The Essential Guide to Best Dual Diagnosis Treatment

An alcohol or drug addiction rarely appears out of the blue. Most people with addictions do not simply choose to continue abusing drugs or alcohol without a reason for doing so. Oftentimes, a pre-existing mental health condition causes, contributes to or exacerbates a person’s addiction. The consumption of drugs or alcohol can also cause, contribute to or worsen an individual’s psychological conditions. When addiction and mental illness exist simultaneously, it is referred to as a dual diagnosis or a co-occurring disorder. Any person struggling with both these problematic conditions requires specialized dual diagnosis care administered by qualified trained professionals.

The Link between mental illness and substance abuse
The Link between mental illness and substance abuse

What is Dual Diagnosis?

While it didn’t always have an official term or named condition, mental illness and substance abuse have been linked for decades. Dual diagnosis can range from a person abusing drugs to cope with a preexisting mental health issue like depression, to someone who developed a mental health problem as a result of using a specific drug over an extended period. No matter what the reason for substance abuse is, it has been conclusively proven that drugs and alcohol only make symptoms of psychological illnesses worse and can also lead to the development of other mental health problems. [1]

Being that both mental illness and addiction primarily affect the brain, both conditions play off of each other, and the existence of one makes the occurrence of the other more likely. Symptoms of dual diagnosis vary widely due to there being a virtually endless amount of potential combinations. Here are some common symptoms to look for:

  • Sudden changes in behavior
  • Engaging in risky behaviors while under the influence
  • Feeling like drugs or alcohol are necessary in order to function
  • Loss of control over substance use and abuse
  • Withdrawal from friends or family
  1. 1. http://www.nami.org/Learn-More/Mental-Health-Conditions/Related-Conditions/Dual-Diagnosis
How Common Are Dual Diagnoses or Co-occurring Disorders?

Statistics show that there is a high prevalence of dual diagnoses in America. It’s estimated that 50 percent of people with a mental illness also have a substance abuse problem and that more than half of people with a substance use disorder also have a diagnosable mental illness.

Why Does Addiction Co-occur with Mental Illness So Often?

Establishing an exact causality or directionality in the relationship between an addiction and a mental illness is nearly impossible because of the myriad factors that can contribute to either condition.

Even if one condition appeared before the other, it does not mean one was caused by the other. This is because subclinical symptoms of a mental illness may prompt drug or alcohol use and people often have imperfect recollections of the exact moment they began abusing.

Common reasons for co-occurrence:

  1. Drugs or alcohol can cause people to experience symptoms of another mental illness
  2. Mental illnesses can lead a person to abuse drugs or alcohol as a means of self-medication. This can occur before the individual has a diagnosable mental health condition but is still struggling with subclinical symptoms 
  3. Substance use disorders and other mental illnesses are caused by overlapping risk factors, including genetic predisposition, environment and early exposure to trauma

    How to Effectively Treat Dual Diagnosis Patients

    One of the most highly perpetuated errors in the addiction recovery industry is to focus only on a person’s drug or alcohol addiction even when there is knowledge of another preexisting mental condition. Many times this is simply because many addiction rehab facilities do not offer mental health services.

    People with dual diagnoses need extra care in order to make progress in rehab. This frequently includes a combination of psychotherapy, behavioral therapies, medication and help from peer-support groups. Any rehab facility that does not include concurrent mental health treatment will be inadequate to help a person with a dual diagnosis. [1]

    The first step in dual diagnosis treatment includes a full assessment of the severity of both conditions. This can prove difficult because in many cases, symptoms of one disorder mimic symptoms of the other. The ensuing dual diagnosis treatment stages should provide education to the client and his family about the mental illness and how it interacts with the addiction. Patients should also be taught social skills and healthier coping mechanisms to help them safely navigate through the symptoms of mental illness and stressful situations.

