Brief Integrated Motivational Intervention E-Book

Hermine L. Graham

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 177

Veröffentlichungsjahr: 2016

Beschreibung

BRIEF INTEGRATED MOTIVATIONAL INTERVENTION BRIEF INTEGRATED MOTIVATIONAL INTERVENTION

A TREATMENT MANUAL FOR CO-OCCURRING MENTAL HEALTH AND SUBSTANCE USE PROBLEMS

Brief Integrated Motivational Intervention provides clinicians and specialist practitioners with a brief, evidence-based treatment approach for motivating clients who have comorbid mental health and alcohol and drug misuse issues. Developed by an expert team with many years of research and practice experience in the fields of psychosis and addiction, this approach combines cognitive behavioural therapy (CBT), motivational interviewing, and the authors’ own cognitive-behavioural integrated treatment (C-BIT). It allows practitioners to engage clients in meaningful dialogue for change during short windows of opportunity following relapses or admittance to psychiatric hospital, and helps clients consider the impact of substance misuse on their mental health. Easy to understand and implement, this guide also includes helpful tools for practitioners, such as session-specific content, illustrative case material, easy-to-use worksheets, and additional information for family members and friends.

Leseprobe

Table of Contents

Cover

Title Page

About the Companion Website

About the Authors

Acknowledgments

CHAPTER ONE: Introduction

A Window of Opportunity

Brief Integrated Motivational Intervention (BIMI)

CHAPTER TWO: Getting Started

Staying Motivated

STEP 1: Building Engagement and Assessment

Session One Overview

Session One Outline

Session Two Overview

Session Two Outline

Frequently Asked Questions (FAQs)

CHAPTER THREE: Making Decisions About Change

How to Decide on the Next STEP

STEP 2: Making Decisions with Your Client

Outline of Sessions

Taking Another Look at What You Think About Alcohol and Drugs

Relationship Between Mental Health Problems and Substance Use

Reviewing Any “Costs” of Using

CHAPTER FOUR: Change

STEP 3: Change Plans and Social Support

Outline of Sessions

Social Support for Change

Developing Supportive Social Networks

Helpful Information for Family Members or Supportive Social Network Members

CHAPTER FIVE: Boosting Change

Booster Session Content

Booster Session Outline

Link in with Community‐based Substance Misuse Treatment Services

APPENDIX: Worksheets and Handouts

Worksheet 1: What Do I Enjoy About Using or What Keeps Me Using?

Worksheet 2: What I Enjoy About Using or What Keeps Me Using (Table)

Worksheet 3: How Does My Use Sometimes Affect Me?

Worksheet 4: Taking Steps Toward My Goal

Handout 1: Helpful Information for Family Members or Supportive Social Network Members

Handout 2: How Can I Best Support My Family Member or Friend?

References

Index

End User License Agreement

List of Tables

Chapter 01

Table 1.1 Overview of BIMI.

Table 1.2 Booster Session Content.

Chapter 02

Table 2.1 BIMI Brief Assessment Sheet.

Table 2.2 BIMI Brief Assessment—

Case Example Crystal

.

List of Illustrations

Chapter 02

Figure 2.1 Example of using stress‐vulnerability model.

Chapter 03

Figure 3.1 How to decide which step is best suited.

Chapter 04

Figure 4.1 An example of a social network diagram.

Guide

Cover

Table of Contents

Begin Reading

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Brief Integrated Motivational Intervention

A Treatment Manual for Co-occurring Mental Health and Substance Use Problems

Hermine L. Graham, Alex Copello, Max Birchwood, and Emma Griffith

This edition first published 2016© 2016 John Wiley & Sons, Ltd

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Library of Congress Cataloging-in-Publication Data

Names: Graham, Hermine L., author. | Copello, Alex, 1957– author. | Birchwood, M. J., author. | Griffith, Emma (Psychologist), author.Title: Brief integrated motivational intervention : a treatment manual for co-occurring mental health and substance use problems / Hermine L. Graham, Alex Copello, Max Birchwood, Emma Griffith.Description: Chichester, UK ; Hoboken, NJ : John Wiley & Sons, 2016. | Includes bibliographical references and index.Identifiers: LCCN 2016024932| ISBN 9781119166658 (pbk.) | ISBN 9781119166672 (epub)Subjects: LCSH: Crisis intervention (Mental health services) | Substance abuse–Treatment. | Mental health–Treatment. | Remotivation therapy.Classification: LCC RC480.6 G713 2016 | DDC 616.89/14–dc23LC record available at https://lccn.loc.gov/2016024932

A catalogue record for this book is available from the British Library.

