Dual Diagnosis Treatment
What is dual diagnosis?
The term “dual diagnosis,” sometimes referred to as “co-occurring disorders” or “co-morbid disorders,” means that the patient is suffering from chemical abuse or dependence, in combination with a diagnosable psychiatric condition.
For instance, a patient with a Generalized Anxiety Disorder may suffer from Alcohol Dependence. This makes sense, doesn’t it? The anxious person may drink to excess in order to feel calm. After all, alcohol is readily available, socially acceptable, and relatively inexpensive.
Or a bipolar client (this used to be called “manic depression”) may in the throes of a manic episode, with little self-regulation and feelings of grandiosity, head off on a three-day cocaine binge, which will certainly lead to further mental, emotional, and legal problems.
Co-occurring disorders affect the patient deeply, and often impair his ability to successfully function in society, i.e., hold a job, enjoy successful relationships with others, attend school, etc.
Is dual diagnosis a common phenomenon? According to the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA), an estimated 10 million people in the United States will have a combination of at least one mental health and one substance abuse disorder in any twelve-month period. One recent article stated that 37% of alcohol abusers and 53% of drug users also have at least one serious mental illness.
Who is affected?
It is not always possible to determine which came first, the psychiatric condition or the chemical dependency. However, we do know that people who suffer from a psychiatric disorder are generally more at risk to become chemically dependent. One study showed that a person with an antisocial personality disorder was at an increased 15.5% risk for substance abuse, a person with a manic episode 14.5%, and so on.
Why is this? Oftentimes, people dealing with psychiatric disorders attempt to self-medicate in order to escape depressive or anxious feelings, the memory of past trauma, and voices in their head.
But the reverse can sometimes be true: a person may drink or drug to the point where they become mood disordered (depressive, manic), or even psychotic. Alcohol or drug abuse can even result in suicidal thoughts and attempts.
The dual diagnosis patient can become lost in a downward spiral. Many of these patients have a poor self-image. Buffeted by thoughts and feelings of self-hatred (“I’m such a loser”), they will self-sabotage with drugs or alcohol, and seek out other people with similar issues and backgrounds in order to feel accepted by a group who truly understands them (and then internally beat themselves up by joining a group that, the words of Groucho Marx, would have them as a member!)
They may become defeatist and resigned to their fate, and believe that the only way to escape bad feelings is to continue to drink and drug, perhaps to an even greater degree. It is a true downward spiral.
The family’s role
How can the family help their dual diagnosis loved one to recover?
First, let’s look at what they must not do: stop enabling by giving them money, excusing their poor behavior, and making empty threats. Instead, insist that the patient get professional help right away.
Second, family members must seek help for themselves as well. Al-Anon is an excellent program, and has been around forever. It’s free, to boot. We also recommend the Betty Ford family program in Ranch Mirage. Finally, there are a variety of mental health support groups for family members struggling to understand and deal with the consequences of their loved one’s mental health issues. You might check out the NAMI website, as a starting point.
At Milestones, our therapists conduct family sessions to deal with family wounds, learn new and improved ways of communicating, and help family members plan for the future. Our therapists are expert in helping families in crisis, and provide phone coaching and regular communication, in addition to family sessions.
The family must, however, be forthright with the Milestones treatment staff regarding any history of chemical dependence and/or psychiatric disorder. Families sometimes hold secrets, and these can prove toxic to the family system.
What is effective treatment?
A true dual diagnosis treatment program treats both mental health and substance issues, understanding the intricate relationship between the two sides of the coin. If you only address one, the other is likely to resurface – and sooner than later.
Often, the dual diagnosis patient uses a substance to self-medicate the psychiatric disorder. For instance, a bipolar patient may take drugs or drink alcohol to “come down” from a manic state, or conversely, “lift up” from a depressive state. It is important to help this patient regulate mood with the use of psychotropic medications and psychotherapy.
With regard to chemical dependency treatment, high-quality programs typically offer psychoeducation around relapse prevention, a review of triggers, and suggest substitute behaviors. Triggers and substitute behaviors, of course, vary from client to client. There is no one size fits all. Trained counselors will assist the client in looking at patterns of use in order to work up an efficient aftercare plan, an important component in dual diagnosis recovery.
