Care and Support Services
Individuals seeking help must contact the clinic by telephone. The intake coordinator will explain the service and admission requirements and collect preliminary demographic and substance related information. The intake coordinator also sets up an appointment for a full assessment from 4-10 weeks after the initial contact. A referral note from a health care provider may be requested in some cases.
On the day of the assessment there is an individual interview with one of the team therapists or senior trainees, followed by a brief psychiatric evaluation. The assessment involves questions related to: alcohol and substance use, medical history, psychiatric history, family and relationships and educational history. This entire process takes between 2-3 hours and concludes with an individualized plan for joining the treatment program.
In the first phase of treatment, primarily psychoeducational, cognitive-behavioural, and motivational interviewing approaches are used. In the second phase of treatment, in addition to these approaches, group therapy also may include psychodynamic understanding and formulation of each case and of the group as a whole.
Our services are designed to address the specific needs of the individual and to offer support using various treatment modalities. Therapy sessions are offered both in individual and group formats.
Therapy can vary from a few sessions to 12 months, depending on specific needs. Throughout therapy individual needs are identified and additional interventions are offered, including: relapse prevention, stress management, pre-vocational counselling, psychiatric consultation, pharmacotherapy, as well as referral to other specialized treatment for additional care.
Following the initial assessment, the client participates in Phase 1 of the treatment program.
Phase 1 is about 6 week duration and includes both individual and group sessions. During this time, the goal is to reduce consumption and achieve abstinence.
The individual sessions take place 1x /week. The client works with the primary therapist to develop strategies to achieve and maintain abstinence.
Group sessions may be either 1x /week or some clients may take part in the Day Program.
The Day Program is a 6-week program of 2 group sessions, daily, from Monday to Friday. The Day Program provides structure and support in order to help clients achieve or maintain abstinence. Some examples of themes covered in the Day Program include: education about addiction and other psychiatric problems, life and coping skills, yoga, etc.
People who complete Phase 1 of the program are encouraged to continue with Phase 2 which can last between 6-12 months. Phase 2 sessions are offered 1-2x/week in a group format.
The goal of Phase 2 is to maintain a substance free lifestyle, as well as identify and deal with the underlying issues of addiction.
Groups on relapse prevention, stress management, pre-vocational training, cognitive screening and rehabilitation as well as individual sessions with a psychiatrist are also offered.
This group meets once a week for sessions of 1.5 hours. The size of the group is 6-8 clients with one therapist.
- To provide a semi-structured, didactic experience about the nature, course, treatment and management of the dual disease.
- To provide emotional support.
- To help clients develop and/or improve interpersonal skills.
- To assess cognitive/functional impairments that may be present in performance.
- To aid clients in setting realistic goals, i.e. job seeking, education, home or leisure activities.
This Phase 2 group is based on the premise of age specific treatment that is supportive and nonconfrontational, at a pace and with content appropriate for the older person with alcohol and/or drug problems. Group members meet weekly for 1 ½ hours and receive reinforcement from peers, share experiences, and learn from each other. The focus is also on addressing depression, loneliness, coping with losses, health concerns, life transitions, and helping members develop links with medical services, referrals, and re-building ties with the community.
Most of the women referred to the women’s group report chaotic family relationships during their early years. Many have experienced neglect and physical and/or sexual violence at some time in their lives. Frequently they have symptoms of an eating disorder and engage in self-harming behaviours. Because violence against women is usually inflicted by men, it is important to provide a safe and supportive environment where male/female dynamics does not play a role. Women can then more easily discuss their feelings related to past traumas: shame, guilt, powerlessness, anxiety and fear, while learning to cope with a substance free life.
This group of 6-8 women meets twice weekly for 1 ½ hours.
Relapse Prevention (RP) is an important component of substance addiction treatment. The RP Program at the Addictions Unit was initially designed as an adjunct to existing treatments and intends to help clients understand and manage the relapse process.
The RP model employed at the Addictions Unit was mainly adapted from Marlatt and Gordon’s (1985) Relapse Prevention model and the Structured Relapse Prevention (SRP) from the Centre for Addiction and Mental Health. Both models are based on a cognitive-behavioural approach to the treatment of addictive behaviours and try to address the nature of the relapse process as well as suggest coping strategies useful in maintaining change. The models incorporate both a conceptual framework of relapse and a set of specific and global intervention strategies that allow clients to address each step of the relapse process.
