Mental Health

The Need for Integrated Treatment

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It’s common for mental illnesses to lie beneath an addiction issue. In fact, the Substance Abuse and Mental Health Services Administration reports that of the 17.5 million adults in the United States with a serious mental illness in 2002, 4 million also had a substance use disorder. Even though these two problems often go together, many treatment programs don’t address both problems at the same time. Some only offer care for an addiction, for example, while others provide care only for a mental illness.

At The Canyon, we know that robust healing can only take place when all of the problems a person faces are treated at the same time. Our science-based, Dual Diagnosis approach allows us to do just that.

The Foundation of Our Care

Tailoring Care

As treatment moves forward, people continue to learn and grow. In time, they may be able to:

  • Identify their triggers for disordered thinking
  • Explain how their mental illnesses contribute to substance use and abuse
  • Explain how addictions can make mental illnesses worse
  • Deal with a trigger without lapsing into poor behavior
  • Know when they need touch-up therapy in order to prevent a relapse

As our clients change, our treatment programs change. Elements are added while others are removed, all allowing our clients to take charge of their mental health and their addictions, while building up a life that’s both healthy and rewarding. It can be an amazing journey, and we’d like to help you to get started. Please call us to find out more, or to schedule an intake appointment.

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General Information on Mental Health Disorders

Note: The therapies and techniques described in the following sections may or not be included in The Canyon’s treatment curriculum. Please contact us for those details. The information below is intended as an informative resource on the general topic of mental health treatment

The Diagnostic Manual of Mental Health Disorders (DSM) is a main reference source and diagnostic tool for psychiatrists, psychologists, and other mental health clinicians.[1] The DSM-5, the most current edition, was published by the American Association of Psychiatry in 2013.

The DSM-5 is so indispensable to the field of mental health treatment that most every insurance company will decline to cover medical claims if the diagnosed disorder has not been officially recognized in this manual. The following is a list of each mental health disorder category included in the DSM-5:

  • Common disorders (includes substance use disorder and bipolar disorder)
  • Childhood disorders
  • Personality disorders
  • Sleep and wake disorders
  • Dissociative disorders
  • Sexual and paraphilic disorder
  • Feeding and eating disorders
  • Other mental health disorders (such as acute stress disorder)[2]

one in eight er visitsAn Agency for Healthcare Research and Quality (AHRQ) report found that nearly one in eight emergency room hospital admissions was based on a mental health disorder or substance abuse issue.

Source: ADAA

Prevalence of Mental Health Issues

An awareness of the prevalence of mental health disorders can help to draw public attention to mental illness as a way to help relieve any stigmas that may persist in this area.

The National Alliance on Mental Illness provides the following statistics that illuminate the degree to which mental health disorders occur in the US:

  • Approximately 43.7 million American adults (one in five adults) experience mental illness in any given year.
  • Approximately 13.6 million adult Americans (one in 25) will face a serious mental illness that substantially disrupts their life in any given year.
  • About 2.6 percent of American adults live with bipolar disorder.
  • Approximately 1.1 percent of American adults live with schizophrenia.
  • About 6.9 percent of American adults experienced an episode of major depression in the past year (based on a survey taken in 2012).[3]
mental health disorder rates

Experiencing mental illness occurs with a frequency that demands sensitivity around this status, whether the associated symptoms are temporary or permanent. Within American society, an understanding of mental health disorders continues to develop and expand. Today, there is greater awareness of the possible causes of mental illness compared to earlier points in our history. A consideration of the causes of mental illness makes clear that while some individuals may be more susceptible than others, no one is truly immune from the experience a mental health disorder.

In general, mental health disorders derive from a constellation of genetic and environmental factors. A person may have inherited traits of mental illness. Research supports that mental health disorders are more likely to occur in individuals who have relatives with mental health disorders. Certain genes, which are, of course, shared within family bloodlines, can increase the risk of a mental illness manifesting in one’s lifetime. Environmental factors/life situations may trigger the expression of latent genes involved in any given mental health disorder. [4]

However, mental illness can also occur outside of a family-based genetic disposition. For instance, research shows that fetus exposure to alcohol, toxins, or viruses can cause genetic mutations linked to mental health disorders.[5] Mental illness can also occur due to interferences with a person’s brain chemistry.[6] Drugs are one example of how an exterior influence can impact brain function and cause symptoms of mental health disorders to manifest. For instance, drug-induced psychosis can arise after use of a variety of drugs of abuse, such as cocaine.

