For decades scientists and researchers have studied the nature of addiction and the environmental landscapes that can put someone at risk for drug use. But only recently have studies taken into account the Biopsychosocial model, and started looking more inward at the individual risk that mental health issues carry for drug use.
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When given a dual diagnosis, addressing clients’ goals in treating both disorders is a key factor in the outcome of their recovery.
As we continue our look into dual diagnosis, we already have identified the many challenges involved, symptoms, and some at-risk populations. Today we discuss dual diagnosis treatment.
Once again, the National Alliance on Mental Illness (NAMI) says that dual diagnosis is “a term for when someone experiences a mental illness and a substance use disorder simultaneously.” The two diagnoses share a close relationship across a number of areas. NAMI states: “Either disorder—substance use or mental illness—can develop first. People experiencing a mental health condition may turn to alcohol or other drugs as a form of self-medication to improve the mental health symptoms they experience. However, research shows that alcohol and other drugs worsen the symptoms of mental illnesses.”
And, as we’ve note, NAMI further states: “According to a 2014 National Survey on Drug Use and Health, 7.9 million people in the U.S. experience both a mental disorder and substance use disorder simultaneously. More than half of those people—4.1 million to be exact—are men.”
Dual Diagnosis Treatment
How can dual diagnosis be treated?
As we noted previously, the Substance Abuse and Mental Health Services Administration (SAMHSA), “supports an integrated treatment approach to treating co-occurring mental and substance use disorders. Integrated treatment requires collaboration across disciplines. Integrated treatment planning addresses both mental health and substance abuse, each in the context of the other disorder. Treatment planning should be client-centered, addressing clients’ goals and using treatment strategies that are acceptable to them.”
NAMI notes that “the best treatment for dual diagnosis is integrated intervention, when a person receives care for both their diagnosed mental illness and substance abuse.” Importantly, “the idea that ‘I cannot treat your depression because you are also drinking’ is outdated—current thinking requires both issues be addressed.”
Common methods can include:
- Inpatient Rehabilitation. “A person experiencing a mental illness and dangerous/dependent patterns of substance use may benefit from an inpatient rehabilitation center where they can receive medical and mental health care 24/7. These treatment centers provide therapy, support, medication and health services to treat the substance use disorder and its underlying causes.”
- “Supportive Housing, like group homes or sober houses, are residential treatment centers that may help people who are newly sober or trying to avoid relapse. These centers provide some support and independence. Sober homes have been criticized for offering varying levels of quality care because licensed professionals do not typically run them. Do your research when selecting a treatment setting.”
- “Psychotherapy is usually a large part of an effective dual diagnosis treatment plan. In particular, cognitive behavioral therapy (CBT) helps people with dual diagnosis learn how to cope and change ineffective patterns of thinking, which may increase the risk of substance use.”
In our last post, we started to identify the many challenges associated with “dual diagnosis.” Today we go deeper into symptoms and identify different communities that may be susceptible.
We reported that the National Alliance on Mental Illness (NAMI) says that dual diagnosis is “a term for when someone experiences a mental illness and a substance use disorder simultaneously.” The two diagnoses share a close relationship across a number of areas. NAMI states: “Either disorder—substance use or mental illness—can develop first. People experiencing a mental health condition may turn to alcohol or other drugs as a form of self-medication to improve the mental health symptoms they experience. However, research shows that alcohol and other drugs worsen the symptoms of mental illnesses.”
NAMI further states: “According to a 2014 National Survey on Drug Use and Health, 7.9 million people in the U.S. experience both a mental disorder and substance use disorder simultaneously. More than half of those people—4.1 million to be exact—are men.”
So what are the symptoms and what populations might be at risk?
NAMI notes that the symptoms can vary widely. This is because “many combinations of dual diagnosis can occur,” As a result, “mental health clinics are starting to use alcohol and drug screening tools to help identify people at risk for drug and alcohol abuse.”
According to NAMI, substance use disorder symptoms may include:
- Withdrawal from friends and family
- Sudden changes in behavior
- Using substances under dangerous conditions
- Engaging in risky behaviors
- Loss of control over use of substances
- Developing a high tolerance and withdrawal symptoms
- Feeling like you need a drug to be able to function
Symptoms of a mental health condition can also vary greatly. Warnings signs, such as extreme mood changes, confused thinking or problems concentrating, avoiding friends and social activities and thoughts of suicide, may be reason to seek help.
