While addiction can be an expensive and life-shattering problem, it is not the worst case scenario. Addiction is just the beginning. Substance abuse can ignite more mental health problems. Likewise, a person suffering from mental health disorders are also likely to suffer from substance use disorder. Either way, the addiction plus mental challenge condition is called co-occurring disorders.
Formerly known as dual diagnosis or dual disorders, co-occurring disorders continue to remain a mainstay problem of modern health care.
What is Dual Diagnosis?
Dual diagnosis is when a person is diagnosed to have both substance abuse disorder and any type of other mental health disorders.
Nowadays, co-occurring disorders are no longer a rare occurrence as the incidences of co-occurring disorders continue to soar. In fact, approximately 8 million adults are suffering from dual-diagnosed disorders by 2014 as SAMHSA states.
Making an Assessment
Not all substance abuse and mental health problem are considered. Therefore, if the symptoms are not ruled out as independent of the substance abuse, it will not be considered as a dual diagnosis. Given this complexity, specialists have to rely on various details about the patient, such as:
How Common is Dual Diagnosis?
Sadly, dual diagnosis is as common as seeing people eating bacon for breakfast. In fact, SAMHSA states that among the 20.2 million adults in the U.S. who experienced a substance use disorder, 50.5%—10.2 million adults—had a co-occurring mental illness. This statistic is a HUGE chunk of the society and is a clear indication that a substance abuser will likely suffer from a mental health challenge and vice versa.
History of Dual Diagnosis
Before the existence of dual diagnosis treatments, people had to undergo either sequential or parallel treatment. Unfortunately, neither of these approaches proved effective.
Patients are required to undergo rehab first before they are given treatment for whatever mental health problem exists. Hence, patients have to be sober first before they become “worthy” of therapies that will address their psychological problems.
The underlying philosophy of sequential treatment is to avoid the reoccurrence of the mental health problem after the treatment. That is, it was believed that if left untreated, the substance abuse disorder will simply ignite another mental health challenge. While utterly undeniable, the philosophy proved ineffective as it failed to address an elusive flaw that remained invisible during the entire sequential treatment era; the fact that mental health challenges can cause substance use disorders. Therefore, people became sober and freed from mental health disorders only to become substance abusers again. Does it mean that the order of treatment has to be reversed in order to patch things up? Of course not!
Say, it was the mental health challenge that was addressed first, and it was treated just fine. During the process, the sufferer may develop additional SUDs or even worsen the existing ones. Therefore, reversing the order is not the key. The problem has to be addressed at the same time. This is where parallel treatment comes in.
Parallel treatment methods address the problem at the same time. This means that a patient will undergo drug rehab and mental health treatment simultaneously, usually at two different facilities. It may appear to be an innovation of sequential treatment, but it is not.
Remember the parallel lines lesson from your basic math days? Remember their primary characteristics? “Parallel lines never meet. They will go on and on and on and on, but they will never meet.” That, my friend, is exactly the weakness of parallel treatment.
Parallel treatment will address the problem at the same time, but they will never meet. It will be like living in two independent worlds where one does not care about the other. Professionals will render their service and standard procedures in treating disorders, but they will not consider its effects to the other. This can lead to the worsening of the situation, sometimes even causing death or delayed treatment as drug interactions mess things up.
All that said, neither sequential nor parallel treatment works fine. The solution is not just treating substance abuse disorder and the mental health problem at the same time. It is integrating the treatment methods.
Integrated treatment methods address the lapse that both sequential and parallel treatment possessed. These methods address both the addiction problem and the mental disorder at the same time while bridging the gap between the two areas of parallel treatment methods.
In short, integrated treatment methods will treat addiction while treating mental health challenges along with the disorders that pops up in the process while considering the interaction of all the existing disorders. Hence, integrated treatment facilities house both addiction specialists and mental health challenge specialists who cooperate in treating an individual.
To tap it all, sequential treatment is about hitting two birds with two stones thrown at different times, sequential treatment is about hitting two birds with two stones thrown at the same time, and integrated treatment is about hitting two birds with one stone. Thankfully, the latter has been displaying its prowess as more and more dual-diagnosed individuals find their way to sobriety and mental wellness.
Being diagnosed with Co-occurring Disorders and Planning Treatment
Having a substance abuse disorder and mental health problem at the same time is not the sole criteria for being dual-diagnosed. There are a lot of factors that should be considered in order to declare an individual to be suffering from co-occurring disorders, such as substance use history (usually including consumption for medical purposes) and medical history (physical and mental). These factors are also important in planning out the treatment model to be utilized in treating an individual. In addition, past experiences are assessed, such as traumatic experiences and major life challenges faced by the individual.
