Dual diagnosis is an area of drug and alcohol treatment that treats both the substance abuse and other psychiatric disorders of a user. The mental disorder is typically a mood disorder, ranging from mild depression to schizophrenia. Dual diagnosis is commonly referred to as co-occurring disorders, signaling that there may be more than two (dual) disorders occurring at one time. “Co-occurring disorders of mental health conditions and substance abuse or dependence are truly “interactive” in that they each may exacerbate the symptoms and impact of the other.”1
To recover effectively, the person needs effective treatment for both problems.2
One of the interesting and often conflicting elements of treatments associated with the connection and co-occurrence of substance abuse and psychiatric disorders is that, “The primary goal of treatment in the recovery model is abstinence from mood altering substances. This conflicts with the psychiatric model that stresses emotional stability and commonly involves the use of medication.”3
The failure to combine the two conflicting approaches to treating substance abuse and psychiatric problems often results in a confused, scattered approach to rehabilitation rather than the holistic and cohesive treatment plan the user needs. This is why it is extremely important for the user and his or her loved ones to understand his/her specific needs and take control of his/her own treatment plan.
You can help ensure a more successful recovery by:
1) Becoming knowledgeable about your particular issues.
2) Telling your treatment or rehabilitation center about what you have researched and found what you need.
3) When looking at new treatment rehab centers ask specific questions about their capabilities to meet your particular issues.
The organization, Mental Health America, has a similar call to action when it comes to dual diagnosis treatment, which includes:
- Advocating for the involvement of consumers of mental health and substance dependence/abuser services in planning, implementing, and evaluating services.
- Advocating for the integration of mental health and substance recover services.
- Building coalitions to address the availability and accessibility of treatment and recovery services.
- Building and developing core curricula for training and experience in mental health and substance use.
- Educating the public about substance dependence/abuse and co-occurring disorders.
- Advocating for appropriate and effective recovery-oriented treatment.
- Monitoring outcomes of diversion for substance-related offences.1
The statistics for those who have a mood or psychiatric disorder and have a substance abuse/dependency problem are staggering:
“According to a report published by the Journal of the American Medical Association: 37% of alcohol abusers and 53% of drug abusers also have at least one serious mental illness.”2
Similarly, the probability of there being a co-occurring mental disorder and substance dependency problem is also extremely high:
“People with major depression and panic disorders are likely to have co-occurring substance use disorders at the rates of nearly 30% and 22% respectively as compared with about 15% in the general population."3
These figures show that because of the prevalence of co-occurring disorders, it is important for all substance dependents and abusers to at least get an evaluation to see if they have a mental disorder or problem along with their substance dependence.
Do not feel afraid or ashamed to ask for this evaluation and treatment. In fact, having the knowledge that you may have a co-occurring problem puts you farther along in the treatment and recovery process. It will be easier for a rehabilitation and treatment center to know exactly what you need and to help you recover more quickly and successfully. Rather than a trial and error approach, a treatment center will be able to quickly pinpoint a treatment plan that is right for you, without losing any time trying unsuccessful methods.
There are different approaches to treating co-occurring disorders. Depending on whether the rehab and treatment center uses a recovery model or a psychiatric model, you will get different answers and treatment plans.
The basic difference in treatment plans is the question of whether substance dependency has lead to the mental disorder or the mental disorder has lead to substance dependency. Depending on what side the treatment center is on, the difference is between whether or not the center uses replacement drugs, therapy, and other rehabilitation methods to help the user recovery.
Compared to the amount of people who have multiple disorders, there are relatively few rehabilitation and treatment centers that adequately treat all of the disorders together. However, the importance of treating all of your disorders cannot be stressed enough. This is because if you only treat one disorder, your success rate of staying clean and sober is decreased because the other disorder may flare up and you will not have the tools to deal with it appropriately.
Therefore, if the treatment center in your area does not have an integrated dual diagnosis program, tell your case worker what you have found about your co-occurring disorders and see if you are able to get a comprehensive treatment through a special program or project.
The more people ask for this integrated treatment, the more noticeable the demand will be to rehab and treatment centers.
Stages of Effective Co-Occurring Treatment In September 2003, Dr. Robert Drake reviewed the stages of effective co-occurring treatment for the National Alliance on Mental Illness. These are the stages found and reviewed of a program that will properly treat multiple disorders for a successful rehabilitation and treatment:4
1.) Trust between dependent and caregiver: Trust motivates the dependent to learn control skills and focus on goals. Accountability, relationship, and trust help prevent relapse.
2.) Assertive outreach by the treatment programs by using intensive case management, including house calls, monitoring, and counseling. This reinforces and maintains the relationship developed in stage 1.
3.) Motivational interventions, including education, support, and counseling, help empower dependents and gives them the tools to recognize how their substance dependency and mental disorders effect their daily lives, their desire to use drugs and alcohol, and how to maintain healthy habits that keep them from relapsing.
4.) Counseling in one on one, group and family therapy sessions is fundamental to building trust, building community and accountability, and gaining the support of people who hear you out and hear about the struggles of drug addiction and mental problems.
5.) Comprehensive care and treatment includes looking over all areas and elements of a person’s life including: stress, social networks, jobs, housing, activities, family dynamics, past experiences, medical history, and cultural and social history and sensitivity.
These are various stages of an effective, comprehensive dual diagnosis treatment program and plan. In fact, these stages are important for all people being treated for substance abuse or dependency, whether or not you have multiple disorders.
1.) “Position Statement 33.” Mental Health America. Date downloaded: July 2, 2010.
2.) “Factsheet: Mood Disorders.” Mental Health America. Date downloaded: June 22, 2010.
3.) “Dual Diagnosis: An Overview.” Dual Diagnosis by Foundations Recover Network. Date downloaded: July 2, 2010.
4.) “Mental Illness.” National Alliance on Mental Illness. Reviewed by Robert Drake, MD, Sept. 2003. Date downloaded: July 2, 2010.