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Safety Tips at Home Entrance Install handrails for the steps. Make sure there are no trip hazards, such as cracks in the pavement. If entering through the garage, remove boxes or other clutter that impede the path. Keep walkways free of clutter. Throw rugs, cords or wiring under carpeting, and raised flooring or doorway thresholds are all causes for concern. Rubber tips on walkers or canes can reduce the risk of slipping. Bathroom Nonskid rubber mats on the floor and just outside of the tub/shower are helpful, as are grab bars both in the shower and by the toilet. Shower chairs or benches are recommended for those who need them. It may also be advisable to have someone assist the elderly person. Lighting and Seating Nightlights in bedrooms, hallways and bathrooms can reduce the risk of falls when getting up at night; beds, sofas and chairs should be a proper height to prevent falling when getting up; stairs should have railings and be well lit. If the bedroom is upstairs, consider relocating it to the first floor. Dress Properly Improper footwear — socks only, loose slippers or heeled shoes, particularly on stairs — and clothes that don’t fit properly can create tripping hazards. Stay Connected Keep a cordless or cell phone on the person at all times: have a bell, whistle or intercom system to call for help; or install an emergency response system. If the individual at risk lives alone, it may be wise to coordinate with family and neighbors for daily check-ins. Stay Fit Remain as physically active as possible. “Regular physical exercise with appropriate supervision is key. A sedentary lifestyle contributes to gait and balance problems, so it is important to keep moving. Continued from cover Dual Diagnosis Program Aims to Help Those with Addiction Plus Other Disorders Stewart and Lynda Resnick Neuropsychiatric Hospital at UCLA, which houses the eight-week outpatient program. “And just as failing to address a substance-abuse problem makes it more difficult to treat other medical and psychiatric disorders, if you don’t address an addicted person’s psychiatric disorder, it is going to be much harder to tackle the addiction.” Jason Schiffman, MD, MBA, the program’s director, explains that addictive behaviors serve as a way to avoid the unpleasant symptoms associated with depression, anxiety and other psychiatric disorders. Thus, he says, many people experience a vicious cycle in which they become sober yet they still have intolerable feelings that end up driving them back to the addictive behavior, which can then worsen the symptoms of the co-existing psychiatric disorder. “Traditionally, the thinking was that you treated the addiction first and then you started addressing the co-occurring issues,” Dr. Schiffman says. “We believe one of the reasons relapse in early sobriety is so common is that these people are dealing with untreated anxiety or depression, and that if you treat those issues at the same time as the addiction, these individuals will have a stronger foundation upon which to build lasting recovery.” behavioral therapy approach to treating addiction. “An addiction is any persistent detrimental behavior driven by cravings and impulsivity,” Dr. Schiffman explains. “We teach people how to manage the process of craving, including an awareness that it is a time-limited phenomenon.” Mindfulness and cognitive behavioral techniques are also used for co-occurring conditions of depression and anxiety, while a psycho-educational approach is applied to bipolar disorder or attention deficit hyperactivity disorder. Dr. Schiffman notes that the program’s approach is compatible with 12-step recovery, although attending 12-step meetings is not a requirement. Individuals who believe they could benefit are given a 90-minute psychiatric diagnostic assessment; based on the results, they are either admitted to the program or directed to another treatment program at UCLA or elsewhere in the community that would be most appropriate for them. While the UCLA Dual Diagnosis Program is covered by many insurance plans, in some cases there may be a significant patient share of the cost; patients should verify their coverage before enrolling. One of the challenges for the program is that many of the medications used to treat the psychiatric conditions that commonly occur alongside a substance abuse disorder — including certain tranquilizers and stimulants for attention deficit disorder — are themselves susceptible to being abused. The UCLA Dual Diagnosis Program provides intensive outpatient treatment that includes five nights a week of two- hour-long group sessions, one hour a week of individual psychotherapy and biweekly medication management. The program takes a mindfulness-based, cognitive For more information about UCLA’s Dual Diagnosis Program, go to: dual-diagnosis-program Vital Signs Summer 2013 Vol. 59 7