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Dual Diagnosis Treatment

In the realm of substance abuse treatment, it has become an axiom:  People who abuse substances are more likely to have a mental health issue and people with mental health issues, are more likely to abuse substances. National statistics support this notion.

About half of people who experience a mental illness will also have a substance use disorder at some point in their lives and vice versa, according to the National Institute on Drug Abuse (NIDA). The National Bureau of Economic Research (NABR) reported that, at one time, people who have been diagnosed with a mental health disorder in their lifetime consumed about 69 percent of the country’s alcohol and 84 percent of its cocaine.

What’s more, an estimated 8.2 million Americans had mental health and substance abuse disorders in 2016, according to the National Survey on Drug Use and Health by the Substance Abuse and Mental Health Services Administration (SAMHSA). 

At one point, plentiful treatment options did not exist for people who had both conditions concurrently. Now, reputable treatment centers have come up with a nuanced, multilevel option to effectively address both disorders. This option is known as dual diagnosis treatment. 

Read on to learn more about this comprehensive program, along with what constitutes mental illness and substance abuse.

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What Is Mental Illness? 

Mental illness is described as health conditions marked by changes in emotion, thinking, behavior, or some combination of those factors. They are characterized by distress and/or problems with functioning in social, work, or family activities, according to the American Psychiatric Association (APA).

People with mental health disorders can have difficulties meeting the daily obligations of life, particularly when it comes to social situations, employment, and regular tasks. Mental health disorders include the following:

  • Depression
  • Generalized anxiety disorder
  • Bipolar disorder
  • Post-traumatic stress disorder (PTSD)
  • Schizophrenia
  • Personality disorders
  • Borderline personality disorder
  • Obsessive-compulsive disorder (OCD)
  • Panic disorder
  • Eating disorders (anorexia, bulimia, binge eating)

Signs of Mental Illness

Mental illness can manifest at any age, but three-fourths of all cases begin at age 24, according to the APA.

Various mental health disorders can impact people differently. A person can have a condition that hardly interferes with her daily life. Another person can have a mental illness so debilitating that it requires hospitalization.

Common symptoms associated with all mental illness include:

  • Restlessness
  • Feelings of helplessness
  • Mood swings
  • Irritability
  • Strong feelings of guilt or worthlessness
  • Loss of interest in activities
  • Excessive tension or worrying

  • Sleep disorders, such as insomnia
  • Appetite or weight changes
  • Inability to experience pleasure

  • Numbness
  • Trouble concentrating

  • Sharp increases in energy
  • Racing thoughts or rapid speech
  • Impaired judgment or impulsivity

When Substance Abuse Is Present 

The World Health Organization (WHO) defines substance abuse as harmful or hazardous use of psychoactive substances like drugs or alcohol. That abuse becomes established when a person develops a dependence, which WHO characterizes as a cluster of behavioral, cognitive, and physiological phenomena that manifest after repeated use of drugs or alcohol.

Dependency blooms into addiction when a person exhibits compulsive behavior toward obtaining their substance of choice.

Addiction will also compel them to use despite the harmful consequences and adverse effects that come from it.

The APA publishes the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which outlines 10 or 11 criteria, depending on the substance, that describes “a problematic pattern of use of an intoxicating substance…” that occurs within a 12-month period.

Frustrated woman with headache

A person who meets two or three of the following criteria has a “mild” disorder; four or five is considered “moderate,” and six or more is considered “severe.”

The criteria include:

  1. The substance is often taken in larger amounts or over a longer period than was intended.
  2. There is a persistent desire or unsuccessful efforts to cut down or control the use of the substance.
  3. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
  4. Craving, or a strong desire or urge to use the substance, occurs.
  5. Recurrent use of the substance results in a failure to fulfill major role obligations at work, school, or home.
  6. Use of the substance continues despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of its use.
  7. Important social, occupational, or recreational activities are given up or reduced because of use of the substance.
  8. Use of the substance is recurrent in situations in which it is physically hazardous.
  9. Use of the substance is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
  10. Tolerance, as defined by either of the following:
  1. A need for markedly increased amounts of the substance to achieve intoxication or desired effect
  2. A markedly diminished effect with continued use of the same amount of the substance.

