The U.S. Department of Housing and Development’s (HUD) 2015 Annual Homeless Assessment Report (AHAR) to Congress notes on any given night in the U.S., 564,708 people are homeless. Between 10 and 20 percent of these individuals have co-occurring mental health and substance abuse issues. In 2014, nearly 50,000 veterans were homeless. Over 40 percent of homeless veterans have mental illness; roughly 70 percent have a substance abuse problem. This article examines what is being done to help homeless people with dual diagnosis.
In its report, “Implementing Interventions for Homeless Individuals with Co-Occurring Mental Health and Substance Use Disorders,” the Projects for Assistance in Transition from Homeless (PATH) program lays out a four-phase plan as part of a conceptual framework for treatment. These phases are:
- 1. Engagement. This may be the most difficult phase. Convincing a homeless person that treatment can be beneficial requires finesse, particularly if the individual has schizophrenia characterized by paranoia. PATH recommends aggressive outreach: creating a trusting relationship through satisfying the individual’s immediate wants (food, clothing, shelter). The authors acknowledge building trust may take time. It is imperative to inculcate this bond by continuing to provide food, clothing and other necessities.
- 2. Persuasion. Why would someone living on the street abandon the (albeit temporal) relief from a grim existence alcohol or drugs provide? The main challenge to anyone working with the homeless is to persuade them that treatment and abstinence can lead to a better life. Individuals with dual diagnosis are more apt to cling to their drugs because these facilitate escape from pain, emotional turmoil and boredom. These individuals are less likely to remain on psychotropic meds because of the negative side effects. Thus, the advocate must sing the praises of abstinence and promote the long-term benefits of psychotropic drugs over the short-term pleasures afforded by alcohol and illicit drugs.
- 3. Active treatment. In layman’s terms, this is learning how to live. It is said getting sober is easy; staying sober is a bear. Active treatment focuses on providing the individual with the skills and the mindset to remain sober. The cornerstone of active treatment is support. Support comes in various forms, from 12-step groups to case management. Support also includes medical and psychiatric treatment, housing, family involvement and a daily regimen to ensure the individual stays on track and remains committed to his or her recovery.
- 4. Relapse prevention. More so than for individuals with a stable existence, for the homeless, maintaining sobriety is their only viable means to reintegrate into society. Frustration, impatience, fear, suspicion – these feelings will manifest during the long, often tedious, process of stabilization. The onus on the advocate is to sustain optimism and to mark progress, even if it is negligible. The homeless are no different from others in the sense they derive security from routine, even if this routine involves scrounging through trash for food. Continual positive reinforcement coupled with a healthy diet, medication, hygiene and shelter provide the groundwork for success and constitute a formidable bulwark against relapse. In short, the advocate must not falter when the homeless individual’s zeal does – and it will.
Individuals with co-occurring mental health and substance abuse disorders are trapped. They self-medicate with substances in order to quell the inner demons brought on by a mental illness. But self-medication only serves to exacerbate the problem. Sovereign Health Group’s dual diagnosis treatment program breaks this vicious cycle by treating both conditions simultaneously. Contact our 24/7 helpline to find out more about our treatment programs and philosophy.
About the author:
Darren Fraser is a content writer for Sovereign Health Group. He worked two and half years as reporter and researcher for The Yomiuri Shimbun until they realized he did not read, speak or write Japanese and fired him. Undeterred, he channels his love of research into unearthing stories that provide hope to those dealing with addiction and mental illness. Darren loves the Montreal Canadiens hockey club and horror films and would prefer to enjoy these from the comforts of his family’s farm in Quebec. For more information about this media, contact the author at firstname.lastname@example.org.
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