One population where dual disorders can occur is with military veterans. The Substance Abuse and Mental Health Services Administration (SAMHSA), part of the U.S. Department of Health and Human Services, notes that “co-occurring disorders, such as post-traumatic stress disorder (PTSD) and substance use, is prevalent among veterans and the military community. According to the Veterans Affairs Department (VA), approximately one-third of veterans seeking treatment for substance use disorders also met the criteria for PTSD.”
It continues: “Veterans and service members benefit from integrated care for mental and substance use disorders. However, some veterans may not seek medical treatment for one of many reasons, including a fear of being treated differently.”
Another area to watch: Primary Care. SAMHSA notes: “People who receive primary care often may have multiple health issues, including co-occurring disorders. Integrating behavioral and primary care is especially important to meeting their needs.”
“People with co-occurring disorders may seek primary care services first before seeking behavioral health services. As a result, primary care practitioners have unique opportunities to identify people with co-occurring disorders through screening. Screening for co-occurring disorders in primary care settings can assist practitioners in recognizing and addressing conditions early. Screening also can serve as a baseline to measure clinical progress.”
How is dual diagnosis treated? That’s our next post.
Among the many challenges associated with substance abuse is the propensity for “dual diagnosis.”
As the National Alliance on Mental Illness (NAMI) notes, dual diagnosis is “a term for when someone experiences a mental illness and a substance use disorder simultaneously.” The two diagnoses share a close relationship across a number of areas. NAMI states: “Either disorder—substance use or mental illness—can develop first. People experiencing a mental health condition may turn to alcohol or other drugs as a form of self-medication to improve the mental health symptoms they experience. However, research shows that alcohol and other drugs worsen the symptoms of mental illnesses.”
In fact, the interactions may be even more tightly intertwined. How common Is dual diagnosis?
The Substance Abuse and Mental Health Services Administration (SAMHSA), part of the U.S. Department of Health and Human Services, notes that “People with a mental disorder are more likely to experience a substance use disorder and people with a substance use disorder are more likely to have a mental disorder when compared with the general population. According to the National Survey of Substance Abuse Treatment Services (N-SSATS), about 45% of Americans seeking substance use disorder treatment have been diagnosed as having a co-occurring mental and substance use disorder.”
Or, as NAMI states: “According to a 2014 National Survey on Drug Use and Health, 7.9 million people in the U.S. experience both a mental disorder and substance use disorder simultaneously. More than half of those people—4.1 million to be exact—are men.”
Dual Diagnosis Integrated Treatments
As highlighted here, some co-occurring or dual diagnoses include:
- Anxiety: Symptoms, OCD, PTSD, Phobia
- Bipolar Disorder: Symptoms, Bipolar Depression, Treatment
- Depression: Symptoms, Stats, Demographics
- Eating Disorders: Symptoms, Medical Complications, Treatment
In fact, SAMHSA “supports an integrated treatment approach to treating co-occurring mental and substance use disorders. Integrated treatment requires collaboration across disciplines. Integrated treatment planning addresses both mental health and substance abuse, each in the context of the other disorder. Treatment planning should be client-centered, addressing clients’ goals and using treatment strategies that are acceptable to them.”
The site continues: “Integrated treatment or treatment that addresses mental and substance use conditions at the same time is associated with lower costs and better outcomes such as:”
- Reduced substance use
- Improved psychiatric symptoms and functioning
- Decreased hospitalization
- Increased housing stability
- Fewer arrests
- Improved quality of life
In our next post, we’ll go deeper into symptoms and certain populations at risk.
Suicide Warning Tool: Is path warm?