Cover image: Gettyimages/ImpaKPro

To Chloe and Niamh (HG)

To my family and friends (EG)

About the Companion Website

This book is accompanied by a companion website:

www.wiley.com/go/graham/bimi

The website includes:

Handouts and worksheets

About the Authors

Hermine L. Graham is a consultant clinical psychologist and lecturer at the University of Birmingham, United Kingdom. She has expertise in cognitive behavioral therapy, and has led the development and research of service models and treatment approaches for people with severe mental health and co‐occurring alcohol and drug problems in Birmingham. This work has been highlighted as a model of “good practice,” and is referenced in national policy guidelines for the treatment of “dual diagnosis” (DOH, 2002). She has published widely in peer‐reviewed academic journals and is co‐author of Cognitive‐Behavioral Integrated Treatment (C‐BIT): A Treatment Manual for Substance Misuse in People with Severe Mental Health Problems (Wiley, 2004) and co‐editor of Substance Misuse in Psychosis: Approaches to Treatment and Service Delivery (Wiley, 2003).

Alex Copello is a professor of addiction research at the School of Psychology at the University of Birmingham, United Kingdom, and a consultant clinical psychologist with the Birmingham and Solihull Mental Health NHS Foundation Trust. His career has combined clinical and academic work, and his research has had a major impact on addiction treatment in the United Kingdom in recent years. He has been widely published in academic scientific journals and has authored and edited many books, including Social Behavior and Network Therapy for Alcohol Problems (Routledge, 2009); Coping with Alcohol and Drug Problems: The Experiences of Family Members in Three Contrasting Cultures (Routledge, 2005); Cognitive‐Behavioral Integrated Treatment (C‐BIT): A Treatment Manual for Substance Misuse in People with Severe Mental Health Problems (Wiley, 2004); and Substance Misuse in Psychosis: Approaches to Treatment and Service Delivery (Wiley, 2003).

Max Birchwood is a professor of youth mental health at the University of Warwick, United Kingdom. He pioneered the concept and practice of early intervention in psychosis and opened the UK’s first early intervention in psychosis service in 1994. He has published widely in the field of psychosis and is the author of many books, including Early Intervention in Psychosis: A Guide to Concepts, Evidence and Interventions (Wiley, 2000); Cognitive Therapy for Delusions, Voices and Paranoia (Wiley, 1996); A Casebook of Cognitive Behavior Therapy for Command Hallucinations: A Social Rank Theory Approach (Routledge, 2005); Cognitive‐Behavioral Integrated Treatment (C‐BIT): A Treatment Manual for Substance Misuse in People with Severe Mental Health Problems (Wiley, 2004); and Substance Misuse in Psychosis: Approaches to Treatment and Service Delivery (Wiley, 2003).

Emma Griffith is a Lecturer and Clinical Tutor for the Doctorate in Clinical Psychology at the University of Bath, UK, and also works as a Principal Clinical Psychologist in Avon and Wiltshire Partnership Mental Health NHS Trust. She is accredited as a Behavioural and Cognitive Psychotherapist in CBT by the British Association for Behavioural & Cognitive Psychotherapies (BABCP). She has published a number of journal articles and is the co‐author of a book chapter.

Acknowledgments

The research trial that evaluated the Brief Integrated Motivational Intervention program was funded by the National Institute for Health Research (NIHR)—Research for Patient Benefit research grant (PB‐PG‐1010‐23138), and sponsored by Birmingham and Solihull Mental Health NHS Foundation Trust (BSMHFT). We are thankful for the invaluable input from Nick Freemantle and Paul McCrone as co‐applicants in the research trial, and grateful to Latoya Clarke, Kathryn Walsh, and Chrysi Stefanidou for their involvement as research associates. We greatly appreciate the support and involvement of the inpatient and community staff and service users in BSMHFT who were willing to trial the approach. Special thanks are owed to Jon Kennedy and Gary Roberts for their openness to us piloting the approach on the inpatient units, and to the members of the COMPASS program team (Jo Leci, Rob O’Brien, David Ryan, Catherine Henry, Helen Tuffey, Debbie Boulton, Sue Middleton, and Gemma Martin) and Dionne Harleston for their input into drafts of the manual and for being willing to trial the treatment approach. We also appreciate the input of Blessing Marandure on the effects of cannabis on mental health and Greg Griffith for producing Figure 2.1. Finally, we thank the service user researchers and consultants for ensuring this treatment approach was relevant.