11. Withdrawal, as manifested by either of the following:

  1. The characteristic withdrawal syndrome for the substance (as specified in the DSM-5 for each substance).
  2. The use of a substance (or a closely related substance) to relieve or avoid withdrawal symptoms.

What is Dual Diagnosis Treatment

Ideally, dual diagnosis is an integrated treatment approach that should address a substance addiction and a mental health condition concurrently. This method discards the old attitude that once existed, where a patient who had symptoms of depression was denied treatment because he had an existing alcohol abuse problem.

A reputable dual diagnosis program offers a comprehensive array of services to address both conditions. According to the National Alliance on Mental Illness (NAMI), the following services are commonly employed in dual diagnosis treatment:

This is the initial phase of the treatment process where trained medical staff weans a patient off the addictive substance. They also medically intervene when withdrawal symptoms arise. This is ideally an inpatient process, where the patient is under around-the-clock care and supervision for up to seven days to ensure a safe and comfortable detox process.

In an inpatient or residential setting a patient gets the opportunity to receive full-time care for a mental health and substance abuse disorder, which is the optimal environment for dual diagnosis treatment. Why? Because it allows a client to receive medical and mental health care 24/7. In an accredited, respected, residential program, a patient can receive the support, therapy, medication and health services to treat the underlying cause of his or her addiction.

This phase of treatment helps a patient change the negative and destructive thought patterns that lead to substance abuse. This is often accomplished through the implementation of cognitive behavioral therapy (CBT), which teaches clients how to unlearn preconceived notions they have about themselves and life while instituting better decision-making practices.

Medications are administered to treat the symptoms of a mental health issue as a patient goes through treatment.

 

A reputable residential program will provide room and board or resources for sober living facilities so that clients can optimally recover in stable environments.

The recovery process can be difficult and isolating. Thus, credible dual diagnosis programs include recovery communities in its treatment processes to provide patients support. Support groups allow members to share frustrations, celebrate successes, find referrals for specialists, find the best community resources and swap recovery tips, states NAMI.

How Dual Diagnosis Treatment Can Help You

Dual diagnosis offers a specialized plan that allows for the effective treatment of co-occurring substance abuse and mental health disorders. In addition to detoxification services, clients can receive residential treatment, where they can receive therapy and care, including medication and CBT.

After someone goes through a detoxification regimen, they can enter into residential treatment where housing is provided. NIDA recommends that people with complex, co-occurring conditions should consider remaining in residential treatment for 90 days or more to maximize the program’s effectiveness. 

In addition to treatment, a professional recovery program can help clients connect to a community that provides encouragement and support. Communities that are offered through a 12-step program or SMART Recovery® can keep clients from succumbing to relapse. 

Sources

(n.d.). Retrieved from https://www.psychiatry.org/patients-families/what-is-mental-illness

Center for Behavioral Health Statistics. (n.d.). Key Substance Use and Mental Health Indicators in the United States: Results from the 2016 National Survey on Drug Use and Health. Retrieved from https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2016/NSDUH-FFR1-2016.htm#adults1

Delphi Behavioral Health Group. (n.d.). Dual Diagnosis Treatment | Recovery & Symptoms. Retrieved from https://delphihealthgroup.com/dual-diagnosis-treatment/

NAMI. (n.d.). Retrieved from https://www.nami.org/Learn-More/Mental-Health-Conditions/Related-Conditions/Dual-Diagnosis

National Institute on Drug Abuse. (n.d.). 7: Duration of treatment. Retrieved from https://www.drugabuse.gov/publications/teaching-packets/understanding-drug-abuse-addiction/section-iii/6-duration-treatment

National Institute on Drug Abuse. (n.d.). Comorbidity: Substance Use Disorders and Other Mental Illnesses. Retrieved from https://www.drugabuse.gov/publications/drugfacts/comorbidity-substance-use-disorders-other-mental-illnesses

Saffer, H., & Dave, D. (n.d.). Mental Illness and the Demand For Alcohol, Cocaine and Cigarettes[PDF File]. The National Bureau of Economic Research. Retrieved May 1, 2019 from https://www.nber.org/papers/w8699

Substance abuse. (2017, October 05). Retrieved from https://www.who.int/topics/substance_abuse/en/

What are the ASAM Levels of Care? (2018, July 20). Retrieved from https://www.asamcontinuum.org/knowledgebase/what-are-the-asam-levels-of-care/



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