Co-occurring Alcohol and Other Drug and
Mental Health Conditions in Alcohol and
other Drug Treatment Settings
Session 4:
Management and
Treatment
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Comorbidity Guidelines
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Refer to:
 Chapters 7 and 8
 Appendix C – Case Studies
 Appendices D, Q to Ee
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Management vs Treatment
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Management of symptoms of mental illness
to allow AOD treatment to continue with
minimal disruption to retain clients in
treatment
Treatment refers to evidence-based practice
for working with comorbidity
Suggested treatments may be beyond scope
of some AOD workers – awareness only
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Managing Comorbidity
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Comorbid mental health symptoms can be
managed and controlled whilst the client
undergoes AOD treatment
Consider whole person (from psychological,
physical and socio-demographic perspectives)
when managing symptoms of comorbid
mental conditions
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Managing Comorbidity
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Suicide risk should be monitored throughout
treatment
Motivational enhancement, simple CBT-based
strategies, relaxation and grounding
techniques can be useful in managing AOD
use as well as mental health conditions
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Managing Comorbidity
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Symptoms of trauma, grief, loss can be
managed through anxiety management
strategies and open discussion with client
When dealing with more challenging clients
ensure safe environment, set clear
boundaries and place strong emphasis on
engagement and rapport building
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Managing Suicidality
“Dos and Don’ts”
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Managing Symptoms of
Depression
“Dos and Don’ts”
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CBT and Symptoms of
Depression
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Cognitive restructuring
Pleasure and mastery events scheduling
Goal setting
Problem solving
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Cognitive Restructuring
A. Antecedent –Event
that triggers automatic
thoughts
B. Beliefs about event –
Automatic thoughts
C. Consequences – feelings/behaviours that result
from thoughts
D. Disputing automatic thoughts – look for evidence to
support/disprove these thoughts
E. Alternative explanation – Rational
alternatives to the automatic thought
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Anxiety, Panic or Agitation
“Dos and Don’ts”
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Managing Symptoms of anxiety,
panic or agitation
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Progressive muscle relaxation
Controlled or abdominal breathing
Calming response
Visualisation and imagery
Grounding
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Managing Symptoms of
Trauma
“Dos and Don’ts”
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Managing Grief and Loss
“Dos and Don’ts”
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Phases of Aggression
(Source: NSW Department of Health 2007)
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Managing Aggression
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Listen actively
Acknowledge the problem/situation
Separate from others
Sit down
Indicate possible options
Encourage client to try these options
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Managing Aggression
“Dos and Don’ts”
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Managing Symptoms of Psychosis
“Dos and Don’ts”
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Managing Personality Disorder
Symptoms
“Dos and Don’ts”
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Managing Cognitive Impairment

Techniques for problem-solving, planning,
sequencing or decision-making difficulties
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Be clear and explicit in direction
Encourage rehearsal of sequences
Encourage routines
Teach step-by-step decision-making and problemsolving
Use timetables and other aids to help client plan
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Managing Cognitive
Impairment
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Techniques for slow information processing
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Summarise and repeat important points; have
client relay these back to you
Encourage questions
Go slowly
Techniques for poor attention/concentration
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Stress important points, repeat if necessary
Minimise distractions
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Managing Cognitive
Impairment
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Techniques for poor memory
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Use memory aids, routines and written
instructions
Make sessions at routine times
Limit amount of information covered, repeat key
points, and go slowly
Remind the client of appointments and key points
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Treatment of Comorbidity
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Good treatment requires a good therapeutic
alliance which includes client choice (including
not to be involved in treatment)
Some interventions have been designed for
treatment of specific comorbidities; however,
interventions have not been well researched
In absence of research on comorbid
disorders, recommended to use most
effective treatments for each disorder
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Treatment of Comorbidity
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Both psychosocial and pharmacological
interventions have been found to have some
benefit in treatment of comorbidities
When pharmacotherapy is used, this should
be accompanied by supportive psychosocial
interventions
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Models of Care
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Sequential treatment
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Parallel treatment
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Integrated treatment
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Stepped care
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Motivational Interviewing with
Co-occurring Disorders
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Increasing research base for applying MI with
clients with co-existing disorders
“Spirit” of MI can be useful for engaging
clients to address both MH and AOD concerns
Principles and strategies for using MI detailed
in Appendix D of Comorbidity Guidelines
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Cognitive Behavioural Techniques
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Evidence-based treatment approach used in
both AOD and MH settings
Particularly useful for managing symptoms of
anxiety and depression
Underpinnings of Relapse Prevention in both
AOD and MH contexts
See Appendix Q of Comorbidity Guidelines for
an overview of techniques for using
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Other Treatment Approaches
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Psychosocial groups
Self-help groups
Mindfulness training
Contingency management.
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Medications
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Medications form part of evidence-based
practice in treatment of mental health
concerns.
Stabilising on appropriate medications and
continued use whilst in AOD treatment can be
essential to successful outcome for both AOD
and MH
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Commonly Prescribed
Medications
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Antidepressants
Mood stabilising medications
Anti-anxiety Medications
Antipsychotic Medications
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Medication Adherence
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Making regimes as simple as possible
Giving clear instructions
Associating medication with predictable daily
events such as meal times
Using pill dispensing containers with daily
organisers
Using alarms
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Medication Adherence
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Acknowledge any reluctance to take
medications and allow client to express these
concerns
Motivational interviewing, contingency
management and CBT have been shown to
be particularly useful in improving medication
compliance
Facilitate discussion with medication
prescriber if necessary
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In sum…
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Range of approaches for managing symptoms
of mental illness within AOD treatment
settings
Treatment of co-existing disorders can occur
within AOD settings
Further training in specific treatment
approaches is recommended
Refer to Chapters 7 and 8 and Appendices in
Guidelines for further information
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