People sometimes contemplate suicide because of overwhelming things in their life, depression, loss, or for many other reasons. But being aware of some signs and symptoms can help to prevent suicide. Often, preventing a loved one from suicide can depend on the ability of individuals in their life to recognize distress and risky behaviors. Recently, the American Association of Suicidology developed a simple tool that is available for everyone to use to remember the warning signs of suicide. This helpful tool is called “IS PATH WARM” and outlines the key points to remember:
I – Ideation (suicidal thoughts)
S – Substance Abuse
P – Purposelessness
A – Anxiety
T – Trapped
H – Hopelessness/Helplessness
W – Withdrawal
A – Anger
R – Recklessness
M – Mood changes
The American Association of Suicidology also indicated that other signs and behaviors to be aware of including:
- Direct and indirect verbal expressions: “I don’t want to live anymore”, “there is nothing to live for anymore”, “people will be better off without me”
- Dramatic changes in mood
- Loss of interest in previously enjoyed activities
- Increase in drug and alcohol use
- Risk taking behavior
- Aggressive, impulsive and/or violent acts
- Expressions of hopelessness and purposelessness
- Lack of self care or outright neglect of self
- Sleeping too much or too little
- Feeling tired most of the time
- Gaining or losing a significant amount of weight
- Changes in eating and sleeping pattern
- Withdrawal from family, friends, and interests
- Giving away prize possessions and/or making a will; tidying up personal affairs; writing notes; making notes on belongings
- Reconnecting with old friends and extended family as if to say goodbye
- Previous unresolved or recent suicide attempt(s)
- Unusual happiness and peace after an intense period of turmoil and displaying the above characteristics
If a loved one is showing these symptoms, it is important to get help from a trustworthy source and to let other loved ones know as soon as possible. Doing so could prevent suicide and help the loved one find peace and solace and heal from suicidal thoughts and behaviors.
Talking About Depression
Unfortunately, depression seems to be lurking everywhere. It’s become more common among teens and the elderly and remains a problem for many adults. Talking to those you love about their depression can be difficult. Individuals may become defensive, angry, or even more depressed. The website helpguide.org gives guidelines concerning the discussion about depression. Most individuals want to help those they love to overcome or lessen their depression and the following ideas and suggestions can be very helpful. However, it is key to remember that giving advice won’t go as far as simply being a compassionate listener. Usually, individuals with depression need someone to listen to their concerns and feelings without judgment. As a good friend or loved one, the simple act of listening, maybe over and over, can really help those who are struggling with depression.
The following is taken directly from helpguide.org and can significantly benefit the process of opening up a conversation with someone dealing with depression:
Ways to start the conversation:
- “I have been feeling concerned about you lately.”
- “Recently, I have noticed some differences in you and wondered how you are doing.”
- “I wanted to check in with you because you have seemed pretty down lately.”
- Questions you can ask:
- “When did you begin feeling like this?”
- “Did something happen that made you start feeling this way?”
- “How can I best support you right now?”
- “Have you thought about getting help?”
- “You are not alone in this. I am here for you.”
- “You may not believe it now, but the way you’re feeling will change.”
- “You are important to me.”
Being supportive of a loved one with depression will go a long way. This can take patience and extra compassion, but allowing that person to feel loved is key to them overcoming depression.
Two years ago, when he made the decision to tell the world about his diagnosis of bipolar disorder, KSTP-TV meteorologist Ken Barlow could only guess what kind of reaction he would get.
“I could have lost my job,” he said. “I could have lost my friends. I had no idea what was going to happen, but I felt like I just couldn’t hold it in anymore.”
In 2007, after a lifetime of manic bursts followed by debilitating depressions, Barlow was diagnosed with bipolar I disorder. For five years, fearing that the truth about his mental illness could have a negative impact on nearly every aspect his life, Barlow told only a select few people about his diagnosis. And even those people were sworn to secrecy.
Read the full article here.
Artcile by: By Andy Steiner
Dual Diagnosis Treatment
Dual Diagnosis Treatment is much more common that it once was. Years ago, addiction and mental health disorders were treated separately. In fact, many believed that one had to overcome addiction first in order to work on mental health disorders. Research shows that working on both addictive disorders (alcoholism, drug addiction, gambling addiction, sex addiction or another behavioral addiction) and mental health disorders (depression, bipolar disorder, anxiety disorders, schizophrenia, a personality disorder, etc.) can result in successful outcomes.
So, instead of drawing a hard line between psychiatric health and addiction, the two areas of addiction and mental health are treated as part of a continuum. Therapists and clinicians who work in addiction recovery treatment can now receive training and credentials in the treatment of co-occurring mental health disorders. Also, many rehab facilities now offer recovery services that are personalized for clients with a Dual Diagnosis.
