Cognitive-Behavioural Integrated Treatment (C-BIT) A Treatment Manual for Substance Misuse in People with Severe Mental Health Problems

by Graham, Hermine L.; Copello, Alex; Birchwood, Max J.; Mueser, Kim T.; Orford, Jim; McGovern, Dermot; Atkinson, Emma; Maslin, Jenny; Preece, Mike; Tobin, Derek; Georgiou, George

• ISBN13: 9780470854372
• ISBN10: 0470854375
• Edition: 1st
• Format: Hardcover
• Copyright: 2003-12-02
• Publisher: WILEY

Summary

This exciting new book addresses the important issue of how to provide integrated mental health and substance misuse treatment of individuals with these co-occurring disorders. Combining both theory and practice, by the use of illustrative clinical case material, it provides a survey of different approaches to the integration of mental health and substance misuse services. A unique collection of chapters, from authors who are experts in the field and pioneering innovative approaches, provides an international perspective (including UK, Germany, Australia, USA, Canada) of treatment. Arranged in five sections, Section 1 provides an introduction to the issue of substance misuse amongst those with psychosis. Section 2 introduces a range of integrated service models from different countries. The third section provides a practical hands-on guide to assessment and treatment. The fourth section addresses the specific treatment needs of special population groups (including young people, forensic groups, homeless people and those with HIV/AIDS). The final section examines treatment outcome studies and implications for the future.Clinical psychologists, psychiatrists, nurses, case managers, and psychiatric social workers in training and practice in clinic, hospital and community settings will find this book an essential practical resource for working with individuals (and their families) with co-occurring disorders.

Author Biography

Dr Hermine L. Graham is a Consultant Clinical Psychologist and Lecturer on the Doctorate in Clinical Psychology course at the University of Birmingham, UK. She has led a programme of collaborative research and service innovation in the NHS focused on the integration of substance misuse treatment into mental health services.

Table of Contents

About the Authors	p. xi
Aims of the Book	p. xv
Acknowledgements	p. xvii
Introduction to Cognitive-Behavioural Integrated Treatment (C-BIT)	p. 1
Issues in Working with those with Coexisting Severe Mental Health Problems Who Use Substances Problematically	p. 3
The Nature of Coexisting Severe Mental Health and Alcohol/Drug Problems	p. 3
Models of Comorbidity	p. 6
Obstacles to Treatment and Behaviour Change	p. 9
Treatment Needs	p. 10
Overview of C-BIT Approach	p. 14
Objectives	p. 14
Structure	p. 15
How to Know When to Move on to the Next Phase	p. 16
Treatment Sessions	p. 20
Overview of C-BIT Theory and Techniques	p. 22
Brief Introduction to Cognitive Therapy	p. 22
Cognitive Therapy Techniques in C-BIT	p. 28
Cognitive-Behavioural Integrated Treatment (C-BIT)	p. 37
C-BIT Core Components	p. 39
Assessment Phase: Screening and Assessment	p. 39
Clinical Assessment of Drug/Alcohol Use	p. 40
Assessment and Screening Tools	p. 42
Case Formulation	p. 46
Treatment Planning	p. 49
Treatment Phase 1: Engagement and Building Motivation to Change	p. 51
Strategies to Increase Engagement	p. 51
How to Put Drug/Alcohol Use on the Agenda	p. 55
Building on Motivation for Change	p. 59
Dealing with Resistance	p. 64
Identifying Social Networks Supportive of Change	p. 65
Finances/Money Management	p. 68
Treatment Phase 2: Negotiating Some Behaviour Change	p. 73
Identifying and Setting Achievable Harm-Reduction Goals	p. 73
Working with Resistance to Goal Setting	p. 75
Identifying Activities of Interest	p. 79
Engaging the Client's Interest in the Activity	p. 81
How to Build Social Networks Supportive of Change	p. 81
Strategies to Increase Awareness of Problematic Links Between Mental Health and Substance Use	p. 84
Treatment Phase 3: Early Relapse Prevention	p. 88
Formulating Problems: Cognitive Model of Substance Use	p. 88
Relapse Prevention: Helping Your Clients Manage Their Substance Use	p. 93
Relapse Prevention: Including Social Network Member(s)	p. 94
Coping with Cravings and the Abstinence-Violation Effect	p. 99
Relapse Prevention: For Substance Use and Its Links with Mental Health	p. 102
Treatment Phase 4: Relapse Prevention/Relapse Management	p. 106
Including Social Network Member(s) in Relapse Prevention	p. 107
Identifying a Relapse Signature to Psychotic Relapses and Role of Substance Use	p. 108
Developing a Comprehensive Relapse-Prevention/Relapse-Management Plan	p. 116
Using a Comprehensive Relapse-Prevention/Management Plan--Relapse Drill	p. 118
Additional Treatment Components I--Skills Building	p. 122
Coping with Different Moods: Anxiety	p. 122
The Role of Substances in Creating or Maintaining Anxiety	p. 122
Starting Out: Assessing Anxiety	p. 123
Strategies to Manage Anxiety	p. 125
Coping with Different Moods: Anger and Impulse Control	p. 136
The Role of Drugs/Alcohol in Creating/Maintaining Anger	p. 137
The Role of Psychosis in Creating/Maintaining Anger	p. 138
Starting Out: Assessing Anger	p. 138
Strategies to Manage Anger	p. 140
Impulse Control	p. 148
Coping with Different Moods: Depression	p. 151
The Role of Drugs/Alcohol in Creating and Maintaining Depression	p. 152
The Role of Psychosis in Creating/Maintaining Depression	p. 152
Starting Out: Assessing Depression	p. 153
Strategies to Manage Depression	p. 154
Communication: Social Skills	p. 164
Social Skills	p. 165
Social Skills Training for Mental Health Problems and Substance Use	p. 166
Social Skills Training	p. 167
Applying Social Skills to Specific Situations	p. 173
Assertiveness	p. 175
Assertiveness Training	p. 178
Strategies to Tackle Lack of Assertiveness	p. 179
Applying Assertiveness Skills to Specific Situations	p. 188
Self-Esteem	p. 194
Effect of Low Self-Esteem on Mental Health and Drug/Alcohol Use	p. 194
Effects of Psychosis and Drugs/Alcohol on Self-Esteem	p. 195
Starting Out: Assessing Self-Esteem	p. 196
Strategies to Improve Self-Esteem	p. 197
Lifestyle Balance	p. 205
Strategies to Encourage Lifestyle Balance	p. 206
Increasing Activity Levels	p. 206
Time Management	p. 212
Money Management	p. 213
Additional Treatment Components II--Families and Social Network Members	p. 215
Working with Families and Social Network Members	p. 215
Provision of Psychoeducation	p. 216
Encouraging Involvement	p. 221
Practical Coping Strategies and Skills	p. 223
Implementation Issues	p. 231
Implementation Issues	p. 233
Overview	p. 233
Implementation Obstacles and Solutions	p. 233
Training and Supervision (Capacity Building)	p. 237
Organisational Factors	p. 238
Overview of the Evidence Base and Future Directions for Research	p. 239
Appendices	p. 245
References	p. 285
Index	p. 295
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