Brief Integrated Motivational Intervention A Treatment Manual for Co-occuring Mental Health and Substance Use Problems

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.

About The Companion Website xi

About The Authors xii

Acknowledgments xv

1 Introduction 1
A Window of Opportunity 1
Brief Integrated Motivational Intervention (BIMI) 4
Approach 4
Timing 4
Structure 5
2 Getting Started: Engagement And Brief Assessment 8
Staying Motivated 8
Step 1: Building Engagement And Assessment 9
Session One Overview 10
Session One Outline 10
BIMI Brief Assessment 12
Generating The Personalized Assessment Feedback Sheet 31
Session Two Overview 36
Session Two Outline 36
Frequently Asked Questions (Faqs) 42
Alcohol 43
Drugs And Mental Health 46
Additional Resources 52
3 Making Decisions About Change 53
How To Decide On The Next Step 53
How To Decide What Step Is Appropriate For The Client 53
Step 2: Making Decisions With Your Client 56
Outline Of Sessions 57
Identifying The “Benefits” Of Using 57
Identifying Positive Thoughts And Mis‐Held Beliefs About Alcohol And Drugs 58
Taking Another Look At What You Think About Alcohol And Drugs 60
Relationship Between Mental Health Problems And Substance Use 62
Reviewing Any “Costs” Of Using 65
4 Change 69
Step 3: Change Plans And Social Support 69
Outline Of Sessions 71
Taking Steps Toward My Goals 71
Coping With Setbacks 72
Strategies To Cope With Cravings And Urges 73
Social Support for Change 75
Developing Supportive Social Networks 76
Outline Of Sessions 76
Helpful Information For Family Members Or Supportive Social Network Members 78
Understanding Cannabis, Alcohol, And Other Substance Use, And How It Impacts On Family And Others 79
Do Others Experience Similar Problems? 80
How Do I Make Sense of This? 80
Why Do I Feel So Stressed? 81
To Sum It Up 82
How Can I Best Support My Family Member or Friend? 83
5 Boosting Change 85
Booster Session Content 85
Booster Session Outline 86
Review Self‐Motivational Statements of Concern And Intention To Change 87
Review The Maintenance Cycle For Mental Health Problems And Substance Use 87
Review Progress With Substance‐Related Goal And Skills To Tackle Setbacks 88
Review Social Support For Change 88
Link In With Community‐Based Substance Misuse Treatment Services 89
Appendix Worksheets And Handouts 90
Worksheet 1: What Do I Enjoy About Using or What Keeps Me Using? 97
Worksheet 2: What I Enjoy About Using or What Keeps Me Using (Table) 99
Worksheet 3: How Does My Use Sometimes Affect Me? 100
Worksheet 4: Taking Steps Toward My Goal 101
Handout 1: Helpful Information For Family Members Or Supportive Social Network Members 102
Understanding Cannabis, Alcohol, And Other Substance Use, And How It Impacts on Family And Others 102
Do Others Experience Similar Problems? 103
How Do I Make Sense of This? 104
Why Do I Feel So Stressed? 105
To Sum It Up 105
Handout 2: How Can I Best Support My Family Member Or Friend? 107
Keeping Communication Open 107
Supporting His or Her Goals 107
References 108
Index 115

Hermine L. Graham is a Consultant Clinical Psychologist and Lecturer at the University of Birmingham, UK. She has expertise in cognitive behavioural 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 academic peer-reviewed journals and is co-author of Cognitive-Behavioural Integrated Treatment (C-BIT) (Wiley, 2004) and co-editor of Substance Misuse in Psychosis (Wiley, 2003).

Alex Copello is Professor of Addiction Research at the School of Psychology at the University of Birmingham, UK, and Consultant Clinical Psychologist with the Birmingham and Solihull NHS Foundation Trust. His career has combined clinical and academic work, and his research has had a major impact on addiction treatment in the UK in recent years. He has published widely in academic journals and books.

Max Birchwood is Professor of Youth Mental Health at the University of Warwick, UK. 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.

Emma Griffith is a Lecturer and Clinical Tutor at the University of Bath, UK, and a Clinical Psychologist in Avon and Wiltshire Partnership Mental Health NHS Trust. She is accredited as a Cognitive Behavioural Psychotherapist by the British Association for Behavioural & Cognitive Psychotherapies (BABCP).