May 9, 2013 by Dr. Bob Weathers
Today we are going to discuss the importance of incorporating a multidisciplinary treatment team in addressing co-occurring disorders. By means of review (of three previous blogs here; which please see): co-occurring disorders exist where there are twin diagnoses of substance abuse and psychiatric disorders (e.g., depression or anxiety). Sadly, there has historically been little, multidisciplinary integration of treatment to address these two, co-occurring diagnoses.
What then might be added, in terms of process and outcome variables, were disciplines to cooperate? Let’s start by identifying what makes up an effective multidisciplinary treatment team. At a minimum then, we need: professional mental health counselors, substance abuse/chemical dependency counselors, case managers, nursing staff persons, and consulting psychiatrists. Each of these treatment team members brings a unique and valuable perspective to the actual process of treatment; and each is accountable for possessing at least foundational knowledge of, and appreciation for, other perspectives represented on the treatment team.
In my own experience, as founding clinical director of a Malibu-area rehabilitation center, working in a multidisciplinary fashion is both essential and challenging. On the positive side: the generally held view at this rehab setting was that addiction is indeed a multifarious problem, requiring multiple levels of intervention to be effective. In practice, however, what I experienced was the at times highly competitive, even dismissive, nature between the various, represented disciplines.
For example, chemical dependency counselors — whose specialized training was in the treating substance abuse — would often get into arguments with mental health practitioners, with specialties in psychology and family therapy. Our on-staff, consulting psychiatrist could at times reduce clients’ addictive processes down to “nothing but” biochemical and other brain processes; while our equally highly trained alternative (Chinese) medicine practitioners would hold forth, again on the attack, in an exclusive language prescribing “what was really needed”: homeopathic remedies, nutrition, and re-aligned chi (life force energy).
What is required to move beyond such inter-disciplinary, territorial disputes is an open mind and increased familiarity with those domains beyond the borders of one’s own perspective. (As one model, see Dupuy, 2013.) But who stands to benefit the most is the client…
Take, for example, a client presenting with co-occurring disorders of depression and cocaine dependence. In a genuinely multidisciplinary setting, that client might meet first with the psychiatrist and nursing staff. The goal might well be first detoxifying the client’s body (biological perspective) from the effects of cocaine abuse. Only then might there be an opening into other, more adaptive means for the client’s physiological self-regulation; for example, with the possibility of introducing a course of anti-depressant medication.
Having initially detoxed the patient, then provided alternative routes to medical self-regulation, the next task might require the combined efforts of mental health and chemical dependency counseling staff. The former, mental health professionals would likely intervene with various forms of evidence-based psychotherapy which have proven effective in treating depression. The latter, substance abuse counselors would likely educate the patient in better understanding the addictive process (in this case, cocaine abuse as a temporary antidote to depressed mood), relapse prevention, and also likely provide a link or bridge to support group resources (e.g., 12-step programs like Cocaine Anonymous) — both while in inpatient treatment and upon discharge from the rehab.
Case managers would be working side-by-side with the above personnel, to ensure an effective aftercare plan; addressing family reconstitution, the job environment, and economic stressors, for example.
In such a model as the above, the aim of the multidisciplinary staff is to cooperate synergistically; truly providing a whole which is greater than the sum of its constituent parts (the various disciplines). The client, or patient, in such a multi-pronged intervention climate will be more likely to be retained in the process of treatment, as well as be more successful in the ultimate outcome of overcoming the addiction.
Dupuy, J. (2013). Integral recovery. Albany, NY: State University of New York.