People with both an addiction issue and a mental health issue are sometimes described as having a Dual Diagnosis or a comorbid disorder. These are terms medical professionals use to describe people who have two medical issues impacting them at the very same time. Doctors sometimes struggle with these patients, wondering how to deal with both issues at once. In the past, according to an article published on Medscape, people with addictions and mental health issues received less than optimal care as a result of these struggles. Sometimes, they received care for just one issue, while the other issue was allowed to grow stronger. Sometimes, they received care from two separate sets of providers, and those providers might not have shared information properly. As a result, many of these patients did not succeed in their treatment programs.
Now, medical professionals use an integrated treatment model to help this set of patients. Here, the addiction and the mental illness are addressed at the same time, by the same medical provider, and the entire medical, emotional and social life of the patient is taken into account and amended, if needed. It’s a complete form of care that can make a real difference in the life of someone with a Dual Diagnosis.
While almost any mental illness can run alongside an addiction (co-occurring issues) , there are some mental illnesses that are more commonly associated with substance abuse. According to an article published in the journal Medical Clinics of North America, the most common psychiatric disorders associated with substance abuse include:
- Antisocial personality
It’s very difficult to make generalizations about these issues. While it would be ideal to know for sure whether mental illnesses cause addiction or whether addiction causes mental illness, each patient is different, as is each addiction and each mental illness. Making sweeping statements is difficult, if not inaccurate, as a result.
Similarly, it’s not always clear why the person has asked for help. While some people with a Dual Diagnosis see their doctors because they’d like to rid themselves of their addictions, many others do not wish to control their substance abuse. For example, a study published in the Schizophrenia Bulletin found that of patients with both schizophrenia and an addiction to cocaine or opiates, most patients had a low motivation to quit their abuse. In short, these people may have wanted to gain control over their mental illnesses, but they may not have thought their addictions played a role in their mental illnesses. It’s quite possible that the reverse is also true; some people may want control over their addictions, not realizing their mental illness also needs to be addressed.
Making an Assessment
Putting together an integrated treatment plan requires the doctor to do a bit of detective work. The doctor will need to know:
- What substances the person is abusing
- What mental illnesses the person has
- Why the person wants treatment (i.e., what goals does the person have)
- Where the person lives
- Whether or not the person has a good job or an advanced education level
- If the person faces legal or financial difficulties
- If other medical issues play a role
This is a significant amount of information, to be sure, and sometimes it takes more than a simple interview for the medical professional to answer all of these questions. Sometimes other family members or friends must also chip in and answer questions so the doctor can put together a good plan to help the person.
An integrated treatment model will address all of these issues at the same time, helping the addict to gain control not just of the addiction, but also over the factors that might play into the addiction. This idea isn’t unique to the field of Dual Diagnosis. In fact, the National Institute on Drug Abuse reports that this model of integrated treatment should be used to help all people who are struggling with issues of substance abuse. By crafting a plan that addresses many issues at the same time, doctors can do their part to help addicts rebuild their lives, and with that strong foundation, a relapse is less likely.
But the integrated treatment model does have some important modifications in the realm of Dual Diagnosis. In fact, there are several specific goals that are completely unique when this model is used for Dual Diagnosis patients. For example, according to the National Alliance on Mental Illness, Dual Diagnosis programs often include aggressive outreach, allowing the therapist to actively encourage the person to stay in treatment and resist the urge to drop out. To keep the person involved, some therapists even provide services in the addict’s home, making it easy for that person to access care. In addition, NAMI reports, Dual Diagnosis programs might move at a slower pace than traditional programs for addiction, allowing the addict to move in slow stages through the healing process and develop trust in the therapist.
The Substance Abuse and Mental Health Services Administration reports that some people with Dual Diagnosis issues also have several social or environmental issues impacting them at the same time. They may not have anywhere to call home, and they may not have a job or a means of making money. They may have poor connections with their families, or they may have low social skills that cause them to be isolated and shunned. In an integrated treatment model, these issues are also addressed in a caring and sensitive way, so the person can move forward and get back on track.
Counseling is the primary tool used in the treatment of addiction, and this doesn’t change in an integrated treatment model. No matter how engaged the person is in therapy, and no matter how healthy his/her social life might be, the person still needs to gain insight on addiction and learn how to control urges. Dual Diagnosis patients also need to learn these same lessons about their mental illnesses, and therapy can fulfill this role as well. But, the therapy methods used with Dual Diagnosis patients might be slightly different. According to an article published in the Journal of Substance Abuse Treatment a therapist might:
- Simplify open-ended questions, if the person has cognitive deficits or difficulty understanding difficult concepts
- Listen reflexively, adding in words and sounds of encouragement to build rapport
- Stay positive, praising accomplishments large and small
- Integrate information about the mental illness into feedback given
These minor adjustments might transform a traditional addiction model into a more supportive, open model that can be encouraging for people who have a Dual Diagnosis. In addition, as mentioned, some therapists choose to slow down the pace of counseling. There’s a lot of information to cover, and the person might need more time to absorb all of this information. Taking a slower pace might facilitate treatment.
Medications might play a role in treating both conditions. While some addiction programs might use an abstinence-only policy, where the patients aren’t allowed to use any substances whatsoever, an integrated treatment program realizes that dealing with a mental issue might mean taking medications. It’s just part of healing. Similarly, some addictions are best treated with medications like methadone. These medications might interact with medications the person takes for mental illness. By receiving care in an integrated model from one provider, the risk of medication interactions can be reduced. This sole provider can check the medications, ensure they’re safe to take together, and help prevent problems before they occur.
The integrated model is relatively new, but it has been proven to be an effective method in many scientific studies. For example, a study in the Journal of Substance Abuse Treatment found that people who participated in the integrated model had a lower incidence of psychotic episodes and arrests compared to people who did not participate. Their therapy seems to have allowed them to achieve a level of stability, and this resulted in fewer crises. The model has also been effective in helping to deal with addiction. A study in the journal Hospital and Community Psychiatry found that of 17 people who received inpatient Dual Diagnosis care, 12 reported drug and alcohol abstinence one month later. This is a small study, but the results are certainly exciting and remarkable.
It’s clear that integrated treatment models have the capacity to help people gain control over their addictions, their mental illnesses and the other important aspects of their lives. The lessons they learn in therapy can stay with them for the rest of their lives, as they continue to manage both of these chronic conditions over the long term. Relapse is sometimes an issue for these people, as these conditions are powerful and long-term change is hard to sustain; however, therapy provides a strong foundation that can be readdressed as issues occur.
At The Canyon, we provide ongoing support to all of our patients, helping them if a relapse occurs or just checking in with them regularly. For Dual Diagnosis patients, this service can be of great help, and we’re happy to provide it.