Brief Integrated Motivational InterventionA Treatment Manual for Co-occuring 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. Combines CBT, motivational interviewing, and the authors’ own cognitive- behavioural integrated treatment (C-BIT) to engage clients in meaningful dialogue for change Utilizes the short ‘window of opportunity’ when clients are admitted to psychiatric hospital or have recently relapsed, and helps clinicians to maximize the potential of this ‘teachable moment’ Helpful tools such as session-specific content, illustrative case material and easy-to-use worksheets facilitate implementation of the approach across a range of settings including inpatient, community, and residential Developed by an expert team with many years of experience in both research and practice in the fields of psychosis and addiction
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): 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). 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, 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 Behaviour Therapy for Command Hallucinations: A Social Rank Theory Approach (2005); Cognitive-Behavioural 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). 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 been widely published in academic scientific journals and is the author or editor of many books, including Social Behaviour and Network Therapy for Alcohol Problems (2009); Coping with Alcohol and Drug Problems (2005); Cognitive-Behavioural 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 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.
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. 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.
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