1. Core Skills I&II - Dual Diagnosis
Cashain David
Prisons and beyond 2008

2. Dual Diagnosis in 8 minutes !

3. Stress, Vulnerability, and “Normal Deviations”-
(Understanding Drugs and Mental Health in Eight Minutes…)

4. Dual-Diagnosis is an expression that describes the institutions,
not the patient.

5. Mental Health Sector Alcohol and Other Drug Sector

6. Mental Health Sector Alcohol and Other Drug Sector
Corrective Services

7. Mental Health Sector Alcohol and Other Drug Sector
Triple-Diagnosis?
Corrective Services

8. Normal Distribution- Bell curve.

9. Normal Distribution- I.Q. scores.

10. Normal Distribution- human gestation period- (live births).

11. The effect of lighting a cigarette upon bus arrival times.
A B

12. DSM: IV and the range of human behaviour and belief.
Illness Normal Illness

13. The Stress Vulnerability Model.

14. Psychological and Physiological Responses to Environmental
Stressors.

15. Stress, Anxiety and Depression may motivate us to modify our
environment.

16. If you can’t alter your external environment, you may
use techniques designed to “internally” modify the levels
of stress you are experiencing.

17. Some use more immediate means to alter their state of
consciousness.

18. Environmental Factors modulate genetic predispositions,
potentially shifting anyone either up or down the
Stress / Vulnerability Gradient.

19. Social isolation, disconnection, and discrimination are all risk
factors for psychosis and other symptoms of mental illness.

20. Social inclusion, extended families, rewarding relationships, and
other broad social supports can outweigh the effects of pre-existing
vulnerabilities.

21. Some environments greatly elevate stress, or are characterized by
alternating periods of “Hypo-stress” with short bursts of “Hyper-
stress”.

22. Some environments are deliberately designed to induce adverse
changes in mental state.

23. The same social and environmental stressors that increase
susceptibility to mental illness, can also encourage problematic or
dependent patterns of
drug use.

24. 18.7% of America’s homeless are veterans of war, and veterans
are more than twice as likely to be homeless as those in the
general population. With 141,000 homeless war veterans
in America, there are currently more troops living
rough on U.S. streets than there are serving in Iraq.

25. If you lack the social and economic means to alter your
environment, it is always easy to alter your perceptions of that
environment.

26. Most people use drugs to regulate their
mood.

27. Drug use can increase or
decrease our individual
vulnerability to symptoms
of mental illness.
It depends on the drug, the
person, the dose and
frequency of use, and the
setting.
--
<
Me ill.
>
Me
well
again.

28. Non-medical drug use may be functional, relaxing or socially
enabling. Sometimes, it can prove to be problematic, stressful and
socially isolating.
Illicit drug use may
increase susceptibility
to mental illness not
only through acute
intoxication, but also
through chronic use,
through withdrawal, or
through other factors,
such as poverty, or fear
of arrest .

29. Drug use may be one of many environmental factors that can
increase or decrease our vulnerability to symptoms of mental
illness.
When problematic patterns of use evolve from a “coping
strategy”, this may be a symptom of an intolerable environment
or social circumstances in which the person feels powerless to
realistically effect any change.

30. Understanding Co-Morbidity in one sentence…
Treating problematic drug use, or mental illness, in
isolation from each other, and without addressing
broader social and economic circumstances, is treating
the symptoms, not the causes, of “co-morbid”
disorders.

31. Comments and questions ?

32. Components of the Community of Self
CONSCIENCE WILL
REASON DRIVES
Community of Self MEMORY SENSES
EGO
Cashain David
Prisons and Beyond 2008

33. Na’im Akbar is a Clinical Psychologist
in the Department of Psychology at
Florida State University in
Tallahassee..
Dr. Akbar, a Muslim, says that none of
the concepts in his works are limited
to any particular cultural group.
It was written for the uninitiated and it
can and should be used as a tool to
help us understand ourselves and
grow ourselves.
In his book, Dr. Akbar explains how
the Community of Self has specialists
within it just like one would find in any
other community.

