What is Dual Diagnosis Care?
The term “Dual Diagnosis” is relatively easy to understand. People with this condition have both a mental illness and an addiction. A man with schizophrenia might be addicted to heroin, for example, or a woman with clinical depression might also be an alcoholic. According to the American Society of Addiction Medicine, patients with Dual Diagnoses faced significant treatment challenges in the past. Medical professionals assumed that the addiction came about as a result of the mental illness, and they treated only the mental illness, assuming that the addiction would abate when the mental illness was properly cared for. Unfortunately, this was rarely the case. Even when the mental illness was treated, the addiction still persisted.
Thankfully, new treatments have emerged that can help people with Dual Diagnoses recover. These treatment programs differ from standard addiction therapies and standard mental health therapies in several significant ways.
It’s quite common for someone with a mental illness to have an addiction. In fact, according to the National Institute on Drug Abuse (NIDA), six of 10 people with a substance abuse disorder also have a mental illness. While it’s unclear why these disorders go hand in hand, research has turned up some interesting theories. For instance, according to the NIDA, many studies have suggested that malformations in the pleasure centers of the brain can cause mental illnesses, and these same malformations seem to occur when a person abuses drugs or alcohol. In other words, the drug abuse makes the brain more susceptible to mental illness. Other studies have found that a gene responsible for certain types of mental illnesses can also be linked to certain types of reactions to drugs and alcohol. For example, according to the NIDA, a gene linked to schizophrenia is also linked to psychosis in people who use marijuana. It’s clear that there is some form of biological link between addiction and mental illness. They seem to use the same pathways.
The consequences of a Dual Diagnosis are severe. People with a Dual Diagnosis may:
- Be at a greater risk for committing acts of violence against themselves or others
- Have difficulty relating to others and holding down jobs, and may be forced into homelessness as a result
- Underestimate the severity of the addiction, or believe that an identity as an addict is somehow more desirable than an identity as someone who is mentally ill
- Move in and out of the criminal justice system
Tackling the problem can be slightly difficult, as the person with the Dual Diagnosis might be resistant to treatment. According to the National Alliance on Mental Illness (NAMI), people who have a Dual Diagnosis often don’t have the insight that’s needed to properly identify the problem and develop a set of solutions. They may underestimate how serious the illnesses are, or they may deny that they have any problems whatsoever. For this reason, Dual Diagnosis programs often must move at a pace that respects the dignity of the patient. These patients cannot be forced to move through treatment steps in a specific and predictable manner. Instead, their programs must be tailored to meet their needs, and each bit of progress that the person makes must be rewarded with a significant amount of praise.
What Addictions are Associated with Dual Diagnosis
The dual diagnosis patient may be suffering from one or more of the following conditions:
In a standard addiction program, the addict is told about the significance and consequences of the addiction, and then he or she moves through a detoxification process and a talk therapy process.
The addiction is the centerpiece of the treatment program, and the addict develops a strategy in treatment that he or she can use to put together a meaningful life that doesn’t include substance abuse. By contrast, people with a Dual Diagnosis often need a more intense method of treatment. In addition to addiction therapies, they may need help with education, housing, healthcare and parenting skills. By providing this sort of intensive therapy that deals with many aspects of the addict’s life, meaningful change can take place. According to an article published in the journal Schizophrenia Bulletin, programs that provide this deep level of care tend to be successful, but the journal points out that more research should be done on how these programs are funded. Not all insurance programs cover this level of care, which might make it difficult for people with Dual Diagnoses to get the care they need in order to improve.
reports that effective Dual Diagnosis programs tend to have these aspects in common:
- Treatment progresses in stages and is tailored to the needs of the individual.
- The patient is provided with a significant amount of supervision and support, so he or she can stay motivated and avoid a relapse.
- Treatments focus on empowering the patient to take control and develop positive skills to combat the addiction and the mental illness.
- Social support is considered crucial to success, and the addict pulls from community resources, friends and family members to gain strength.
It’s important to stress that a Dual Diagnosis treatment program is rarely completed within a few weeks or months. Instead, the patient is likely to stay in a treatment program for years. Addiction and mental illnesses are considered chronic conditions that can never truly be cured. Instead, medical professionals focus on helping the patient learn to manage the conditions and live without symptoms or side effects of the conditions. This is a lengthy process that, in all likelihood, is never really finished.
How Treatment Works
In a Dual Diagnosis treatment program, the patient goes through an assessment with a medical professional. This might involve taking tests, answering questions or providing blood samples. Through this process, medical professionals can determine what substances the person is taking (if any) and they can determine what mental illnesses are afflicting the person at that time. Ideally, the person performing these tests will be the person who will provide care to the patient. The patient needs to build up trust with the person who will provide care, so it’s best to start this process early.
Then, the patient goes through the detoxification process. Here, the addict’s body purges alcohol and drugs while medical professionals stand at the ready to provide help if needed. Sometimes, people going through withdrawal stages from drugs or alcohol can exhibit symptoms that look much like the symptoms of a mental illness. If appropriate, doctors can prescribe medications that can ease both the withdrawal symptoms and the mental illness symptoms. For example, according to NIDA, a medication given for methamphetamine withdrawal has been shown to help reduce symptoms of depression. Sometimes, these medications can truly help the patient get through withdrawal without feeling terrible symptoms that can prompt a relapse.
Once detoxification is complete, therapy sessions can begin.
Sometimes, these sessions take place while the person is still living in an addiction treatment center. Other times, these sessions happen in a therapist’s office. Some therapists even come to the patient’s home to give sessions, just to see how the patient is coping with living at home. In these therapy sessions, the patient learns more about the addiction and the mental illness, and he or she is encouraged to think about how the two conditions intertwine. Sometimes, patients are encouraged to think about situations where cravings or mental illness symptoms seem to increase in severity, and then brainstorm ways to avoid those situations. Other times, patients are encouraged to learn to explain their illnesses to others, and ask for help when needed.
In addition, many studies suggest that people with a Dual Diagnosis benefit from participating in 12-step programs such as Alcoholics Anonymous or Narcotics Anonymous.
In 12-step programs, the addict taps into a large group of others who are also in recovery, and for some people, this sense of community can be incredibly powerful and healing. According to an article published in the journal Addiction, people who participated in a 12-step program developed better coping skills than people who did not participate in such programs. These coping skills allowed them to reduce the mental illness symptoms they displayed. In other words, the skills they learned in 12-step programs helped them manage both their addiction and their mental illness. This seems like a huge benefit.
Alcoholics Anonymous and Narcotics Anonymous aren’t specifically designed for people with a Dual Diagnosis, so it’s possible that some people will not connect with these groups. These people may benefit from Dual Recovery Anonymous, which is a 12-step program designed specifically for people with a Dual Diagnosis. The steps may be the same, but the community of people who attend these meetings is slightly different, and some people may relate more readily to those who attend these specialized meetings.
Throughout the rehabilitation process, it’s vital that family members stay involved, engaged and supportive.
The patient is going through a very difficult process, and it’s likely that he or she will sometimes feel helpless and hopeless. By providing encouragement, the family can help the patient stay motivated. Praising small steps of progress, reminding the person of the importance of treatment or just listening to the person talk about his or her feelings could all make a world of difference in terms of recovery. The patient needs his or her family, now more than ever.
For more information on Dual Diagnosis treatment, call us today. Our trained counselors are ready to answer any questions you may have.