CHAPTER ONEIntroduction

A Window of Opportunity

In healthcare settings, a number of opportunities to talk to clients about health‐related behaviors (e.g., tobacco, alcohol, or drug use) are often “missed,” which may have indirectly contributed to them being admitted or referred for treatment (e.g., Buchbinder, Wilbur, Zuskov, Mclean & Sleath, 2014). Often viewed as “precontemplators,” these clients do not recognize their behavior as causing any problems or as the primary presenting problem. However, it has been suggested that such occasions—that is, when problems are acute—represent “teachable moments” (e.g., Lau et al., 2010; Buchbinder et al., 2014) that present staff in healthcare settings with natural “windows of opportunity” to start conversations about behaviors that may have indirectly impacted on their clients’ physical and mental health (Graham, Copello, Birchwood et al., 2016). As such, there exists a significant need for brief interventions that can be delivered in inpatient or acute healthcare settings, when clients who are not necessarily motivated to talk about their substance abuse are more “open” to considering their use. This period can be viewed as a “window of opportunity” to help clients gain insight into the role of substance use in triggering acute mental health symptoms or hospital admissions, and to improve their engagement in treatment.

Drug and alcohol use and misuse are common in clients who experience severe mental health problems (Regier et al., 1990; Mueser et al., 2000; Graham et al., 2001; Swartz et al., 2006). Substance misuse in this population has been found to be associated with poorer engagement in treatment, more symptoms and relapses, and poor treatment outcomes (Mueser et al., 2000; Graham et al., 2001; Swartz et al., 2006). In addition, these clients often express low motivation to change their drug and alcohol use (McHugo, Drake, Burton & Ackerson, 1995; Carey, 1996; Swanson, Pantalon & Cohen, 1999), and are often poorly engaged in treatment, which forms a significant barrier for change and good treatment outcomes (Mueser, Bellack & Blanchard, 1992; Swanson et al., 1999; Drake et al., 2001; Mueser, 2003). Drug and alcohol misuse have also been found to be associated with increased psychiatric hospital admissions, and seems to have a negative impact on inpatient stays (Lai & Sitharthan, 2012). Therefore, unsurprisingly, 22–44% of those admitted in the United Kingdom into psychiatric inpatient facilities for mental health problems have been found to also have coexisting alcohol or drug problems (DOH, 2006). In the United Kingdom, national health policy guidance has pointed to the need to train staff to improve routine assessment and treatment of substance misuse as part of the clinical management strategy of a psychiatric admission (DOH, 2006). Nonetheless, this has remained a significant gap in service provision (DOH, 2006; Healthcare Commission, 2008), and this natural window of opportunity is often missed.

As the acute symptoms of mental ill health decline for an inpatient, this can be a time of contemplation, when he or she reflects on how they “ended up in hospital.” It may be a window of increased awareness and insight into the factors that contributed to him or her becoming unwell and/or being admitted in a hospital. However, this increased “insight” may result in increased emotional distress, and some research has shown that post‐discharge is a time when individuals may “seal over” the experience, in an attempt to reduce emotional distress. That is, the inpatient may deny or minimize any recent mental health symptoms or experiences and precipitating factors, because they may be too upsetting to think about. As a result, he or she may lose awareness of the triggers for becoming unwell (Tait, Birchwood & Trower, 2003). Sealing over the experience of relapse was found to predict low engagement with services 6 months after discharge for inpatients (Tait et al., 2003). However, we know that engagement in treatment is key to improving treatment outcomes for mental health clients (Carey, 1996; Swanson et al., 1999).

The Brief Integrated Motivational Intervention (BIMI) seeks to target this window of contemplation. It provides clinicians with a brief, targeted, easy‐to‐use intervention that motivates people who experience mental health problems to engage in treatment and make changes in their substance use (Graham, Copello, Griffith et al., 2015). The approach seeks to raise awareness of the impact of drugs and alcohol on mental health. BIMI is empirically grounded in cognitive behavioral therapy (e.g., Beck, Wright, Newman & Liese, 1993; Greenberger & Padesky, 1995) and motivational interviewing (e.g., Hettema, Steele & Miller, 2005). It draws on the initial phases of the longer‐term integrated treatment approach C‐BIT (Graham et al., 2004), and on developments in the use of brief interventions in the treatment of substance use in those who experience severe mental health problems (Carey, Carey, Maisto & Purnine, 2002; Kavanagh et al., 2004; Edwards et al., 2006; Kay‐Lambkin, Baker, Kelly, Lewin & Carr, 2008; Baker et al., 2009). It reflects the research evidence on increasing engagement and motivating behavior change in those with co‐morbid mental health and substance misuse. BIMI was initially developed and piloted in a randomized controlled trial in acute mental health inpatient settings and has demonstrated positive outcomes for engaging inpatients with severe mental health problems in addressing their drug and alcohol use (Graham, Copello, Griffith et al., 2015).