34. The Community of Self
CONSCIENCE WILL
REASON DRIVES
MEMORY SENSES
EGO

35. The earliest citizens in the self community,
says Akbar, are the drives or instincts
which are the movers of the self. There are
two types/classes of drives. One is
movement towards what gives pleasure
and the other is the reverse in that it moves
one away from what causes pain or
dissatisfaction. In a word, we humans have
an affinity for pleasure and an aversion to
pain. "If the drives are given free rein, they
will drive the entire community to seek only
pleasure."

36. Senses are defined as the windows of the
community into the outside world. "The
senses are to the community of self what
communication is to communities of
people." They give only incomplete
information about things and are therefore
not capable of making judgments. "We
must conclude, says Akbar, "that the
senses are an important part of the
community, but they make a poor ruler
over the self."

37. Another prominent citizen of the self
community is the ego. The ego uses the
tool of emotion to speak up for the rights of
the individual and is therefore vital for the
life of the community. And when it is not
properly developed, the community fails to
support itself. An overdeveloped ego,
however is a detriment to the community.
The ego fails to concern itself with things
which it cannot see and can therefore be a
tyrannical ruler over the community. Akbar
therefore concludes that ego is a
necessary citizen but "not an appropriate
ruler over the self."

38. Memory is another important member of
the community of self. Like a library, it
"stores the many records of experience
that have gone into the building of the
person." "Without memory, there would be
little continuity in the community," says
Akbar, "But, we can also see that if
memory rules the community, the
community lives in the past."

39. Reason is another important member of
selfhood. "Reason brings order and
organization to the information brought in
by the senses." It lets know that our senses
give us incomplete information and works
throughout the community keeping order
and organization. Reason judges only on
the basis of facts and if it tried to rule the
community, the self becomes like a
machine because unfeeling order destroys
peace and happiness within the self.

40. As the conscience begins to develop, the
element of justice is introduced into the
community. Conscience gives upward
direction to the community of self, but
Akbar warns us that, "An unchecked
conscience, however, can be as disruptive
to the self community as the other parts
previously discussed. The over-developed
conscience can demand nothing short of
perfection and its self-sacrificing tendency
can become greedy for punishment."
Conscience doesn’t have the restraint to
rule the community.

41. Dr. Akbar tells us the ruler over the self
community is the Will. He says man’s Will
has the ability to pull the mind and flesh in
the direction of Truth. Akbar defines the
Will as "the Divine representative within the
person when working with the higher parts
of conscience and guided by the proper
direction." And "when the Will achieves
rulership over the self community, the self
grows to be the proper ruler over the
earth." In a word, if we are to restore our
communities, we must first understand and
develop our communities of self.

42. Questions / Comments ?

43. CASE STUDY
Prisons and Beyond

44. Our client (M) is 40 years old afro-
Caribbean male.
He has been diagnosed with paranoid
Schizophrenia and he believes nothing
wrong with him but little depression in the
past
He also has a long history of poly-
substance misuse, including cannabis,
crack cocaine and heavy alcohol use

45. Past history
There is no M has long forensic
information held history over 100
about M`s childhood convictions of theft
or family history but One conviction for
born and brought up violence in 89
in London by One other for
grandparents which possession of
he describes as very shotgun in 92
religious

46. Past history
Through out his late teens and twenties he
often lived rough on the streets as he had
been made homeless whilst going “in and
out” of prison
Although he has auditory hallucinations in
the third person,
He was very long time non-compliant with
medication

47. Current presentation
M believes because of his stealing God is
which he refers as Jesus angry with him
and punish him with this voices, “all God
doing” and “Jesus is not forgiven”
He believes he should give up and
disgusted with alcohol and after effects
each time he drinks….but
Has no problem with his smoking cannabis
as he controls it

48. current
He lives in a dual diagnosis residential
house with other forensic clients and he
does not likes it
He likes playing music, drinking, smoking
and nothing else
Although he wants a job when he has he
give up easily
Plan is move him independent living

49. The Task
In groups / pairs
Use one member of the community of self
to consider one key intervention that would
be helpful
10 minutes
Feedback to wider group