Psychology and Film: A Beautiful Mind (2001)

Few films have delved into the psyche of a person suffering from a mental illness as articulately as this film, directed by Ron Howard. The story is based on the real-life experiences of John Forbes Nash, Jr., a paranoid schizophrenic with a stratospheric aptitude in math. Through Nash’s eyes, the audience experiences his visual hallucinations and acute paranoia but also follows Nash through lucid times and brilliant accomplishments.

One of the film’s greatest achievements is its portrayal of schizophrenia in a way that comports with the hallmarks of this condition as discussed in the DSM. A Beautiful Mind is recommended for anyone personally or laterally affected by schizophrenia or anyone who would like to learn more about this mental health disorder through the biography of one of America’s most renowned mathematicians.

Source: Psychology Film Analysis

Dual Diagnosis

The term “dual diagnosis” refers to the co-occurrence of a substance use disorder and at least one mental health disorder. It may come as a surprise to some Americans, but substance abuse is considered a mental health disorder. As mentioned above, the DSM-5 includes substance use disorder. As the National Institute on Drug Abuse explains, drug use can alter complexes operating in the brain.[7] The brain is a creature of habit; it will adjust to the circumstances in its environment, such as the presence of drugs. When the brain adjusts to a drug environment, it can cause the substance abuser to manifest new types of behavior, such as acting compulsively.

Some symptoms associated with drug abuse are also common to mental health disorders. For this reason, when a person is just beginning to sense that a loved one has a problem, he may question whether the loved one is abusing drugs or possibly experiencing a separate psychiatric illness, such as depression, anxiety, or psychosis.

mental illness and co-occurringFamily members and other loved ones are usually the individuals most involved in getting a substance abuser into rehab. For this reason, it is important for family members to recognize the signs and symptoms of substance abuse disorders and mental health disorders, and follow up on instinctual hunches or suspicious behaviors. However, making a dual diagnosis is reserved for a mental health professional. The diagnostics stage is actually the first step in any rehab process for singular conditions or co-occurring ones.

According to research from the National Alliance on Mental Illness, of 20.7 million American adults who experienced substance abuse, 40.7 percent of this population (8.4 million) had a co-occurring mental health disorder.[8]

Certain mental health disorders co-occur with substance abuse with greater frequency than others. For example, it is well observed in the mental health treatment community that substance abuse and bipolar disorder frequently occur together. Research studies show that at least 40 percent of those with bipolar disorder have a substance use disorder.[9] It is difficult to assess the relationship between substance abuse and mental health disorders (i.e., causation versus correlation and other factors), however, there is a general consensus that anyone afflicted with a dual diagnosis receive treatment for both conditions.

Specifics of Mental Health Treatment

Mental health disorders can stem from a complex of biological and social factors, and for this reason, they require multidisciplinary treatment efforts. Depending on the severity of the mental health disorder, treatment can occur in an outpatient or residential program. In the case of a co-occurring diagnosis, a dual diagnosis center will be best equipped to offer treatment for all disorders.

If a dual diagnosis treatment center is not an option, a standard drug rehab center can work in conjunction with a local mental health clinic to ensure that all necessary components of treatment are provided. It is critical to understand that treatment of a mental health disorder without simultaneous treatment of the substance abuse is never recommended. In fact, a medical detox to rid the body of all intoxicants is usually necessary before mental health treatment can commence. After the detox, abstinence maintenance treatment can begin for the substance abuse, and primary care treatment can start for the mental health disorder.

The following are some main treatment services used to help treat mental illness:

  • Medication: Geared toward successful management of symptoms, different medications are used to treat each discrete mental health disorder.
  • Psychotherapy: Mental health disorders are proven to respond to “talk therapy” about thoughts, emotions, and feelings. Some of the numerous approaches are discussed below.
  • Hospitalization: In a small number of cases, admission to a hospital will be necessary to provide 24/7 monitoring and stabilization. After release, treatment should continue in a residential or outpatient program.
  • Case management: Although not a medical treatment, these services provide the support needed to achieve a well-balanced life. A case manager can help a client to complete tasks, such as budgeting, food shopping, and personal hygiene.
  • Wellness services: Although not a standard form of treatment, holistic services, such as yoga classes, acupuncture, and massage, complement treatment and self-management of symptoms.[10]

Researchers at Duke University Medical Center reviewed more than 100 studies on yoga on the alleviation of mental health disorder symptoms and concluded that yoga has positive effects on mild depression, sleep problems, ADHD, and schizophrenia among patients who take medications for these illnesses.

Source: TIME

Medications for Mental Health Disorders

In some cases, the symptoms of a mental health disorder may be treated with psychotherapy alone, without resorting to pharmaceutical medications; however, many mental health disorders are responsive to targeted medications. Today, treating symptoms of mental health disorders with medication is standard practice. As these medications are U.S. Federal Drug and Administration-approved, they have been subjected to clinical trials (trials are of limited duration so newer drugs have less established reputations). However, a medication can interact negatively (i.e., have severe side effects or cause an allergic reaction) with any individual user. For this reason, whenever taking a medication, it is necessary to immediately report any adverse side effects or concerns to the prescribing doctor.