Family members also play an important role in the planning phase by providing details asked by the doctor, such as social behaviors and relationships. This way, the treatment process will be tailor-made for the individual and is well-suited for his/her needs. Every mental health problem will be addressed without compromising substance use disorders and even physical health as undesired drug interactions will be avoided.
Unfortunately, there are times that patients and family members will not cooperate well. For instance, the patient is unwilling to give up the substance abuse and is only interested in treating his/her mental health problem. The reason behind this can be personal or legal. In either case, the treatment process will be a hundred times as difficult as it is supposed to be since the client will easily be back to square one as the substance abuse spark more mental health challenges. Hence, the cooperation of the family and the client is of utmost importance. In some cases, the client will come to realize the importance of giving up his/her attachment to the abused substance because of fellowships and counseling session thus revealing the substance abuse along the way thus professionals have to alter the treatment approach.
The Best Dual Diagnosis Treatment. . .
The best dual diagnosis treatment method will greatly vary from individual to individual. A thousand combinations of dual-diagnosed disorders are possible, hence the variety of dual diagnosis treatments as well. The treatment for a PTSD patient who also has a history of substance abuse is different from the treatment for a bipolar who also happened to use drugs. However, some rehab facilities offer so-called “Integrated Treatment” without integrating anything at all. That means that they call the program as Integrated Treatment but only applies standard rehab procedures without considering the mental health problem that accompanies it. In fact, there are rehab facilities that introduce their service as such, without treating anything at all, such as services that offer only fellowships without professional service.
For a dual diagnosis treatment to be considered at least decent, it should possess the following characteristics:
- Considers psychotherapeutic drugs. This means that they know how to handle those medications and the interaction and side effects they will have with a person not fully detoxed. They should be used to applying medications such as antidepressants which will normally have no interactions if the treatment is sequential.
- Integrates Detox with Therapies Applying detox meds recklessly without knowing the psychotherapeutic drug interaction can be fatal. Thus, it is important to have a well-coordinated treatment method. This may also include counseling and other psychosocial activities that will help patients find a new purpose in life and the force of will they will require to be sober once and for all.
- Decent Sober Environment If treatment is inpatient, the facility should be free from stressful elements that can be a barricade to sobriety. This is especially true for an individual who suffers from depression, PTSD, and other related problems. The patient must be as far away as possible from stress-inducing elements and entities that will remind them of their problems and the substance they abused.
- Proper Drug Education Dual-diagnosis treatment facilities often provide educational materials and courses to help patients realize the destruction that drugs brought upon them and how such drugs will be harmful to the physical health. Also, they are sometimes educated in their mental health problem so that they will understand how they can deal with the situation.
- Aftercare Programs The road to sobriety does not end as one finishes a rehab program or dual-diagnosis treatment. Follow-ups should happen so that the chances of relapse is reduced. Thankfully, some dual-diagnosis treatment centers offer this.
How Does Integrated Treatment Work?
Integrated treatments include series of meticulous planning, rehabilitation, and therapies trying to address all the problems at the same time. This chain of processes includes detox, drug education, counseling, fellowships, a plethora of professional services and even aftercare programs. First, the treatment model to be utilized is planned by assessing the individual and by seeking details from family members and, sometimes, peers. Then, the treatment plan is executed.
Treatment will include detox in order to free the body from the existence of the residue of the drug abused while applying procedures that will not interfere with the mental health therapy. Some facilities offer rapid detox, though it is considered to be experimental (which means it is not covered by insurance). Alongside detox comes counseling sessions that aim to address not only the addiction problem but also the mental health challenge. Thus, such counseling is not only about drug education and the devastating effects of drugs, but also avoiding the events that will possibly ignite more mental health problems.
Counselors will help the client control the urge of using substances while trying to uplift the spirit of the client and cement their desire to achieve sobriety which requires forming a personal bond with the patient. Hence, clients usually feel free to talk and voice out thoughts.
Most of the times, fellowships are also involved in integrated treatment. While not a medical necessity, fellowships help quench the innate social craving of people; a social craving usually unsated by addiction sufferers. This is an important contributing factor to a person’s journey to recovery, especially because the people a client will meet in a rehab center share the same dilemma hence giving them enough comfort to voice out their thoughts, life stories and desire to be sober.
The path to sobriety is a difficult journey, especially in the presence of co-occurring disorders. Thankfully, modern rehab centers now address dual-diagnosed disorders the right way – treating them at the same time, in an integrated manner. An effective facility will need prowess not just in medical aspects of rehab, such as detox, but also in important psychosocial activities like counseling and fellowships. All these processes engage the patient at the same time, without compromising each other and without compromising the patient. This way, a systematized and organized treatment model is produced, always tailor-made for individuals addressing problems, behaviors and social needs specific to a person.
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