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What are the most common challenges for clients with co-occurring issues in making positive life changes?

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Co-occurring issues, also known as dual diagnosis, refer to the presence of both a mental health and a substance use disorder in a client. This can make it harder for them to cope with their problems and to make positive life changes. Motivational interviewing (MI) is a client-centered and collaborative approach that helps clients explore and resolve their ambivalence about changing their behavior. MI can be effective for clients with co-occurring issues, but it also poses some challenges that need to be addressed. Here are some of the most common ones and how to overcome them.

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1 Complexity of issues

Clients with co-occurring issues often have complex and interrelated problems that affect their physical, psychological, social, and spiritual well-being. They may have multiple triggers, barriers, and goals that make it difficult to prioritize and focus on one change at a time. They may also have different levels of readiness and motivation for different aspects of their recovery. As a practitioner, you need to be flexible and adaptable in your MI approach, and tailor it to the individual needs and preferences of your client. You also need to help your client identify and address the root causes of their problems, and not just the symptoms.

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Dr. Joey (The Traveling Social Workers)? Pagano, DSW, LSW, CRS, FPS, Life Coach

?? 2024 Mental Health America, Pittsburgh Recovery Walk Advocate, NASW Emerging Leader, & PA Peer Support Coalition Award Winner?? | 2 X #1 Best-Seller & Pulitzer Contender ??? | Pioneer in SUD Education ??
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Clients with co-occurring issues often face challenges like stigmatization, which can hinder seeking help. They may struggle with complex symptoms, making diagnosis and treatment intricate. Managing multiple treatments simultaneously can be overwhelming. Additionally, fluctuating motivation and limited support systems often impede sustained progress. Financial constraints and access to comprehensive care services also pose significant barriers. Overcoming these requires tailored, integrated treatment plans, consistent support, and a strong focus on building resilience and coping strategies.

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2 Stigma and shame

Clients with co-occurring issues may face stigma and shame from themselves, their families, their peers, and their communities. They may feel guilty, hopeless, unworthy, or isolated because of their conditions. They may also internalize negative stereotypes and beliefs about themselves and their potential for change. These factors can lower their self-esteem, confidence, and trust, and hinder their engagement and participation in MI. As a practitioner, you need to create a safe and supportive environment for your client, and use affirmations, reflections, and summaries to express empathy, respect, and validation. You also need to help your client challenge and reframe their negative self-talk, and highlight their strengths, values, and achievements.

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3 Co-morbidity and relapse

Clients with co-occurring issues may have higher rates of co-morbidity and relapse than clients with single disorders. Co-morbidity means having other physical or mental health conditions that complicate or worsen the co-occurring issues. Relapse means returning to the problematic behavior after a period of abstinence or improvement. These factors can increase the risk of adverse outcomes, such as hospitalization, homelessness, incarceration, or death. They can also affect the client's motivation, commitment, and progress in MI. As a practitioner, you need to monitor and assess your client's health and well-being regularly, and refer them to appropriate services and resources when needed. You also need to help your client cope with stress, cravings, and triggers, and plan for possible setbacks and lapses.

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Ken Loftus

CEO, Clinical Director, Counsellor, Consultant
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Letting your client know about relapse is a very important tool. When your client is close to wrapping up their sessions or a particular topic, that is a great time to share that in their future, there may be a time that older non-beneficial thoughts may resurface, possibly due to a long weekend that included alcohol, late nights, an argument with a partner. They may think "Oh no, I'm back to square one!" which could have them spiral, but if they are already aware that slight relapse is possible, they will be able to catch those thoughts, bring self-awareness in to know that just because one old thought resurfaces, does not mean they will back track, but instead use their learned skills to get back on track.

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4 Collaboration and coordination

Clients with co-occurring issues may require a comprehensive and integrated treatment plan that involves multiple professionals and agencies. This can pose challenges for communication, coordination, and collaboration among the different providers and systems. It can also create confusion, inconsistency, or conflict for the client, who may receive different messages, expectations, or interventions from different sources. As a practitioner, you need to establish and maintain a good rapport and relationship with your client, and be their advocate and ally in their recovery journey. You also need to communicate and collaborate effectively with other providers and agencies, and ensure that your MI approach is compatible and consistent with the overall treatment plan.

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5 Here’s what else to consider

This is a space to share examples, stories, or insights that don’t fit into any of the previous sections. What else would you like to add?

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Ken Loftus

CEO, Clinical Director, Counsellor, Consultant
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With any client with substance use issues, it is important to psychoeducate them around addictions having a Physical Side and a Psychological Side. There are chemicals that will latch on to parts of our body / brain that increase the likelihood of physiological addiction, but also bring awareness to the behavioural side of the addictions. For example, smokers knowing that yes, nicotine is a highly addictive chemical, but if they need to alter their past behaviour habits, as in certain coffee breaks, or where they go for their walk - if both of these events also were associated with smoking.

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What are the most common challenges for clients with co-occurring issues in making positive life changes?

1

2

3

4

5

1 Complexity of issues

2 Stigma and shame

3 Co-morbidity and relapse

4 Collaboration and coordination

5 Here’s what else to consider

Motivational Interviewing

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What are the most common challenges for clients with co-occurring issues in making positive life changes?

1

2

3

4

5

1 Complexity of issues

2 Stigma and shame

3 Co-morbidity and relapse

4 Collaboration and coordination

5 Here’s what else to consider

Motivational Interviewing

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