    1. 1. https://medlineplus.gov/dualdiagnosis.html

    Dual Diagnosis Treatment Obstacles

    People with dual diagnoses tend to have symptoms that are more persistent, extreme and resistant to treatment than people with a single diagnosis. Additionally, co-occurring disorders tend to be more chronic and have a more severe course of development. Dual diagnosis patients are often exposed to additional environmental risk factors and are limited in what medications they can take because of the potential for abuse. [1]

    One potential problem in providing effective dual diagnosis treatment is that many healthcare providers have minimal training in this area. In these situations, the psychiatrist, physician or addiction care specialist may have focused on one condition or another during their education and training, with only a few classes on the others. Additionally, because many dual diagnosis patients present a large amount of obstacles during rehab, they are often not thought of as good candidates for treatment and have their treatment terminated early or are allowed to dropout prematurely. [2]

    1. 1. https://www.mentalhelp.net/articles/10-things-you-need-to-know-about-dual-diagnosis-treatment/
    2. 2. http://jdc.jefferson.edu/cgi/viewcontent.cgi?article=1233&context=jeffjpsychiatry

    How Dual Diagnosis Differs from Traditional Addiction Treatment

    The treatment of patients with dual diagnoses can be difficult to approach. Determining how one condition is affecting the other, the severity of each condition on its own, or even determining which condition came first presents a challenge. Both conditions can have conflicting and overlapping symptoms so studying one condition in the immediate presence of the other condition relies on a degree of trial and error.

    Of the patients with both a mental illness and a drug addiction, only 7.4 percent get treatment for both conditions.

    - Substance Abuse and Mental Health Services Administration

    Research has shown that the best treatment of patients with dual diagnoses are derived from evidence-based practices (EBPs), which have been researched academically or scientifically, proven effective and replicated by more than one study. This treatment model stems from the prioritization of scientifically-proven methods along with individual patient values. There are five steps in the evidence-based practice treatment process [1]:

    1. Assess the patient and discover his or her critical needs
    2. Acquire relevant research including all studies and investigations
    3. Appraise the validity and quality of your research as it applies to the patient
    4. Discuss your findings with the patient and determine how best to approach treatment given his or her values and needs.
    5. Develop a plan that works for the patient and the provider and apply it 
    1. 1. http://guides.mclibrary.duke.edu/c.php?g=158201&p=1036021

    Types of Evidence-Based Practices

    Just as co-existing conditions vary, so do their methods of treatment. Some variant EBPs employed in the treatment of different conditions are cognitive behavioral therapy for insomnia and depression; exposure therapy for anxiety, phobias and post-traumatic stress disorder (PTSD); and motivational therapy, which is similar to an intervention, for helping patients overcome their substance addictions. [1]

    Despite the variations in types of evidence-based practices, most EBPs include some form of an integrated intervention, which entails the patient receiving care for both the mental illness and substance abuse. Additionally, many EBPs comprise the same several steps when applied to substance abuse.

    1. 1. http://deploymentpsych.org/treatments
    Detoxification

    The patient undergoes withdrawal during this period, either tapering off of the substance that he or she is dependent on or abruptly stopping its use.

    Inpatient Rehabilitation

    Inpatient or Outpatient Rehabilitation

    Medication

    Used to blunt the effects of withdrawal or to help treat and manage symptoms of mental illness.

    Psychotherapy

    All therapy involves an analysis of the old behavior that led the patient to his or her current situation - a key step in ensuring that history doesn’t repeat itself.

    Support Groups

    Maintaining a support system following treatment is vital. Having a forum to share your successes and struggles as well as to hear what others are going through can help you get through the uncertain, early stages of sobriety.

    The Importance of Choosing A Rehab with Mental Health Services

    Many patients with undiagnosed mental illnesses attempt to self-medicate with drugs or alcohol. Whatever substance they use, it seemingly causes their symptoms like restlessness, anxiety, depression, paranoia, neuroses, etc., to become more manageable. However, their symptoms return when the high is over, often more intensely than before.

    This leads to repeated substance abuse, creating a dangerous drug addiction in addition to a pre-existing mental illness. Stopping a substance abuse habit in a patient that also has a mental illness is possible, but it takes time, willpower and therapy. Today, drug addiction is viewed as a mental illness, as both conditions drastically alter the brain.

