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Abstract: 

The term “co-occurring disorders” (CODs) refers to substance abuse or dependence occurring with one or more diagnoses of a mental health problem. Several long-term studies show low rates of spontaneous remission of substance abuse in clients who have severe mental health issues. One of the main challenges in treating this population is a lack of motivation on the part of the clients. They often have many external problems, including legal issues, hygiene problems, family entanglements, and financial catastrophes. These outside events create stress and a sense of hopelessness. The external problems are compounded by internal issues related to their mental illness and substance abuse. There is often a layer of denial with both diagnoses. Many clients present in a “clouded stupor” over how to proceed and where to go for help. At Alvis House, motivation is viewed as a key ingredient to engaging clients; basic trust needs to be built from day one. This means getting to know how our clients see their challenges/issues in order to start to develop basic relationships that will later support education and treatment. The authors review key strategies for successful motivation, overcoming obstacles to reentry, developing a crisis plan, and treatment models.

Keywords: Therapeutic relationships; screening; medication non-compliance; relapse; Integrated Treatment Model.

Affiliations:  1: Alvis House; 2: Alvis House.