Dual Diagnosis Program
History / Mission
Fellowship House has provided alcohol and drug treatment for severely
impaired clients for over forty (40) years. We have tried to continually
adapt and develop our services to meet the needs of people seeking this
type of help, leading to individualized treatment for women, prison diversion and others.
The FSH dual diagnosis program evolved in the mid 1990’s in response to the
growing demand for residential treatment for addicted, mentally ill clients. These
were typically clients diagnosed with alcohol or drug dependence, and with a serious
mental illness such as bipolar disorder, major depressive disorder or schizophrenia.
The biggest barrier to treatment for this population was mainly that their addictive
behavior interfered with mental health treatment and their mental illness interfered
with addiction treatment.
A cycle of institutionalization plays out for this population in hospitals,
jails, shelters, emergency rooms, prisons, and a variety of treatment centers.
Their behaviors lead to these places but often any therapeutic response is limited
to addiction treatment or mental health treatment, rather than an integrated plan to
address the whole person. Our desire at Fellowship House is to empower these individuals,
as we do with others, to live as independently and productively as possible, with freedom
from reliance on institutions – including our own.
In addition to the usual criteria for admission, the following requirements
must be met for a client to be admitted to the FSH dual diagnosis program:
- Axis I diagnosis of chemical dependence
- Axis I diagnosis of mental illness
- Must be under the care of a contracted mental health provider or a personal
doctor who will contract with FSH. The contract provides for mental health care
beyond the scope of FSH (i.e. medication, hospitalization, etc)
- Must be currently not homicidal or suicidal, and capable of participating in
the treatment regimen (i.e. oriented to person, place, time, situation)
- Prescribed medications cannot include drugs with a. high risk of abuse,
such. as benzodiazepines or opiates.
We receive dually diagnosed referrals from state mental health providers,
such as Western MH, UAB Community Psychiatry, and Smolian Clinic. We also serve
clients referred by public and private treatment programs, the VAMC, and clients
referred by the criminal justice system. During out screening interviews, if a
client exhibits a need for mental health eva1uation/treatment, the intake department
wi1l make an appropriate referral prior to admission.
Residential Treatment
While all of our treatment plans are designed individually, three particular goals
are addressed with each dually diagnosed client.
First, medication management is established for clients on prescribed medication.
Medication is kept in a central, locked area, and is given out four (4) times daily
in accordance with dosage instructions. The client is responsible for reporting on
time for medication pickup, taking his medication, obtaining refills when needed,
and communicating symptoms/problems with meds with his FSH counselor and mental
health provider. Medication management group and case management are used for
information, guidance and support on how to meet these responsibilities consistently.
Second, we emphasize education to the client’s mental illness and addiction.
Clients are provided access to programs such as the day treatment and clinics at
UAB community psychiatry, and further individual counseling and support via other
United Way and community agencies. Specialized classes are
attended to inform the client on physical, mental and spiritual aspects of addiction.
Clients also attend individual counseling and group counseling sessions weekly
Third, the treatment team stresses social support systems that suit the individual
needs of the client. Each client becomes involved with the self-help community,
beginning with participation in Bridge group, an informative meeting designed to
help transition to the addiction self-help programs of AA, NA, and CA. The Double
Trouble self-help meeting meets weekly at Fellowship House, providing a unique fellowship
and support for only dually diagnosed people both in and outside of treatment.
Case Management
The primary counselor case manages each dually diagnosed c1ient in areas needed to
re-enter society as independently as possible. Job readiness begins at FSH as each
client performs OJT duties along with daily household responsibilities. Clients are.
referred to outside agencies such as Alabama Department of Rehabilitation Services,
Adult Learning Center, Occupational Rehabilitation Center, and Workshops, Inc., for
assistance in developing job skills, training, education, and job placement.
Budgeting classes and relevant goals are established to assist each individual in
managing either earned or SSI income. Other areas of case management include legal
issues, transportation, and independent living skills. After the client has increased
structure and stability in life through employment, self-help and treatment involvement,
independent living goals are established.
Supportive housing program
Dually diagnosed clients usually move into the supportive housing program to further
develop the self-discipline and independent living skills necessary for living outside
of institutions. These needs are addressed through case management and group counseling
in this phase of our program.
In supportive housing, clients share financial responsibilities with their roommates.
They remain involved in group and individual counseling at FSH, but usually with decreasing
frequency. Counseling continues in areas such as maintaining abstinence, housing plans,
medication management, meal planning, budgeting, legal responsibilities, and transportation.
The supportive housing clients also remain involved by performing night-watch or other
household duties weekly, and serving as mentors for newer residents.
The main goal of this phase of the program is to provide housing and
support until each individual is ready to move to a more independent setting.
Aftercare
Aftercare participation is a continuation of existing services, notably group and
individual counseling and self-help community participation. Each client’s treatment file
remains in active status for the first year after they leave residential treatment.
This means that their primary counselor will contact the client at designated intervals
throughout that period, even if the client does not continue regular participation in services.
This allows for an effective transition to a non-institutional lifestyle, while leaving
supports in place to re-apply services as needed, such as a temporary return to supportive
housing or a review of classes
Treatment files are placed in inactive status after one year, but any past client
can participate in aftercare groups and self-help meetings at Fellowship House as
they are needed, indefinitely, without engaging in a structured treatment plan.