Specific interventions of the Addictions Unit Relapse Prevention program include:
- Increasing the client’s self-efficacy, eliminating myths regarding alcohol and drug effects, managing lapses, and restructuring the client’s perceptions of the relapse process.
- Identifying specific high-risk situations for each client and enhancing the client’s skills for coping with those situations.
- Identifying and recognizing urges and cravings and exploring techniques for coping with them.
- Understanding passive/aggressive/assertive behaviour, identifying and recognizing angry feelings and learning about anger management techniques.
- Introduction to relaxation and stress management and problem solving techniques.
- Discussion of strategies on how to achieve a balanced lifestyle and how to handle a relapse episode.
The stress management group is an 8-session structured program of 1 ½ hours weekly that is offered to all clients in Phase 2 treatment. The sessions are based on learning new ways to recognize and cope with stress and anxiety. The group provides an opportunity to learn basic relaxation techniques, cognitive behavioral strategies, and skills for assertive communication.
Work is frequently the last role to be lost to the addiction process; at the same time work constitutes 1/3 of our daily routine and in recovery the need to structure time in a meaningful manner is crucial to both a stable recovery and a return of self-esteem. There is a need for treatment programs to provide rehabilitation in this area to restore basic skills destroyed by drug use, or maintain the productivity of those clients who have remained socially productive despite their addiction. Through pre-vocational counseling, the opportunity is offered for our clients to re-evaluate their work skills and develop a planned approach to active job searching.
Cognitive Assessment and Rehabilitation
Approximately 1/3-2/3 of drug abusers show deficits in cognitive functioning and work performance. Due largely to the impact of drugs/alcohol on the frontal lobe, clients can demonstrate difficulty with short-term memory, new learning and problem-solving that can have an effect on the ability to handle decisions and responsibilities in daily life. There is a natural recovery of cognitive functions for most drug users within the first three months of abstaining from alcohol and/or drugs. However there is a proportion of clients who continue to demonstrate cognitive deficits which affect their quality of life. With sustained abstinence, those clients with cognitive deficits are assessed with standardized tools and have a computerized cognitive rehabilitation program available to stimulate the cognitive recovery process.
Individual Cognitive-Behavioural Therapy (CBT)
Some clients who have done well in the program are still facing problems with depression, anxiety, and eating disorders. If these problems are not addressed, the likelihood of relapse on drugs and alcohol is higher. For clients who have achieved at least 6 months of abstinence short-term individual cognitive-behavioural therapy (CBT) is available, with referral from the client’s Phase 2 group therapist.
CBT is a psychotherapeutic approach that aims to address problems concerning emotions, behaviours and thoughts in a systematic manner with targeted goals. There is evidence that CBT has been effective for the treatment of a variety of problems, including mood, anxiety, personality, eating, substance abuse, and psychotic disorders. Although the therapeutic techniques vary according to the problem being treated, commonly used strategies include keeping a diary of significant events and associated feelings, thoughts and behaviours; questioning and testing thoughts, assumptions, and beliefs that might be unhelpful and unproductive; gradually facing activities which may have been avoided; and trying out new behaviours and activities. Relaxation, mindfulness and distraction techniques are also often used. CBT may also be used in conjunction with mood stabilizing medications.
Specialized pharmacotherapies, based on newer and established medications are utilized in some cases. These treatments serve to assist the patients attending the Unit in the process of detoxification (in hospital or at the out-patient clinic) or to help maintain abstinence from substance abuse. Examples are the use of Methadone in decreasing doses for inpatient detoxification from opioids, and the use of the Naltrexone or Acamprosate to decrease craving and help maintain sobriety after detoxification from alcohol.
Detoxification can be completed safely and effectively in both inpatient and outpatient treatment settings. A person may be admitted to the hospital for detoxification when withdrawal in an outpatient setting may be hazardous. Inpatient detoxification includes medical treatment and counseling to help relieve the immediate symptoms of withdrawal and to overcome physical and psychological dependence on alcohol or other substances. While undergoing detoxification and achieving abstinence, co-morbid psychiatric and medical conditions are also addressed. There are 4 beds allocated to the Addictions Unit for detoxification on the Psychiatry Inpatient Service of the Montreal General Hospital.
Once discharged from the inpatient facility, the person may continue in the outpatient program or in some cases be referred to other treatment facilities.
Significant others are invited to attend a session with the client and primary therapist. Significant others play an important role in recovery and mutual benefit may be obtained by the client and family member learning more about the consequences and reactions long-term substance abuse and dependence can engender.