    A drug addiction can form so rapidly in the presence of mental illness due to the nature of how the brain processes pleasure. The brain views all pleasure in the same way, whether it comes from food, money, sex, drugs, etc. No matter the source, pleasure triggers the release of the neurotransmitter dopamine in the nucleus accumbens of the brain. However, the consumption of addictive drugs causes a huge amount of dopamine to be released into the brain, resulting in the strongest pleasure reaction. Depending on how quickly, consistently and intensely this reaction takes place, the individual is more or less likely to become addicted to the drug that he or she is abusing. [1]

    1. 1. http://www.health.harvard.edu/newsletterarticle/how-addiction-hijacks-the-brain

    The consumption of addictive drugs causes a huge amount of dopamine to be released into the brain.

    Based on this principle, mental health patients often find themselves with a substance abuse issue long before they are even aware of their undiagnosed mental illness. Oftentimes, patients will know that something is wrong with them and that consuming their drug of choice temporarily makes them feel better. What they don’t know is that they are only making their problem worse and creating a new problem on top of it.

    The Cycle of Self-Medication with Drugs and Alcohol

    In most cases, these patients have an undiagnosed illness, meaning that they aren’t being treated, leaving it up to them to find a way to manage their symptoms. Undiagnosed mental illness frequently leads to substance abuse as the patient continually attempts to deal with the symptoms of his or her condition with drugs or alcohol.

    Those with mental health conditions are more sensitive to drugs or alcohol, which compounds the degree of their addictions. The most common substances that mental health patients use to self-medicate are alcohol, tobacco, cocaine and marijuana. In addition to the increased risk of addiction among all those with mental illnesses, certain mental disorders have higher substance abuse rates than others.

    Other mental health disorders that commonly occur with drug addictions are depression, obsessive compulsive disorder, eating disorders, and schizophrenia. [1]

    1. 1. http://www.helpguide.org/articles/addiction/substance-abuse-and-mental-health.htm

    Drug Addiction Is a Mental Illness

    A drug addiction changes the brain in fundamental ways, rearranging a person’s normal hierarchy of needs and wants and introducing new priorities associated with acquiring and using the substance of abuse.

    Addiction changes the brain, disturbing the normal hierarchy of needs and desires.

    - National Institute on Drug Abuse - https://www.drugabuse.gov/publications/research-reports/comorbidity-addiction-other-mental-illnesses/drug-addiction-mental-illness

    The following inability to control impulses preceded by compulsive behavior in spite of life consequences, occurs with numerous mental illnesses as well.[1] The changes to the brain caused by substance abuse are what make addiction a mental illness.

    Under normal circumstances, the brain maintains a delicate balance of chemicals known as neurotransmitters or molecules that enable sections of the brain to communicate with the other sections and ultimately allow the body to regulate its various behaviors. Drug or alcohol consumption leads to an imbalance of neurotransmitters in the brain, resulting in drowsiness, loss of coordination, euphoria and other common symptoms of intoxication by numerous substances.

    In most cases, the brain corrects this imbalance following a period in which it is not exposed to any drugs or alcohol, however, with continued exposure, the brain begins to adapt to the regular changes in its chemical environment. In the case of long-term, severe, substance abuse, the brain will assume that it will always maintain a presence of the given substance, meaning that it will begin to rely on the substance for things it would otherwise produce naturally. This chemical inequality is where substance addiction comes in. [2]

    In the case of a mental illness co-occurring with a drug addiction, it isn’t apparent if one condition caused the other, regardless of which came first. Even determining which condition was first is difficult as is establishing the cause of either condition. However, research suggests that mental disorders and drug abuse are both capable of leading to the other.

    Habitual self-medicating with alcohol, tobacco, cocaine, etc., mental illness or not, is known to lead to dependence followed by addiction. Additionally, predisposed genetic vulnerabilities can result in greater susceptibility to mental illnesses and/or drug addictions either at first or after the initial disorder appears. [3]

    In order to achieve a full recovery from drug addiction, treatment must also address mental health. If left untreated, a mental illness that co-occurred with substance abuse could lead a recoveree right back to where he or she started.

