"Removing Barriers: Dual Diagnosis Treatment and Motivational Interviewing"

In the past, traditional treatment methods for drug addiction and alcoholism have been characteristically intense and confrontational. They are designed to break down a client’s denial, defenses, and/or resistance to his or her addictive disorders, as they are perceived by the provider. Admissions criteria to substance abuse treatment programs usually require abstinence from all illicit substances. Potential clients are expected to have some awareness of the problems caused by substance abuse and be motivated to receive treatment. In contrast, traditional treatment methods for mental illness have been supportive, benign and non-threatening. They are designed to maintain the client's already-fragile defenses. Clients entering the mental health system are generally not seeking treatment for their substance abuse problems. Frequently clients within the mental health system who actively abuse drugs and alcohol are not formally identified. If they are, they do not admit to such substance use. As some attention began to focus on clients with both substance abuse problems and mental illnesses, it quickly became apparent that new methods and interventions were necessary. Working with dual disorder clients who deny substance abuse, who are unmotivated for substance abuse treatment, and who are unable to tolerate intense confrontation, required a new model, a non-confrontational approach to the engagement and treatment of this special population. I first developed such a treatment model in 1984, with the goal of providing nonjudgmental acceptance of all symptoms and experiences related to both mental illness and substance disorders.