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PracticePlanners SeriesTreatment PlannersThe Complete Adult Psychotherapy Treatment Planner, Third EditionThe Child Psychotherapy Treatment Planner, Third EditionThe Adolescent Psychotherapy Treatment Planner, Third EditionThe Addiction Treatment Planner, Third EditionThe Continuum of Care Treatment PlannerThe Couples Psychotherapy Treatment PlannerThe Employee Assistance Treatment PlannerThe Pastoral Counseling Treatment PlannerThe Older Adult Psychotherapy Treatment PlannerThe Behavioral Medicine Treatment PlannerThe Group Therapy Treatment Planner, Second EditionThe Gay and Lesbian Psychotherapy Treatment PlannerThe Family Therapy Treatment PlannerThe Severe and Persistent Mental Illness Treatment PlannerThe Mental Retardation and Developmental Disability Treatment PlannerThe Social Work and Human Services Treatment PlannerThe Crisis Counseling and Traumatic Events Treatment PlannerThe Personality Disorders Treatment PlannerThe Rehabilitation Psychology Treatment PlannerThe Special Education Treatment PlannerThe Juvenile Justice and Residential Care Treatment PlannerThe School Counseling and School Social Work Treatment PlannerThe Sexual Abuse Victim and Sexual Offender Treatment PlannerThe Probation and Parole Treatment PlannerThe Psychopharmacology Treatment PlannerThe Speech-Language Pathology Treatment PlannerThe Suicide and Homicide Risk Assessment & Prevention Treatment PlannerThe College Student Counseling Treatment PlannerThe Parenting Skills Treatment PlannerThe Early Childhood Education Intervention Treatment PlannerThe Co-occurring Disorders Treatment PlannerProgress Notes PlannersThe Child Psychotherapy Progress Notes Planner, Second EditionThe Adolescent Psychotherapy Progress Notes Planner, Second EditionThe Adult Psychotherapy Progress Notes Planner, Second EditionThe Addiction Progress Notes PlannerThe Severe and Persistent Mental Illness Progress Notes PlannerThe Couples Psychotherapy Progress Notes PlannerThe Family Therapy Progress Notes PlannerHomework PlannersBrief Therapy Homework PlannerBrief Couples Therapy Homework PlannerBrief Adolescent Therapy Homework PlannerBrief Child Therapy Homework PlannerBrief Employee Assistance Homework PlannerBrief Family Therapy Homework PlannerGrief Counseling Homework PlannerGroup Therapy Homework PlannerDivorce Counseling Homework PlannerSchool Counseling and School Social Work Homework PlannerChild Therapy Activity and Homework PlannerAddiction Treatment Homework Planner, Second EditionAdolescent Psychotherapy Homework Planner IIAdult Psychotherapy Homework PlannerParenting Skills Homework PlannerClient Education Handout PlannersAdult Client Education Handout PlannerChild and Adolescent Client Education Handout PlannerCouples and Family Client Education Handout PlannerComplete PlannersThe Complete Depression Treatment and Homework PlannerThe Complete Anxiety Treatment and Homework Planner

PracticePlanners Arthur E. Jongsma, Jr., Series EditorThe Co-occurring DisordersTreatment PlannerJack KlottArthur E. Jongsma, Jr.JOHN WILEY & SONS, INC.

This book is printed on acid-free paper. oCopyright 2006 by Jack Klott and Arthur E. Jongsma, Jr. All rights reserved.Published by John Wiley & Sons, Inc., Hoboken, New Jersey.Published simultaneously in Canada.No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form orby any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permittedunder Section 107 or 108 of the 1976 United States Copyright Act, without either the prior written permission of the Publisher, or authorization through payment of the appropriate per-copy fee to the CopyrightClearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, (978) 750-8400, fax (978) 646-8600, oron the Web at www.copyright.com. Requests to the Publisher for permission should be addressed to thePermissions Department, John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, (201) 748-6011,fax (201) 748-6008. e-mail: permcoordinator@wiley.com.Limit of Liability/Disclaimer of Warranty: While the publisher and author have used their best efforts inpreparing this book, they make no representations or warranties with respect to the accuracy or completeness of the contents of this book and specifically disclaim any implied warranties of merchantability orfitness for a particular purpose. No warranty may be created or extended by sales representatives or written sales materials. The advice and strategies contained herein may not be suitable for your situation. Youshould consult with a professional where appropriate. Neither the publisher nor author shall be liable forany loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages.This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold with the understanding that the publisher is not engaged in rendering professionalservices. If legal, accounting, medical, psychological or any other expert assistance is required, the servicesof a competent professional person should be sought.Designations used by companies to distinguish their products are often claimed as trademarks. In all instances where John Wiley & Sons, Inc. is aware of a claim, the product names appear in initial capital or allcapital letters. Readers, however, should contact the appropriate companies for more complete informationregarding trademarks and registration.All references to diagnostic codes are reprinted with permission from the Diagnostic and Statistical Manualof Mental Disorders, Fourth Edition, Text Revision. Copyright 2000. American Psychiatric Association.For general information on our other products and services please contact our Customer Care Departmentwithin the United States at (800) 762-2974, outside the United States at (317) 572-3993 or fax (317) 5724002.Wiley also publishes its books in a variety of electronic formats. Some content that appears in print maynot be available in electronic books. For more information about Wiley products, visit our web site at www.wiley.com.Library of Congress Cataloging-in-Publication DataKlott, Jack.The co-occurring disorders treatment planner / Jack Klott, Arthur E. Jongsma, Jr.p. cm. — (Practice planners series)ISBN-13: 978-0-471-73081-1 (pbk. : alk. paper)ISBN-10: 0-471-73081-5 (pbk. : alk. paper)1. Dual diagnosis—Handbooks, manuals, etc. 2. Dual diagnosis—Treatment—Planning—Handbooks, manuals, etc. I. Jongsma, Arthur E., 1943– . II. Title. III. Series: Practice planners.[DNLM: 1. Mental disorders—diagnosis—handbooks. 2. Diagnosis, Dual (Psychiatry)—methods—handbooks. 3. Patient Care Planning—methods—handbooks. 4. Diagnostic Techniquesand Procedures—handbooks. WM 34 K66ce 2006]RC564.68.K56 2006616.07'5—dc222005018425Printed in the United States of America10 9 8 7 6 5 4 3 2 1