Schizophrenia medications+

Antipsychotic medications are used to treat schizophrenia. Older generation medications are often referred to as “typical antipsychotics” and include haloperidol, chlorpromazine, and perphenazine. Newer medications are called “atypical antipsychotics,” and brand names include Abilify, Seroquel and Clozaril.

Depressive disorder medication+

Known categorically as antidepressants, types include selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and monoamine oxidase inhibitors (MAOIs). Brand names of SSRIs include Prozac, Lexapro, and Zoloft. SNRI drugs include Pristiq, Cymbalta and Effexor. MAOIs are older generation antidepressants, such as Marplan, Parnate and Nardil.

Anxiety medications+

Antidepressants, particularly SSRIs, are adapted to the treatment of generalized anxiety disorder. For mild cases, antihistamines (e.g., hydroxyzine) and beta-blockers (e.g., propranolol) can be helpful. For acute anxiety/panic attacks, benzodiazepines (i.e., sedatives) are most commonly prescribed and include Xanax, Klonopin, Ativan and Valium.

Bipolar disorder medication+

Mood stabilizers are used as a standalone treatment or in conjunction with an antipsychotic and/or antidepressant. In use since the 1970s, lithium, a mood stabilizer, is effective for some sufferers. Anticonvulsant medications can be used a mood stabilizer, such as valproic acid, oxcarbazepine and carbamazepine.

Sources: National Institute of Mental Health / WebMD

Psychotherapy for Mental Health Disorders

The mind is a largely unknowable terrain of chemical neurotransmitter processes that drive thoughts and behaviors. However, talk therapy helps individuals to develop a greater understanding of their thoughts and how those thoughts motivate behaviors. There is no singular psychotherapy approach, and it’s a good thing because different clients have different needs. Depending on the treating psychotherapist’s recommendations, a person may be treated with a single psychotherapy approach or a combination of methods.

CBT+

Cognitive Behavioral Therapy (CBT) is one of the most commonly offered approaches in drug rehab and general mental health treatment clinics. Studies have shown that CBT is effective in the treatment of numerous mental health disorders, including depression, anxiety disorders, bipolar disorders, schizophrenia, and eating disorders.[11] In general, CBT is considered to be a short-term therapeutic strategy. However, there is no standard period of CBT treatment. Sessions are usually one hour each and occur at least once a week.[12]Developed in the 1960s, CBT centers on a person’s thoughts and beliefs in order to identify how unhealthy ideations leads to unhealthy behaviors. True to its name, this approach has both cognitive (mental) and behavioral (action) dimensions. It is a practical treatment approach; in a typical session, a psychotherapist will help a person to work toward a resolution of current problems.[13] For example, a client who believes (cognitive) he is “worthless” or “unlovable” may affirmatively seek (behavior) an abusive romantic partner who reinforces this negative self-perception. Through CBT work, an individual can confront and change his negative thoughts to self-affirming ones. Complementary behaviors are then likely to occur, such as seeking a loving and supportive romantic partner.

DBT+

Dialectical Behavior Therapy (DBT) is a well-utilized approach that developed out of CBT. Originally, DBT was used to treat severely suicidal individuals, and it soon proved to be an effective treatment. As many individuals with a diagnosis of borderline personality disorder (BPD) have suicidal thoughts, DBT became an acceptable standard treatment for this illness. According to the National Institute of Mental Health, compared to other treatment approaches, DBT decreased suicide attempts by 50 percent in individuals with BPD.[14]The term “dialectical” may seem too academic for some, but it refers to how DBT focuses on two seemingly non-complementary, opposite processes. The first stage of DBT involves having a person accept his reality, however painful it may be or however guiltridden the individual may feel. Acceptance is usually associated with not making changes; however, in DBT, a therapist will help a client to develop new, healthier life choices and coping skills. Through this education, many DBT clients begin to make positive changes to stop disruptive behaviors.[15]

IPT and IPSRT+

Interpersonal Therapy (IPT) is an evidence-backed treatment approach for depression. IPT is based on the treatment assumption that helping a clinically depressed person to improve communications with others will help to alleviate depressive symptoms.

During an IPT session, a counselor can help a client to identify behaviors that are causing relationship problems and work toward changing interpersonal dynamics. A counselor can discuss all sources of depression, such as grief or environmental conflict, and explore how underlying mood can exacerbate these life stressors. Together, the therapist and client can work to improve negative mood and behaviors that are disruptive to one’s relationship and level of life satisfaction. Studies have reached varying conclusions as to the effectiveness of IPT for treatment of mental health disorders other than depression.

