depressive symptoms. Non-judgmental and active listening techniques contribute in building a strong therapeutic alliance with the client while altering the experience of the client. Healing from substance use and depression is a very challenging and requires the partnership of the clinician and the client in order to have lasting recovery.
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