To my children—Jack, Karey, Peggy, Kevin, and Hannah—andmy grandchildren—Kacie, Owen, Claire, and MacKenzie—and, most certainly, those to come. Your love is the light ofmy life . . . thank you for being the people that you are . . .being your father and grandfather is my greatest joy.—J. K.To my friend, Reverend David Breen, whose heart is on his sleeve andwhose hand is lovingly and persistently outstretched toward othersin God’s name. Do not be afraid, David. God goes before you.—A. E. J.

CONTENTSPracticePlanners Series PrefaceAcknowledgmentsIntroductionAcute Stress Disorders with Sedative, Hypnotic, orAnxiolytic AbuseAdolescent Asperger’s Disorder with Alcohol AbuseAdolescent Attention-Deficit/Hyperactivity Disorder (ADHD)with Cannabis AbuseAdolescent Conduct Disorder with Alcohol AbuseAdult Attention-Deficit/Hyperactivity Disorder (ADHD) withCocaine DependenceAnorexic Female with Amphetamine DependenceAntisocial Personality Disorder with Polysubstance DependenceAvoidant Personality Disorder with Cannabis DependenceBipolar Disorder Female with Alcohol AbuseBipolar Disorder Male with Polysubstance DependenceBorderline Female with Alcohol AbuseBorderline Male with Polysubstance DependenceBulimic Female with Alcohol AbuseChronic Medical Illness with Sedative, Hypnotic, or AnxiolyticDependenceChronic Undifferentiated Schizophrenia with AlcoholDependenceDepressive Disorders with Alcohol AbuseDepressive Disorders with Cannabis DependenceDepressive Disorders with Pathological GamblingDissociative Disorders with Cocaine AbuseGeneralized Anxiety Disorder with Cannabis AbuseIntermittent Explosive Disorder with Cannabis 82192203216229241xi

xiiCONTENTSObsessive-Compulsive Disorder with Cannabis AbuseParanoid Schizophrenia with Polysubstance DependencePosttraumatic Stress Disorder with Polysubstance DependenceSocial Phobia with Alcohol Abuse253266278290Appendix A: Bibliotherapy SuggestionsAppendix B: Professional BibliographyAppendix C: Index of DSM-IV-TR Codes Associated withPresenting Problems301305307

PRACTICEPLANNERS SERIES PREFACEThe practice of psychotherapy has a dimension that did not exist 30, 20, oreven 15 years ago—accountability. Treatment programs, public agencies, clinics, and even group and solo practitioners must now justify the treatment ofpatients to outside review entities that control the payment of fees. This development has resulted in an explosion of paperwork.Clinicians must now document what has been done in treatment, what isplanned for the future, and what the anticipated outcomes of the interventions are. The books and software in this PracticePlanners series are designedto help practitioners fulfill these documentation requirements efficiently andprofessionally.The PracticePlanners series is growing rapidly. It now includes not only theoriginal Complete Adult Psychotherapy Treatment Planner, Third Edition, TheChild Psychotherapy Treatment Planner, Third Edition, and The AdolescentPsychotherapy Treatment Planner, Third Edition, but also Treatment Plannerstargeted to specialty areas of practice, including: addictions, juvenile justice/residential care, couples therapy, employee assistance, behavioral medicine,therapy with older adults, pastoral counseling, family therapy, group therapy,neuropsychology, therapy with gays and lesbians, special education, schoolcounseling, probation and parole, therapy with sexual abuse victims and offenders, and more.Several of the Treatment Planner books now have companion ProgressNotes Planners (e.g., Adult, Adolescent, Child, Addictions, Severe and Persistent Mental Illness, Couples, Family). More of these planners that providea menu of progress statements that elaborate on the client’s symptom presentation and the provider’s therapeutic intervention are in production. EachProgress Notes Planner statement is directly integrated with “Behavioral Definitions” and “Therapeutic Interventions” items from the companion Treatment Planner.The list of therapeutic Homework Planners is also growing from the original Brief Therapy Homework for Adult, Adolescent, Child, Couples, Group,Family, Addictions, Divorce, Grief, Employee Assistance, School Counseling/School Social Work Homework Planners, and Parenting Skills. Each of thesexiii