IPT influenced the development of interpersonal and social rhythm therapy (IPSRT), an approach that has been shown to be effective for the treatment of bipolar disorder. One of the hallmarks of bipolar disorder is difficulty continuously maintaining balance in the execution of day-to-day affairs. IPSRT combines the basic concepts of IPT with behavioral psychoeducation. One goal is to help clients with bipolar disorder to maintain a routine of helpful behaviors, such as regularly taking one’s medication as prescribed and going to bed and waking at the same time each day. IPSRT, when combined with the appropriate psychopharmacological medication, can help to manage bipolar disorder and prevent a relapse of symptoms.[16]

Family Therpy+

Family-focused therapy (FFT) was specifically created to treat bipolar disorder. It is based on the assumption that family members are integral to a bipolar person’s treatment success. FFT is unique because it includes family members directly in the treatment process. In a typical session, an individual and her family work with the therapist as a group.[17] In this way, the family can work together to heal any damage to the family dynamic and develop improved intra-family relations.

Although FFT occurs in a group setting, the individual’s needs are not neglected. The therapist will help the individual with bipolar disorder to identify any conflicts with family members that may exacerbate the symptoms of this illness. The therapist can help the individual develop improved ways to interact with loves ones and resolve any disputes.[18]

For family members, the therapist will help to provide an education about bipolar disorder symptoms and the different ways they can manifest throughout the course of this illness. Family members will also learn how to help the individual to manage bipolar symptoms. In addition, the family’s needs are also addressed. Caregiving is often emotionally draining and physically exhausting. In a run-down state, a caregiver may act out in ways that are not constructive. The therapist can help caregiving family members or loved ones to better communicate their emotions even when under stress. Family involvement in FFT has been shown effective in helping a person with bipolar disorder to stabilize and avoid a relapse of symptoms.[19]

Mental health treatment, in whichever specific form it takes for an individual client, is necessary not only to help restore balanced functioning but also to avoid a worsening of symptoms. Untreated mental health conditions can metastasize and put the individual at heightened risk for initiation into drug abuse or escalation of any existing drug abuse.

Today, there are fewer barriers to treatment than ever before in history as the federal government has made strides to extend claims coverage for mental health services in private and public plans such as Medicaid. Although how or why mental illness occurs remains largely unknown, there is an overwhelming consensus that treatment is necessary.

The Mental Health Parity Act (1996)

This federal law ensures greater equality between mental health treatment services and other medical services. It applies to many insurance programs, including certain employment-based plans. In essence, the law provides that if an insurance plan offers mental health benefits, there cannot be higher lifetime or annual dollar limits on mental health treatment services compared to medical or surgical benefits.

The MHPA was not perfect, so in 2008, Congress passed the Mental Health Parity and Addiction Equity Act (MHPAEA) to cover gaps. The MHPAEA disallowed insurance plans to differentiate between mental health services and medical services in terms of treatment number limits, cost sharing, and out-of-network or in-network service coverage. Significantly, the MHPAEA extended to treatment of substance use disorders, an area that the MHPA did not cover. The MHPAEA is therefore considered to be an achievement for treatment of mental health disorders as well as treatment of drug addiction.

Source: Health Affairs

Citations

[1]DSM.” (n.d.). American Psychiatric Association. Accessed July 19, 2015.
[2]Symptoms & Treatments of Mental Disorders.” (n.d.). PsychCentral. Accessed July 19, 2015.
[3]Mental Health by the Numbers.” (n.d.). National Alliance on Mental Illness. Accessed July 19, 2015.
[4]Mental Illness Causes.” (May 3, 2014). Mayo Clinic. Accessed July 19, 2015.
[5]Drug Facts: Comorbidity: Addiction and Other Mental Disorders.” (March 2011). National Institute on Drug Abuse.
[6]Mental Health by the Numbers.” NAMI
[7] Cerullo, M. and Strakowski, S. (Oct. 1, 2007). “The Prevalence and Significance of Substance Use Disorders in Bipolar Type I and II Disorder.” Substance Abuse Treatment, Prevention and Policy. Accessed July 19, 2015.
[8]Mental Health Treatments.” (n.d.). Mental Health America. Accessed July 19, 2015.
[9]Psychotherapies.” (n.d.). National Institute of Mental Health. Accessed July 19, 2015.
[10]Cognitive Behavioral Therapy.” (Aug. 7, 2013). PubMed Health. Accessed July 19, 2015.
[11] “Psychotherapies.” National Institute of Mental Health.

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