Note :

Serious mental health problems can be an obstacle towards admission into Vilavi's addiction treatment center. Our therapy community in Terrebonne is not equipped with the necessary resources to assure the internal follow-up of said persons, who are thus referred to specialised resources.

On the other hand, if these persons are stable and have psychological and psychiatric aid at their disposal, including but not limited to medication, Vilavi can manage the drug addiction and/or alcoholism aspect of their individual situation at the center in Terrebonne, with the approval and under the responsability of their treating physician.

The article presented does not intend to display Vilavi's practices here in Quebec, but the more general concomitant issues of drug addiction/alcoholism and mental health issues, as well as the practices implemented within the general model of the therapeutic community.

As a model of addiction treatment, the therapeutic community has had to adapt to the new needs of those addicted to drugs. They have also had to adapt to the evolution of the perceptions borne of care networks and society regarding said persons. Thus, the moral model, which in the 60s and 70s, presented "druggies" as being deviant, has progressively evolved towards a medical model, then towards the biopsychosocial model that prevails today in most countries.

The most recent model has driven the community of crisis intervention specialists to consider people's problems as a result of a set of inter-related factors: the person themselves, their living situation, their environment, and finally, the substances they are using.

The therapeutic communities have followed suit, starting by individualising their methods of evaluation and intervention, then with the integration of multidisciplinary teams (intervention specialists, psychologists, educators, etc.) likely to answer more effectively to the needs best identified, and to then greatly improve the quality of the services offered. At the forefront of this approach, the role of the intervention specialist in the pre-reception phase is crucial: the quality of the first interviews, a holistic comprehension of the issue and the appropriate transmission of their information to the multidisciplinary team, depends on the adequate delivery of the individual's treatment plan, and, therefore, the success of the program.

Better evaluating mental health issues

A major challenge is to adapt clinical approaches to the co-occurrence of drug addiction/alcoholism and mental health disorders, i.e. people with mental disorders associated with the misuse of alcohol or other drugs. A major challenge for Vilavi, corroborated by several studies, has shown that more than one person out of two admitted in addiction treatment also suffers from a more or less severe mental health disorder: most often antisocial personality disorder, anxiety or depression.

Dealing with problems of drug addiction and alcoholism without concern for the mental health issues co-occurring limits the effectiveness of the intervention and exposes people to higher risks of relapse, depression, suicide, violence or homelessness, and functional challenges such as unemployment and chronic interpersonal conflicts.

A three-step approach

  • Screening
  • Assessment
  • Orientation or integrated treatment

This finding has led some therapy communities to put in place a procedure for welcome and support to optimize the quality and speed of the therapeutic response.

The first phase of this procedure is screening, carried out during the first admissions interviews. The goal of the latter is not to draw up a complete profile of their psychological functioning and treatment needs of a person, but more to determine if this person may have a mental health problem justifying a more complete evaluation, established by the psychologist of the organisation.

This screening is done using various questionnaires and instruments to highlight: the previous treatments for their psychological problems and the experience of various symptoms such as depression, suicidal ideation, hallucinations or cognitive difficulties, not resulting from drug use. The results of these questionnaires are then sent to the psychologist of the centre, who decides whether to proceed with the second phase of the procedure, either the assessment, in order to consider an intervention and support plan appropriate, or referral to an appropriate resource.

The goal of the evaluation is on the one hand to develop the treatment plan, and on the other hand, to prevent the onset of violent behavior, deterioration of the state of health, or responding to suicidal urgency. The issue of evaluation is important and the task far from simple. Indeed, if this is essential to arranging future treatment, it is particularly complex, given that the healthcare professional must try to disentangle the interactions between the mental health disorders and drug/alcohol addiction.

Although it is essential to proceed at the earliest of the assessment after arrival in the center, it is generally admitted that the diagnosis can only be accurately made after four to six weeks abstinence from drugs. As a result, the treatment plan and support needs to be continually reassessed and adapted, particularly if the associated disorders do not improve after this period of discontinuation of substances.

The inpatients' with associated mental health and drug addiction or alcoholism disorders treatment plan must go beyond psychiatric or medical intervention: various methods of intervention in the therapeutic community support these dimensions through a series of tools inspired by the cognitive behavioral approach, making it possible to appropriately reframe the perceptions of people.

In addition to the relational aspects and behaviors related to community life, group workshops allow the person to better understand the role played by the consumption of substances, its own functioning, the nature of the change it is undergoing operating, and, finally, how to maintain the achievements of the change.

Dans le même temps, les personnes sont suivies conjointement par le psychologue du centre et/ou par le médecin traitant externe. Cette association d’une intervention en toxicomanie ou alcoolisme et d’un suivi psychologique ou psychiatrique participe d’un modèle de traitement dit intégré, c’est-à-dire que tous les acteurs de l’équipe multidisciplinaire, qu’ils appartiennent ou non au personnel de l’organisme proprement dit, travaillent ensemble, et en cohérence, à l’amélioration de la qualité de vie des personnes.

This notion of consistency is essential: the different actors in these two spheres of intervention work together, they talk to each other regularly, they feed their practical experiences and exchanges in order to continually adapt their approach. This example highlights the importance of partnerships: indeed, only comprehensive management involving all participants can make it possible to respond adequately to drug addicts struggling with mental health issues.

Pierre Bremond
Communications consultant - substance addiction intervention specialist