    1. 1. https://www.drugabuse.gov/publications/research-reports/comorbidity-addiction-other-mental-illnesses/drug-addiction-mental-illness
    2. 2. http://pubs.niaaa.nih.gov/publications/AA77/AA77.htm
    3. 3. https://www.drugabuse.gov/sites/default/files/comorbidity.pdf

    Dual Diagnosis Treatment at Unity Behavioral Health

    We set ourselves apart at Unity Behavioral Health by offering a combination of treatments and therapies designed to help break the cycle of mental illness and addiction. We understand that dual diagnosis patients face enormous struggles with both substance abuse and symptoms of one or more psychological disorders. Our understanding uniquely positions us to treat patients with co-occurring disorders.

    Each of our patients receive a personalized treatment plan that focuses on his or her specific obstacles to recovery. Our Dual Diagnosis Treatment Includes:

    Cross-Trained Clinicians

    Each of our addiction care specialists are trained to treat patients with addictions as well as patients with other mental health illnesses.

    Life Skills Training

    It’s critical that dual diagnosis patients be taught how to function in everyday society without the aid of drugs and/or alcohol. Treatment at UBH includes preparation for reentry into the “real world.”

    Holistic Treatment

    Our dual diagnosis patients often find relief in holistic procedures such as acupuncture, meditation and alpha-stim treatment. We provide these therapies in addition to our other addiction rehab services.

    Family Program

    Just as dual diagnosis patients have to understand how addiction and mental illnesses feed off of one another, it’s equally important that family members understand what their loved one is dealing with. Our family program brings siblings, spouses, parents and children closer together.

    Mental Health Expertise

    A large portion of addiction patients have been dealing with undiagnosed mental illness for years. Our psychiatry services not only provide valuable insights into our patients’ mental health, but also helps them understand how to manage and treat their conditions better.

    Dual diagnosis treatment at Unity Behavioral Health begins with a compassionate, medically supervised detox and mental health assessment. We then blend holistic remedies with group and individual counseling, psychological services, physical therapy and a traditional 12-step process. Each of our patients receive a personalized treatment plan that focuses on his or her specific obstacles to recovery.

    Every patient is different, as is their journey to addiction and rehab. Some may have resorted to substance abuse to help deal with symptoms of depression. Others may unknowingly be struggling with undiagnosed schizophrenia or bipolar disorder. No matter what your specific needs are, our mission is to find the dual diagnosis treatment strategy that will most effectively address them.

    10 Essential Qualities of a Reputable Treatment Facility

    10 Essential Qualities of a Reputable Treatment Facility

    1. Evidence-based practices

    The leading addiction treatment facilities will follow evidence-based best practices for treatment of their patients.

    2. Medically-supervised detox

    Substance abuse withdrawal can be painful, draining and potentially life-threatening. Attempting to navigate withdrawal symptoms without the help of medical professionals can put your health at risk.

    3. Medical Supervision

    Continuous medical supervision help patients guard against relapse and other possible health conditions. Patient safety should be the rehab's primary focus at all times.

    4. Individual and group counseling

    Individuals in rehab often struggle with symptoms of depression, anxiety and general mental distress. Individual and group counseling helps guide patients through this difficult process.

    5. Holistic Treatment

    Many patients find relief in holistic therapies such as acupuncture, meditation, alpha-stim treatment and many others.

    6. Mental health services

    A significant percentage of patients who suffer from addiction also have possible mental health issues.

    7. Healing therapies

    Healing therapies help patients manage symptoms of addiction, build confidence, ease traumatic experiences and gain greater self-awareness.

    8. Family involvement

    Aside from the substance abuser, no one feels the impact of alcohol abuse more than his or her family. Because of this, it is essential that those closest to the patient be involved in their treatment to some extent.

    9. Life Skills

    Life skills training an essential part of a successful recovery. Patients are taught essential skills to function in everyday society without the aid of drugs and/or alcohol.

    10. Aftercare

    Rehab is only the beginning of the recovery process. One of the biggest reasons for more than 50 percent of patients relapsing in their first year is they are not actively engaged in any aftercare services.

    Learn More

    Help is just a phone call away for you or a loved one who may have a mental health issue and is simultaneously self-medicating with drugs or alcohol. Contact our addiction care experts and mental health specialists who will craft a custom rehab program tailored for your specific dual diagnosis treatment needs. You can learn more about our programs or begin rehab by calling us at 561-812-5500.

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