However, research shows that finding the right rehabilitation program can still be challenging, especially if individuals are struggling with depression or anxiety as well as substance abuse. Interestingly, The Office of Applied Studies, a division of the U.S. Department of Health and Human Services, reports that in 2002, just 12 percent of the 4 million American adults who suffered from a Dual Diagnosis received adequate treatment for both conditions.
If an individual meets the diagnostic criteria for a mental health disorder and an addictive disorder, they can be classified as a Dual Diagnosis client when entering treatment. The best treatment for a Dual Diagnosis should involve considering both the addiction and the mental illness when going through the recovery process.
Dualdiagnosis.org indicates that to increase the chances of recovering fully, one’s care should include:
“Parallel treatment of your mental health and substance use disorders by the members of a highly trained treatment team
Acknowledgement of the importance of psychotherapeutic medications, such as antidepressants or anti-anxiety meds, in the treatment of co-occurring disorders
A supportive approach to therapy that reinforces self-esteem and builds self-confidence instead of confronting the client with negative, aggressive statements
An inclusive treatment strategy that brings partners, spouses, children and other household members into therapy for individual counseling, group meetings or education
‘Sequential treatment’ was the norm before the 1990s, when clinicians believed that there should be a division between mental health treatment and addiction rehabilitation, note the authors of the text Integrated Treatment for Dual Disorders: A Guide to Effective Practice. In the sequential approach, clients with a Dual Diagnosis were excluded from one area of treatment until they were considered stable in the other. For instance, a depressed person with active alcoholism might not be able to receive therapy for depression until she had been through detox and rehab. Sequential treatment became less popular as research showed that it led to a higher rate of relapse.”
If an individual is struggling with both addiction and mental health issues, it would benefit them greatly to explore the possibilities of Dual Diagnosis Treatment.
Recently, psychcentral.com posted an article written by Natalie Jeanne Champagne regarding Adult ADHD and Addiction. In this very informative article, Champagne discusses the important fact that ADHD is often difficult to diagnose in adults. This is most likely why more children are diagnosed with ADHD than adults. In fact, Champagne suggests that 1-5% of adults who have ADHD do not realize they are struggling with it.
In regards to addiction, many studies have shown that there is a high correlation between ADHD and the development and exhibition of addictions. Champagne points out that those suffering from ADHD who have not been diagnosed or are not treating their ADHD exhibit a much more frequent incidence of addictive behavior than those who do not suffer from ADHD or those who are being treated for ADHD.
One may wonder why this correlation is so prevalent. Again Champagne cites research conducted that enlarges understanding this correlation: “Addiction and ADHD Adults,” Carl Sherman quotes a study by Timothy Milens, MD: “In our study…only 30 percent [of participants] said they used substances to get high… Seventy percent are doing it to improve their mood, to sleep better, or for other reasons” (2007). Sherman goes on to elaborate that abuse of substances, when connected to adult ADHD, often is based on a need to self-medicate the symptoms: “…This kind of ‘self-medication’ seems especially common among individuals whose ADHD remains undiagnosed or who have been diagnosed but have never gotten treatment” (2007).
Most of the research conducted focuses primarily on how nicotine and alcohol addiction correlate with ADHD sufferers. In fact Champagne cites Carl Sherman who indicates that, “A recent survey found that more than 15 percent of adults with the disorder had abused or were dependent upon alcohol or drugs during the previous year. That’s nearly triple the rate for adults without ADHD” (2007).
However, it has been found that other drugs are often abused as well when an individual suffers from ADHD. This includes cocaine, which can provide temporary relief from the frustrating symptoms of ADHD. The medication used to treat ADHD has stimulant properties and affects the same area of the brain as stimulant drugs (cocaine), though to a lesser (safer) degree. Primarily because of this, the potential for abuse among those being treated with adult ADHD, especially those who have a history of substance abuse, is difficult and requires a comprehensive approach.
Further, it is interesting to note that adults suffering from undiagnosed ADHD may engage in addictive behavior can prevent addictive cycles if they receive a proper diagnosis and proper treatment. With these tools, they will be less likely to turn to drugs or alcohol, and less likely to succumb to addiction.