Celebrating Small Victories : A Primer of title: Approaches & Attitudes for Helping Clients With Dual Disorders author: Montrose, Ken.; Daley, Dennis C. publisher: Hazelden Publishing isbn10 | asin: 1568380925 print isbn13: 9781568380926 ebook isbn13: 9780585150079 language: English subject Dual diagnosis. publication date: 1995 lcc: RC564.68.M66 1995eb ddc: 616.89/1 subject: Dual diagnosis. Page iii Celebrating Small Victories A Primer of Approaches & Attitudes for Helping Clients with Dual Disorders Ken Montrose, M.A. Dennis Daley, M.S.W. HAZELDEN ® Page iv Hazelden Center City, Minnesota 55012-0176 1995 by Hazelden Foundation All rights reserved. Published 1995 Printed in the United States of America No portion of this publication may be reproduced in any manner without the written permission of the publisher Library of Congress Cataloging-in-Publication Data Montrose, Ken. Celebrating small victories : a primer of approaches and attitudes for helping clients with dual disorders / Ken Montrose, Dennis Daley. p. cm. Includes bibliographical references and index. ISBN 1-56838-092-5 1. Dual diagnosis. I. Daley, Dennis C. II. Title. RC564.68.M66 1995 616.89'1dc20 95-18958 CIP Editor's note Hazelden offers a variety of information on chemical dependency and related areas. Our publications do not necessarily represent Hazelden's programs, nor do they officially speak for any Twelve Step organization. The personal stories in this book are composites of many individuals. Any resemblance to any one person, living or dead, is strictly coincidental. The Twelve Steps of AA and Twelve Traditions of AA are reprinted and adapted with permission of Alcoholics Anonymous World Services, Inc. The excerpt from The A. A. MemberMedications and Other Drugs is reprinted with permission of Alcoholics Anonymous World Services, Inc. Permission to reprint and adapt this material does not mean that AA has reviewed or approved the contents of this publication, nor that AA agrees with the views expressed herein. AA is a program of recovery from alcoholismuse of the Twelve Steps and Twelve Traditions in connection with programs and activities which are patterned after AA, but which address other problems, does not imply otherwise. Page v CONTENTS Preface ix Introduction 1 Part I: Mental Illness and Substance Abuse: A Different 3 View 1. Treatment Dilemmas 5 What Is the Diagnosis? 6 Mental Illness: A Predisposition to Use? 9 Alcohol and Other Drugs 14 Recovery 15 2. Selling Recovery 17 Selling Street Drugs vs. "Selling" Recovery 17 What Does She Want? 19 What Does He Hope to Avoid? 20 What If She Likes Her Drugs Better? 22 Intervening with Consumers and Families 24 Celebrating Small Victories 24 Becoming a Treatment Team Player 28 Quality Assurance: How Well Are Professionals "Selling" 30 Recovery? 3. Assessment 32 A Day in the Life 32 Trust Me, I'm Wearing White 35 It Never Ends, But It Always Changes 37 Who Would Lie to Someone Wearing White? 39 Who's Kidding Who? 42 The Myth of a Primary Diagnosis 44 Page vi 4. Attitudes of Professionals 48 Selling Long- Term Solutions 48 Giving Up 49 Enabling 50 Confronting 52 Being Needed 54 Doing It Yourself 56 Poor Me, Poor Me, Pour Me Another 58 Knowing Enough 59 Wearing Out 61 Seeing Things Differently 62 5. Coping with Symptoms: A Consumer's Eye View 66 The Paradox 66 Small Is a Relative Term 67 Living in the Chemical Culture 71 Developmental Delay 73 What Will People Think? 74 Part II: Treatment Strategies 79 6. Fundamentals of Dual Disorders Treatment 81 Relationships Between Dual Disorders 81 Assessment 82 Integrated Treatment 82 Motivation of Consumers 82 Therapeutic Alliance 83 Education 84 Recovery Skills 84 Self-Disclosure 84 Identification of Goals 85 Medication 85 Support 85 Community Resources 86 Family 86 Page vii Self-Help Groups 86 Phases of Treatment 86 Persistent Symptoms 87 Setbacks 87 7. Nuts and Bolts Issues in Daily Recovery 89 Coping with Cravings 89 Coping with People, Places, and Things 91 Structuring Free Time 92 Coping with Psychiatric Symptoms 94 Coping with Remission 94 Being Real 96 Dealing with Relapse 96 Staying Safe 100 Experiencing Withdrawal 101 8. Recovery Slogans 103 Don't Pick Up the First Drink or Drug 104 One Day at a Time 106 Hungry, Angry, Lonely, or Tired (HALT) and Other 108 Slogans 9. Timelines and Denial 111 10. Contingency Cards 122 11. Twelve Step Programs 126 Not Getting Lost on the Road to Recovery 126 A Better Way 127 The Recovery Network 131 12. Group Treatment Approaches 132 Interventions of Group Leaders 132 Psychoeducational Groups 135 Possible Structure of Psychoeducational Group Sessions 137 Problem-Solving Groups 139