Brief Integrated Motivational Intervention (BIMI)

Approach

BIMI is designed to be delivered by routine mental health staff or specialist practitioners. This treatment manual provides a framework, session content, illustrative case material, and easy‐to‐use worksheets that can be used when delivering it. BIMI promotes a practical conversational style that seeks to build a good collaborative working relationship as you work together toward the client’s self‐identified goals. It is targeted in its approach and is recommended to take place over a brief period, ideally 2 weeks. Sessions can range from one to a maximum of six, depending on the client, and are intended to be delivered in short bursts, each of 15–30 minutes duration. The evaluation of BIMI was performed by staff members who were trained in the approach and who received case supervision. The evaluation found that, on average, an inpatient received three sessions, in addition to the initial assessment session, each of an average duration of 17 minutes, and that the total time that clinicians (i.e., nurses, occupational therapists, healthcare assistants, activity workers, specialist dual‐diagnosis clinicians) spent receiving the intervention was 57 minutes over the 2‐week period. This short‐burst approach was found to be sufficient to produce improved engagement in substance misuse treatment and some behavior change (Graham, Copello, Griffith et al., 2015). The number of sessions and their duration would best be determined by the needs of the client. Small amounts of information can be discussed in sessions, and it is helpful to provide frequent reflections and summaries of key points talked about during the sessions. Information can be presented in a number of ways (e.g., verbal, written).

Timing

The primary aim of the treatment approach is to quickly engage clients in meaningful change talk about their alcohol or drug use. BIMI is provided relatively early on in the treatment process (e.g., within the first few weeks of an inpatient’s stay in hospital or when presenting at mental health services when acutely unwell). The idea is to maximize the potential of this window of opportunity and teachable moment. This would enable the intervention to take place when problems are acute and clients are “primed” to consider health issues. At this point, the clients are considered to be more cognitively open to engage in considering the links between the issue that led to them being referred or admitted and other health‐related behaviors. By providing a few minutes of quiet time, over a short period, clients can reflect on their use of drugs and alcohol and start to consider the impact of such use on their physical and mental health. The timing is key and balanced with the initial acute symptoms subsiding and it being considered clinically appropriate.

Structure

BIMI uses a simple three‐step framework (see Table 1.1 for an overview of the structure). The initial step (STEP 1) involves carrying out a brief assessment and then providing clients with personalized feedback of the information gathered in this assessment. The feedback details the clients’ patterns of substance use and highlights its potential impacts on their physical and mental health. It is also recommended that clients be provided with individually tailored psychoeducational material/leaflets about the substance(s) they are using. The second step (STEP 2) aims to help clients make decisions about what outcomes/goals they want. This involves using strategies aimed at: increasing awareness of the perceived “benefits” of use and reflection on the “costs” associated with continued substance misuse; re‐evaluation of positive thoughts and beliefs about substances that promote use; and building awareness of how substance use and mental health may interact and worsen each other by identifying a maintenance/vicious cycle. The third step (STEP 3) encourages clients to contemplate change and develop a change plan based on a self‐identified goal, using goal planning. This helps in making change feel possible and achievable. Included are also strategies to cope with setbacks, cravings, and urges, and to provide social support for change. Not all the steps in BIMI need to be delivered. The essential step is STEP 1. The main idea is to engage clients in the step suitable for them, so that they can meaningfully talk about and re‐evaluate their alcohol or drug use (see Box 1.1, for an overview of how to decide which step is best suited). If necessary, and if the setting allows, a “booster session” (see Table 1.2) can be offered 1 month after the last session to help consolidate motivation and ensure that clients have the skills and strategies necessary to access longer‐term help to address their substance use. It is important, if possible, to provide continuity of care—for example, if the client is an inpatient, liaising with the community team concerning the progress that the client has made during BIMI. This process would be facilitated by having a planning meeting with the client and the clinician from the community services team to discuss the work, the client’s goals, and strategies to translate gains to a community setting.

Table 1.1 Overview of BIMI.

Session Content

Session Goals

STEP 1: Building Engagement and Assessment

Carry out brief assessment and score questionnaires

Provide personalized feedback to the client from the assessment regarding:

Levels of use

Identify the client’s thoughts and feelings about the personalized assessment feedback

Potential impact of substance use on mental health

Provide material regarding:

Drug and alcohol use and national patterns/norms

Impact of alcohol and drug use on mental health, functioning, and relapse

Engagement and building rapport