To elaborate on the point, primary/initial treatment is only the first phase of clinical care. The patient will subsequently require medication management, ongoing therapy, and a path to recovery, such as 12 step, meditation, and/or cognitive-behavioral techniques. The latter assist the patient in shifting the thoughts and actions that may lead to, maintain, or worsen, substance use and/or certain psychiatric disorders, such as anxiety and depression (“It will never get better,” “I wonder what will go wrong today,” “Bad things always happen to me”).
We favor a particular approach known as Pointing Out Patterns®. Our clinicians look for the client’s negative patterns of thought, emotion, and behavior, which are maladaptive ways of viewing, and acting in, the world which cause the patient stress, and result in personal and professional failure and unhappiness.
Some common patterns include people-pleasing, intimidation, seduction, displaced anger, excessive anxiety, blame, disrespect, caretaking, and self-pity. These patterns are intimately connected with substance use – they are either a result of addiction, the cause of addiction (for example, an extremely anxious client drinking alcohol to relax), or work in tandem with the addiction. We believe it is very important that these patterns be addressed during the client’s stay at our facility.
Furthermore, we work closely with a Board-certified addiction psychiatrist, who may recommend medications to tackle chemical dependency and psychiatric disorders. We may also, on occasion, request psychological testing by a qualified and experienced psychologist in order to ascertain a patient’s correct psychiatric diagnosis.
Exercise, proper nutrition, sober fun activities, and individual counseling sessions (minimum three times per week) are also a crucial part of our dual diagnosis treatment center.
The process of dual diagnosis treatment often begins with a medically-supervised detox at a reputable clinic or hospital. While many addicts benefit from such treatment, it is essential to the health and welfare of the person who suffers from alcohol or benzodiazepine dependence. A failure to medically detox from either of these dependencies can be fatal, if untreated.
Conclusion
If you or your loved one have a chemical abuse or dependency issue, combined with a psychiatric disorder such as anxiety, depression, bipolar, and so forth, it is important that you receive the best treatment available to you. Ideally, this would be an inpatient program, which assists the patient in stabilizing on medication and undergo a course of evidence-based psychotherapy while learning proper nutrition, sober fun, and exercise.
Please feel free to contact our Clinical or Intake Departments with any questions you may have. We are here to serve you in any way possible.
All the best,
Dr. Seth C. Kadish
Reference Articles:
Psychosocial Approaches to Dual Diagnosis:
http://schizophreniabulletin.oxfordjournals.org/cgi/content/abstract/26/1/105
Information and Treatment for Co-occurring Disorders
http://www.helpguide.org/mental/dual_diagnosis.htm
Removing Barriers: Dual Diagnosis Treatment and Motivational Interv iewing: http://www.treatment.org/Topics/pdf/SciaccaRemovingBarriers.pdf
An Integrated Treatment Approach for Severely Mentally Ill Individuals with Substance Disorders: http://users.erols.com/ksciacca/integ.htm
The Family and the Dually Diagnosed Patient:
http://users.erols.com/ksciacca/chaptfam.htm
Program Development and Integrated Treatment Across Systems for Dual Diagnosis: Mental Illness, Drug Addiction And Alcoholism, MIDAA:
http://users.erols.com/ksciacca/abst2.htm
On Co-occurring Addictive and Mental Disorders: A Brief History of the Origins of Dual Diagnosis Treatment and Program Development:
http://users.erols.com/ksciacca/brifhst.htm
New Initiatives in the Treatment of the Chronic Patient with Alcohol/Substance Use Problems:
http://users.erols.com/ksciacca/newinit.htm
Dual Diagnosis:
http://www.psychosocial.com/dualdx/dualdx2.html
Functional Assessment of Mental Health and Addiction:
A Treatment Planning and Evaluation Strategy for Clients Suffering from Co-Morbidity:
http://www.psychosocial.com/dualdx/lof.html
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