Abstract
Over the past decade, clinicians and policy makers have become increasingly aware of the high prevalence of comorbid substance use among those with mental health disorders. While this has prompted a number of ‘dual diagnosis’ initiatives, the high rates of comorbidity in populations with severe mental illness suggest that all clinicians need to acquire skills to manage comorbid substance use. In line with this, current treatment strategies for comorbidity emphasize an integrated approach rather than traditional sequential or parallel treatment options. However, to date there have been few resources available for clinicians working with clients who have coexisting severe mental health and substance misuse problems.
To this end, Hermine Graham and her co-authors have developed an integrated treatment program (cognitivebehavioural integrated treatment: C-BIT) that assists clinicians in the engagement and collaborative management of substance use problems in clients with severe mental health issues. C-BIT incorporates principles of cognitive behavioural therapy, motivational interviewing and harm reduction, and has been successfully implemented by the authors across a number of mental health teams within the UK. This structured, but flexible treatment approach encompasses: screening and assessment; engagement and building motivation to change; negotiating some behaviour change; early relapse prevention; and relapse management. It also incorporates several skills-building modules that address anger and impulse control, self-esteem issues, communication skills, and coping with anxiety and depression. A treatment module that addresses working with families and social network members is also a key component.
Part One of the book provides an overview of the issues related to working with this population, including a brief review of the impact of substance use on mental health and functioning, as well as obstacles to treatment. It also introduces the C-BIT approach, including both a theoretical and technical overview. Part Two encompasses the main body of the book, and is a step-by-step guide to implementing C-BIT. It provides a comprehensive discussion of the C-BIT approach using illustrative case vignettes, as well as highlighting potential obstacles and techniques to overcome them. Part Three focuses on the key issues involved in implementing integrated treatment and discusses strategies for capacity building. The appendix provides a complete set of worksheets for both assessment and treatment phases, as discussed throughout the book.
I thoroughly enjoyed reading this book. The authors have managed to clearly articulate their treatment approach in a clear and coherent manner. With five chapters covering assessment and the core treatment phases, as well as seven additional chapters discussing skills building and working with families, this book gives a comprehensive overview of the C-BIT approach, enabling the reader to readily apply the techniques described to their own clinical situations. I particularly liked the use of cases to illustrate each component of treatment, as well as all the supporting material needed to implement the therapy. The discussion of potential barriers to treatment and appropriate methods to circumvent these was also useful for those considering commencing C-BIT. The authors have succeeded in producing a highly practical and timely integrated treatment manual, and I thoroughly recommend this handbook for students, clinicians, managers and health providers.