Substance Use, Concurrent Disorders and Gambling Problems in Ontario – Introduction

Why this guide?

A growing number of people who come to health care providers are experiencing not only substance use problems, but gambling and/or mental health issues as well. These problems affect people of all ages, education and income levels, religions and cultures, and in all work situations. Sometimes clients are dealing with just one of these types of problems, but more often than not a person will have more than one of these problems concurrently.

The information in this book is intended to help you determine, when talking with clients, whether someone may need additional counselling or treatment. The book also offers tools to help you to connect with clients about these issues in a way that is empathic and non-judgmental, so that they may eventually seek the help they need.

Helping professionals can make a significant difference in whether people address substance use, gambling and/or mental health problems. Even brief interventions can make a huge difference in people’s lives. Because of our overloaded system, non-specialists are—more and more—being called on to help identify, and in some cases treat, people with the kinds of problems described in this book. In many instances, people would not have received the help they needed within the addiction and mental health treatment system if not for the work of dedicated community clinicians and other helping professionals.

People with the kinds of problems described in this book need a wide range of services and supports—not just health and social services, but housing, education, employment and other supports that can’t possibly be addressed by one provider. It is the responsibility of helping professionals to work together to help people get the various treatments and supports they are asking for.

This guide was created to help you, as a helping professional, to be aware, sensitive and skilled in screening for these kinds of problems in the clients you see, and to refer people for treatment or, for those with appropriate training, to provide some basic counselling yourself.

An earlier version of this guide was published in 1994 under the title Alcohol and Drug Treatment in Ontario: A Guide for Helping Professionals. Feedback on this original guide indicated that it was a valuable resource for helping professionals, but that the material needed to be updated and to include information on how to help identify and, if possible, treat clients with gambling and/or mental health problems as well as substance use problems. Substance Use, Concurrent Disorders and Gambling Problems in Ontario: A Guide for Helping Professionals is the product of that feedback. This revised guide provides up-to-date information on the kinds of issues that clients now present to health providers, along with current prevalence statistics and approaches to screening and assessment, as well as treatment options available in Ontario.

Who should read this guide?

This guide will be useful to people working in such fields as:

health care, addiction services and mental health
family practice / doctors’ offices, community health centres, Aboriginal Health Access Centres, family health teams and Community Care Access Centres
employee assistance programs
social services
child and family services
correctional services.

We generally refer to people working in these fields as “helping professionals.” These are professionals who work in health and social services but who are not necessarily substance use, gambling, mental health or concurrent disorders professionals. They may, for instance, be nurse practitioners, family doctors, social workers, social service workers, probation officers or occupational therapists.

The intended readership for this book is broad, and people will vary in terms of the amount of counselling skills training they have and their level of comfort with providing treatment. For instance, this guide could be equally useful to a family doctor who can prescribe medication and provide counselling or to a settlement or housing worker who may come in contact with someone with a potential addiction or mental health problem while dealing with a non-health-related issue.

How to use this guide

For readers without clinical or counselling training, this book can be used to help identify and screen clients. Those who do have a clinical background will be able to use the information from this book to screen and to begin basic treatment, referring to specialists as necessary. The stages of change model discussed in Sections 2 to 4 can be applied in different ways: a helping professional can use it to help identify the stage the client is at and how motivated the person is to change or, if the professional has a clinical background, he or she can use some of the questions to help explore the problem with the client in more depth and to address the person’s ambivalence about change.

It is important to recognize that not only the person with the substance use problem, gambling problem or concurrent disorders may need help. Those living with or otherwise managing the problems of a significant other may also need support. By asking not only screening questions, but also questions about how family members and friends are coping, you will send the message that they too deserve support in their own right.

Reading this introductory section is a good starting point. It highlights the need to be open-minded with clients, recognizing that what they say, how they say it and sometimes what they don’t say will be influenced by many factors—including the culture with which they identify themselves and the stigma they may have already experienced.

You will likely find that the symptoms and behaviours a client describes reflect multiple causes and that a single problem rarely appears in isolation. The intention of this book is not to provide comprehensive assessment and treatment information, nor to enable you to diagnose; rather, it is to enable you to screen for the various types of problems described in Sections 2 to 4, to provide some basic treatment if you have the clinical background to do so, and to refer the person for further assessment and more specialized treatment if needed. Applying a stages of change model to each of these types of problems will help you to discover where the client is at and how motivated he or she is to address the problem.

While the original guide dealt only with alcohol and other drug problems, this book recognizes that someone may have problems with gambling and/or may have a combination of issues referred to as concurrent disorders—which also requires treatment. By reading each section of this book, you will get a sense of how each type of problem may manifest slightly differently and how clients’ care needs become more complex when they are dealing with multiple problems at the same time.

An overview

This guide contains information about how to:

establish a trusting relationship with clients
identify people who have problems with substance use or gambling, or who have concurrent disorders
explore these concerns with clients and encourage them to take action
connect with ConnexOntario Health Services Information, a gateway to treatment services for alcohol and other drug problems, gambling problems and mental health problems.

The book is arranged in five sections. Section 1 discusses how to build an effective relationship with clients. Sections 2 to 4 follow a similar structure. They begin by providing prevalence statistics that reinforce why you should care about these problems; they define what the problem is (whether a substance use problem, concurrent substance use and mental health problems, or a gambling problem); and they address risk factors and the effects of the problem, how to screen for the problem, and how a stages of change model can be applied to addressing the issue. The final section on treatment offers ways for people to get specialized help.

Section 1: Building a relationship

This section discusses establishing rapport with a client, offers tips for asking difficult questions, and highlights the importance of addressing practical concerns the client might have. It also examines the influence of culture on people’s perception of their problems and their willingness to get help, and suggests ways to make services more accessible to people from diverse cultures. Finally, it looks at involving the family in the client’s care, and providing support and education to friends and relatives coping with the client’s problem.

Section 2: Substance use

This section suggests ways to talk to people about their use of alcohol and other drugs. It presents sample questions to ask, a guide to help you decide whether there is reason to be concerned, a description of how change happens, and ways to build people’s motivation to stop or reduce their substance use.

Section 3: Concurrent substance use and mental health problems

Many people who seek treatment for a substance use problem discover they have a mental health problem that also requires treatment. The converse is also true: people with mental health problems are more susceptible to having substance use problems. When substance use and mental health problems are treated together, people tend to have a better outcome. This section will help you to understand the impact of concurrent disorders, and offers tools for screening people with these problems.

Section 4: Problem gambling

This section provides an overview of what problem gambling is, and some of the common behavioural, emotional and health-related signs that may indicate a gambling problem. Also provided are some tips for making gambling something you can more easily talk about with clients. The section provides information on screening tools, risk factors, signs of a gambling problem and how to use a stages of change approach with people who have problems gambling.

Section 5: Treatment choices

This section presents ways to respond when clients are ready to act. It answers common questions about substance use, concurrent disorders and problem gambling treatment, and describes the types of services available in Ontario. It also includes information on ways to support family members who are affected by the client’s problems.

It is followed by two appendices:

Appendix A: Provincial Programs
Appendix B: CAMH Resources and Publications.