Treatment Techniques for Co-occurring Substance Use and Mental Disorders

This chapter focuses on a basic level of practice: basic techniques that underlie the common clinical approaches that community psychiatrists and other clinicians use in treating patients with co-occurring substance use and other mental disorders (COD). This focus does not describe new interventions for COD or describe standard treatment approaches, but rather offers a clinically oriented way for clinicians to think about them and facilitate their implementation. Skills are basic clinical abilities such as listening to patients, asking open-ended questions, assessing acute risk, maintaining professional boundaries, and developing differential diagnoses. Competence in these basic skills is prerequisite for clinicians wishing to treat COD. Techniques are clinical interventions within a conceptual hierarchy ranging from the basic skills through complex clinical strategies and are the main clinical procedures that clinicians use to conduct treatment. They are how the clinician applies their skills to achieve a specific outcome, such as establishing a therapeutic alliance or managing intoxication. Tactics are the stage-specific and graded clinical decisions about the method and timing to implement specific techniques, since patients are differentially receptive to techniques depending on individual characteristics such as motivational stage, severity of psychopathology, cognitive functioning, and living environment.