xivPRACTICEPLANNERS SERIES PREFACEbooks can be used alone or in conjunction with their companion TreatmentPlanner. Homework assignments are designed around each presenting problem (e.g., Anxiety, Depression, Chemical Dependence, Anger Management,Panic, Eating Disorders) that is the focus of a chapter in its correspondingTreatment Planner.Client Education Handout Planners, a new branch in the series, providesbrochures and handouts to help educate and inform adult, child, adolescent,couples, and family clients on a myriad of mental health issues, as well aslife-skills techniques. The list of presenting problems for which information isprovided mirrors the list of presenting problems in the Treatment Planner ofthe title similar to that of the Handout Planner. Thus, the problems for whicheducational material is provided in the Child and Adolescent Client EducationHandout Planner reflect the presenting problems listed in The Child and TheAdolescent Psychotherapy Treatment Planner books. Handouts are includedon CD-ROMs for easy printing and are ideal for use in waiting rooms, at presentations, as newsletters, or as information for clients struggling with mentalillness issues.In addition, the series also includes TheraScribe , the latest version of thepopular treatment planning, clinical record-keeping software. TheraScribe allows the user to import the data from any of the Treatment Planner, ProgressNotes Planner, or Homework Planner books into the software’s expandabledatabase. Then the point-and-click method can create a detailed, neatly organized, individualized, and customized treatment plan along with optional integrated progress notes and homework assignments.Adjunctive books, such as The Psychotherapy Documentation Primer, andClinical, Forensic, Child, Couples and Family, Continuum of Care, and Chemical Dependence Documentation Sourcebook contain forms and resources to aidthe mental health practice management. The goal of the series is to providepractitioners with the resources they need in order to provide high-quality carein the era of accountability—or, to put it simply, we seek to help you spendmore time on patients, and less time on paperwork.A E. J , J .Grand Rapids, Michigan

ACKNOWLEDGMENTSI remain deeply indebted to Dr. Art Jongsma, series editor for the Practice Planners, not only for the opportunity to work on my second Practice Planner,but also for the support he provided during this effort. Our manuscript manager, Jennifer Byrne, deserves a sincere thank you for her contributions tothe final product. And I am thankful to my wife, Rebecca, for her patience, wisdom, and, on more than one occasion, her valuable insight on the inner workings of the human condition.In a career that has reached its 35th anniversary, I have experienced myshare of frustrations in the challenge of finding the correct approach in thetreatment of the dual diagnosed. Starting in the early 1980s, however, innovations in treatment began that have resulted in more positive treatment outcomes for the dual-diagnosed population. Those innovations include theories on the stages of change from J. Prochaska and C. DiClemente; conceptson motivational interviewing by W. Miller and S. Rollnick; and strategies forintegrated treatment from R. Weiss, D. Ziedonis, K. Minkoff, C. Cline, andJ. Westermeyer. While I am certainly indebted to these leaders in the field oftreatment for the dual diagnosed, I hope all men and women who work withthis population recognize, with sincere gratitude, their valuable contributions.Finally, I want to acknowledge the clinicians I had the privilege of working with while I was managing an inpatient dual-diagnosed treatment programsponsored by Western Michigan University and the Michigan Department ofCorrections. I want to thank Jim Kendrick and Dr. Bob Perra for their administrative guidance. Most sincere thanks is given to clinicians Lance Bettison,Willie Carson, Linda Fox, Julie Strong, and Mike Furney for their dedicationand tireless efforts on behalf of those patients who were brought to health.—J. K.xv

The Co-occurring DisordersTreatment Planner

INTRODUCTIONPLANNER FOCUSThe Co-occurring Disorders Treatment Planner has been written for individual, group, and family counselors and psychotherapists who are working withadults and adolescents who are struggling with addictions to mood-alteringchemicals, gambling, or abusive eating patterns and have a co-occurring mental illness. The list of chapter titles reflects those addictive behaviors and thediagnosis-specific mental illnesses associated with those addictions.For the last two decades increasing evidence exists for the extremely highprevalence of comorbidity of psychiatric and Substance Use Disorders. Studies reveal, for example, that over half of diagnosed schi

Progress Notes Planners contain complete prewritten progress notes for each presenting problem in the companion Treatment Planners. The Adult Psychotherapy Progress Notes Planner.-471-45978-X / 49.95 The Adolescent Psychotherapy Progress Notes Planner.-471-45979-8 / 49.95