Cognitive-Behavioural Integrated Treatment (C-Bit)

This treatment manual was developed specifically for clinicians, who work with clients who have co-existing severe mental health and substance abuse problems, who may not be motivated to tackle their drug/alcohol problems and be poorly engaged with treatment services.

How do you engage a reluctant client in discussing alcohol/drug use and build motivation for change? Hermine L. Graham and her team of co-authors have specifically developed this treatment manual for clinicians and therapists who work with clients presenting with co-existing severe mental health and substance misuse problems.
Cognitive-Behavioural Integrated Treatment(C-BIT) provides a framework that is structured but flexible, assisting clinicians to initially engage with clients and collaboratively tackle alcohol and drug problems in the context of the client's mental health difficulties. The book is set out in three parts:
Part I sets the scene by outlining some of the background issues concerning co-existing substance use and mental health problems.
Part II is a step-by-step manual and will guide you through the C-BIT approach, with practical strategies on how to deliver integrated interventions appropriate to your client's stage of engagement with you.
Part III addresses some of the key issues involved in the process of implementing integrated treatment. It highlights some of the implementation obstacles that can often arise during the developmental stages, with suggested strategies to address these issues.
Each Part has supporting worksheets clearly displayed in the Appendices.
This essential resource and handbook will be invaluable for clinicians, students, researchers, managers and health purchasers/providers in mental health and substance misuse settings.

About the Authors xi
Aims of the Book xv
Acknowledgements xvii
Part One: Introduction To Cognitive-Behavioural Integrated Treatment (C-Bit) 1
1 Issues in Working with those with Coexisting Severe Mental Health Problems Who Use Substances Problematically 3
The Nature of Coexisting Severe Mental Health and Alcohol/Drug Problems 3
Models of Comorbidity 6
Obstacles to Treatment and Behaviour Change 9
Treatment Needs 10
2 Overview of C-BIT Approach 14
Objectives 14
Structure 15
How to Know When to Move on to the Next Phase 16
Treatment Sessions 20
3 Overview of C-BIT Theory and Techniques 22
Brief Introduction to Cognitive Therapy 22
Cognitive Therapy Techniques in C-BIT 28
Part Two: Cognitive-Behavioural Integrated Treatment (C-Bit) 37
C-Bit Core Components 39
4 Assessment Phase: Screening and Assessment 39
Clinical Assessment of Drug/Alcohol Use 40
Assessment and Screening Tools 42
Case Formulation 46
Treatment Planning 49
5 Treatment Phase 1: Engagement and Building Motivation to Change 51
Strategies to Increase Engagement 51
How to Put Drug/Alcohol Use on the Agenda 55
Building on Motivation for Change 59
Dealing with Resistance 64
Identifying Social Networks Supportive of Change 65
Finances/Money Management 68
6 Treatment Phase 2: Negotiating Some Behaviour Change 73
Identifying and Setting Achievable Harm-Reduction Goals 73
Working with Resistance to Goal Setting 75
Identifying Activities of Interest 79
Engaging the Client's Interest in the Activity 81
How to Build Social Networks Supportive of Change 81
Strategies to Increase Awareness of Problematic Links Between Mental Health and Substance Use 84
7 Treatment Phase 3: Early Relapse Prevention 88
Formulating Problems: Cognitive Model of Substance Use 88
Relapse Prevention: Helping Your Clients Manage Their Substance Use 93
Relapse Prevention: Including Social Network Member(s) 94
Coping with Cravings and the Abstinence-Violation Effect 99
Relapse Prevention: For Substance Use and Its Links with Mental Health 102
8 Treatment Phase 4: Relapse Prevention/Relapse Management 106
Including Social Network Member(s) in Relapse Prevention 107
Identifying a Relapse Signature to Psychotic Relapses and Role of Substance Use 108
Developing a Comprehensive Relapse-Prevention/ Relapse-Management Plan 116
Using a Comprehensive Relapse-Prevention/ Management Plan-Relapse Drill 118
Additional Treatment Components I-Skills Building 122
9 Coping with Different Moods: Anxiety 122
The Role of Substances in Creating or Maintaining Anxiety 122
Starting Out: Assessing Anxiety 123
Strategies to Manage Anxiety 125
Cognitive-Behavioural Integrated Treatment
10 Coping with Different Moods: Anger and Impulse Control 136
The Role of Drugs/Alcohol in Creating/Maintaining Anger 137
The Role of Psychosis in Creating/Maintaining Anger 138
Starting Out: Assessing Anger 138
Strategies to Manage Anger 140
Impulse Control 148
11 Coping with Different Moods: Depression 151
The Role of Drugs/Alcohol in Creating and Maintaining Depression 152
The Role of Psychosis in Creating/Maintaining Depression 152
Starting Out: Assessing Depression 153
Strategies to Manage Depression 154
12 Communication: Social Skills 164
Social Skills 165
Social Skills Training for Mental Health Problems and Substance Use 166
Social Skills Training 167
Applying Social Skills to Specific Situations 173
Assertiveness 175
Assertiveness Training 178
Strategies to Tackle Lack of Assertiveness 179
Applying Assertiveness Skills to Specific Situations 188
13 Self-Esteem 194
Effect of Low Self-Esteem on Mental Health and Drug/Alcohol Use 194
Effects of Psychosis and Drugs/Alcohol on Self-Esteem 195
Starting Out: Assessing Self-Esteem 196
Strategies to Improve Self-Esteem 197
14 Lifestyle Balance 205
Strategies to Encourage Lifestyle Balance 206
Increasing Activity Levels 206
Time Management 212
Money Management 213
Additional Treatment Components Ii-Families And Social Network Members 215
15 Working with Families and Social Network Members 215
Provision of Psychoeducation 216
Encouraging Involvement 221
Practical Coping Strategies and Skills 223
Part Three: Implementation Issues 231
16 Implementation Issues 233
Overview 233
Implementation Obstacles and Solutions 233
Training and Supervision (Capacity Building) 237
Organisational Factors 238
Overview of the Evidence Base and Future Directions for
Research 239
Appendices 245
References 285
Index 295
Cognitive-Behavioural Integrated Treatment