Dual Diagnosis: Treatment Approaches and Gettting help

By The Fix staff 01/21/15
Dual Diagnosis Treatment

Just when it seems like a diagnosis of a severe or moderate mental illness cannot be worse, you may discover the situation actually involves a dual diagnosis. Dual diagnosis describes a person who has both a mental health disorder and a substance abuse problem. According to the National Alliance on Mental Illness, up to one-third of all people living with any mental illness also suffer from a problem with alcohol or drugs. Furthermore, one-half of those with severe mental illnesses, which include schizophrenia, bipolar disorder, and major depression, have an alcohol or drug problem. Unfortunately, the treatment for a dual diagnosis disorder remains much more complicated than treatment of either condition alone.

You need to understand how a dual diagnosis is given to patients before you can begin thinking about treatment options. Since both diseases may be causing the exacerbation of the symptoms of the other disease, it can also be hard to accurately diagnosis the underlying mental health condition. Moreover, some mental health disorders may be the direct result of substance abuse, which includes legal and illegal substances.

A Brief Overview of Dual Diagnoses

Drug and alcohol abuse and substance dependency can be a misnomer for some. According to the National Institute on Alcohol Abuse and Alcoholism, a person may have an alcohol use disorder, such as binge drinking or heavy drinking that causes problems in life, but he or she does not show signs of dependency. They are still able to function without using the respective substance on a frequent basis. The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition accounted for this problem by changing alcoholism, which is the term given to alcohol dependency, from the only applicable mental disorder to alcohol use disorder, which includes binge and heavy drinking and ranges in severity from mild to moderate to severe. This new set of criteria enables licensed mental health professionals to diagnosis substance use disorders before they progress into the dependency category. As a direct result, the number of dual diagnoses will likely increase beyond the current statistics publicized by the National Alliance on Mental Health.

Dual diagnoses involving an illegal drug are diagnosed in a similar manner to an alcohol use disorder and another mental illness. However, some drugs, such as cocaine, opioids, or amphetamine, have the potential to make a person dependent much more quickly than alcohol. When a drug use disorder occurs at the same time as a mental health disorder, the treatment options will vary depending on the severity of the illness and the other mental health disorder.

Treatment Options

The treatment for a dual diagnosis varies depending upon a variety of factors. Some may experience difficulty convincing a person with a dual diagnosis to obtain treatment. For these cases, an intervention may be required to begin the treatment and recovery process. Also, the severity of the substance use or alcohol use disorder will assist in determining the best course of treatment. For example, dependency and severe withdrawal symptoms may require inpatient hospitalization for safety and medical reasons. As a general rule-of-thumb, do not allow someone with a severe alcohol dependency to attempt to quit drinking on their own at home.

Inpatient Hospitalization

According to the National Alliance on Mental Illness, the initial phase of dual diagnosis must address the complications of drug use. Since drugs or alcohol can be easily over consumed, they can result in death or severe medical complications. The primary cases of substance abuse requiring immediate medical intervention while using include alcohol poisoning or severe dependency, the use of amphetamines, crack, or cocaine, or the use of benzodiazapines and opiates. Although these risks have life-threatening potential, the effects of attempting detox can be more severe.

When a person begins trying to stop using drugs or alcohol, he may begin experiencing severe withdrawal symptoms. For example, alcohol withdrawal can result in dangerous seizures, delirium tremens, or stroke. Opiate withdrawal may cause severe pain as well as heart problems. Benzodiazapine withdrawal may include severe seizures and tremors. When you consider the addition of a mental illness with these withdrawal symptoms and risks while using drugs, the withdrawal symptoms may be more severe than in a single-diagnosis situation. Furthermore, common mood and behavioral changes attributable to an underlying mental illness, such as major depression or bipolar disorder, may be sudden, dramatic, and dangerous. Your loved one may experience additional irrational thoughts or exhibit self-destructive behaviors like suicidal thoughts or actions.

Suicidal thoughts or actions are a MEDICAL EMERGENCY. Contact Emergency Medical Services, or go to an Emergency Center IMMEDIATELY.

In addition, you or your loved one will receive medication treatment and psychotherapy during inpatient hospitalization.

Treatment Programs

According to the Mayo Clinic, chemical addiction treatment programs often include therapy sessions--which may be conducted individually or in a group session--medication management of symptoms, and education about the causes and nature of addiction. Furthermore, an effective treatment program for a dual diagnosis includes treatment of the respective mental health disorder. For example, mood stabilizers, anti-psychotics, or antidepressants may be needed to treat the symptoms and causes of the mental health disorder with medication. Furthermore, the treatment for drug or alcohol addiction may include psychotherapy, such as cognitive behavioral therapy. The basic principle behind Cognitive Behavioral therapy uses an active, engaged conversation between patient and therapist to understand the causes behind irrational thought processes. The therapist, who may be a social worker, psychologist, psychiatrist, or licensed chemical dependency counselor, will work with you or your loved one to create healthy, effective coping skills rather than using drugs or alcohol as a form of self-medication.

Another concern over dual diagnosis treatment programs is the financial cost. In the past, treatment for addiction may not have been covered by health insurance companies, or treatment for multiple mental health disorders may have required advance authorization. However, the Affordable Care Act requires all insurance carriers to cover substance use treatment as part of the 10 essentials of health coverage. Each insurance plan may have different provider networks, so check with your carrier prior to applying for admission to a treatment program.

Treatment Centers

A dual diagnosis treatment center can help you or your loved one with inpatient or outpatient treatment of a dual diagnosis. When you consider that even inpatient hospitalization only treats dual diagnoses temporarily, you will need additional treatment and management of your condition after discharge. This may include group or solo therapy sessions, visits with a psychiatrist, and possibly home visits. Following discharge, family members and friends should continue to support and encourage their loved one to maintain sobriety and treat his or her other mental health disorder appropriately.

In most cases, you will be assigned a case manager to watch over your progress at a treatment center. The level of care and responsibilities of the case manager vary depending upon the severity of your illness identified by the Global Functioning Assessment (GAF) in the Diagnostic and Statistical Manual of Mental Disorders. For example, severe mental illnesses may warrant home visits or even an additional addiction intervention.

Treatment Centers: Residential Treatment

For some with severe mental illnesses and addiction problems, a residential treatment center may be the best option. According to the National Institute on Drug Abuse, these programs typically last from 6- to 12-months and serve as a constant monitor and control of outside influences encouraging substance use. Furthermore, these residential programs will identify key points where the additional mental illness of a dual diagnosis needs additional treatment. For example, someone with Bipolar disorder may experience a sudden shift in mood and need adjustment in medications or inpatient hospitalization.

Living with a mental health disorder is a difficult and ongoing process, and the addition of drugs or alcohol into the equation complicates an already complicated situation. Ultimately, drugs and alcohol have lasting, damaging effects to the body and should be addressed, but mental health disorder symptoms may mask while worsening the condition. Since the majority of those with a substance use disorder--53% according to the National Alliance on Mental Illness--have a mental health disorder as well, you can infer that most mental health treatments begin with the treatment and management of the substance use disorder.

Once the life-threatening and damaging effects of substance abuse have been stopped, mental health professionals can treat the additional symptoms and causes of mental health disorders. Effective treatment options for dual diagnoses include inpatient hospitalization, treatment programs, and assistance at treatment centers. You can find additional information on locating a dual diagnosis treatment center at the National Institute of Drug Abuse.

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