Dual Diagnosis

When treating patients suffering from drug or alcohol abuse, it is very common for them to struggle with a mental or behavioral disorder and a substance abuse disorder. This is known as dual diagnosis or co-occurring disorders. Typically, substance abuse is seen by the patient as an escape from the mental or behavioral disorder but, in reality, can contribute to or worsen it. In some cases, substance abuse can uncover a mental illness that may not have been known or make the related symptoms worse.

Because it is less common for a patient not to have a secondary mental or behavioral health issue co-occurring with their substance abuse, it is important that a personalized treatment plan address all underlying issues fueling addiction, such as anxiety, depression or trauma. Dual diagnosis treatment addresses not only the substance abuse disorder, but the underlying psychiatric diagnosis as well. A holistic approach, focusing on the mind-body-spirit connection, is often the best treatment for long-term healing and sobriety.

History of Dual Diagnosis

Historically, there has been a split in the US between mental health and addiction treatment services. Because each diagnosis was treated sequentially, it has been extremely difficult for people who have a dual diagnosis to get the care they need in either traditional mental health or addiction treatment programs. Until integrated dual diagnosis programs became available, it was more difficult for people with co-occurring disorders to receive effective help because they generally participated in separate treatment programs that didn’t address their unique needs.

One previous approach to dual diagnosis was sequential treatment. The theory behind sequential treatment was that addiction treatment and mental health treatment should be separate. Recovery professionals thought that individuals needed to stabilize one aspect of their lives before addressing another. In many cases, individuals were required to undergo treatment for their substance abuse issues before they’d be eligible to receive mental health treatments. The results of sequential treatment showed a high rate of relapse.

Anther common approach was parallel treatment. In parallel treatment, an individual receives professional services for both addiction issues and mental health concerns at the same time. Despite receiving simultaneous treatment, the two care team operated independently and rarely communicated with each other. Due to a lack of cohesion, parallel treatment could often be counterproductive when one care team prescribed treatment that conflicted or caused side effects with the other team’s treatment.

Today, we know that many people who abuse substances have a concurrent mental health condition.

  • According to the National Alliance on Mental Illness, “Among the 20.2 million adults in the US who experienced a substance use disorder, 50.5% - 10.2 million adults – had a co-occurring mental illness.”
  • The 2011 National Survey on Drug Use and Health found “among the 18.9 million adults with a past year substance use disorder, 42.3% - 8 million adults – had a co-occurring mental illness.

Clinical Assessment of Dual Diagnosis

During an assessment for dual diagnosis, health care professionals consider a number of factors including:

  • Meeting the criteria for a psychiatric disorder according to The Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association.
  • Having a history of substance abuse that has a negative impact on health, relationships, work and hobbies.
  • Displaying behavioral disorders such as sex or gambling addictions.
  • Having a history of violence or experiencing suicidal thoughts.

Receiving a dual diagnosis may come as a relief if you have lived with an undiagnosed mental illness for a period of time. After all, identifying a problem is the first step in fixing it!

Signs & Symptoms

Mental or behavioral disorders frequently occur along side substance abuse disorders but have distinct symptoms. Signs of mental or behavioral disorders may include:

  • Deliberate withdrawal from others
  • Delusions or hallucinations
  • Feelings of despair, hopelessness or worthlessness for two or more weeks in a row
  • Changes in mood and energy level
  • Lack of interest in daily activities
  • Change in appetite weight or sleep patterns

Signs of substance addiction may include:

  • Leaving friends of family for a new crowd or new activities
  • Expressing feelings of guilt or regret about a compulsive behavior
  • Struggling to keep up with school or work
  • Experiencing withdrawal symptoms
  • An inability to control use of a substance
  • Developing a tolerance for the substance

Treatment for Dual Diagnosis

Integrated treatment is a means of coordinating substance-abuse and mental health interventions, rather than treating each disorder separately and without consideration for the other. Integrated treatment occurs when a person receives combined treatment for mental illness and substance use from the same treatment team. It helps people develop hope, knowledge, skills, and the support they need to manage their problems and to pursue meaningful life goals.

The importance of dual diagnosis treatment cannot be overstated. Issues such as trauma, depression, bipolar disorder, anxiety, ADHD, and compulsive disorders are risk factors for relapse. If a person returns home without addressing their mental disorder, they may feel compelled to self-medicate. Often, substance abuse begins when those suffering from depression or other disorders try to find a solution on their own. They essentially just want to feel better, and in desperation, turn to alcohol and drugs or other compulsive behaviors that seem to mitigate their symptoms. However, this form of self-medicating does not result in any true relief from symptoms.

Holistic treatment can be very effective in dual diagnosis. Holistic rehab programs utilize an integrated physical, mental and spiritual model for treating. For most people, substance abuse goes beyond just the physical addiction. When combined with the effects of mental or behavioral disorders that come with dual diagnosis, simply addressing the physical aspect, as many treatment facilities do, is not enough. The mind and spirit must also be healed for the mind-body-spirit connection to be restored.

A holistic approach helps to resolve issues with the mind, body and soul so participants can learn to lead a sober life. The mind, body and spirit are all connected. A disease affecting one will affect the others as well. A holistic program will work to heal each area so the person can continue to stay sober long after the main issues influencing substance use are resolved.

How Holistic Can Help

One thing that makes dual diagnoses so difficult to treat is that it is hard to know where certain symptoms are coming from. For example, if a dual diagnosis patient is suffering from depression, there is no way to initially know whether the drug addiction or the individual’s mental illness is causing the problem. Depression is a symptom of many things, so the challenge is on the medical professional to find the root cause and treat it. Holistic programs approach treatment from a whole-body perspective, incorporating various natural therapies to promote sobriety, overall health, and contentment such as:

  • Sauna sessions
  • Reiki
  • Massage
  • Exercise
  • Organic meal plans

What to Look for in Dual Diagnosis Rehab

Finding the right dual diagnosis rehabilitation facility can be challenging because there are so many factors to consider.

  • Are programs offered for your specific needs? This is the single most important question for dual diagnosis patients. A rehab facility must be specialized in your specific mental, behavioral and substance abuse disorders to provide the level of care you need.
  • How are treatment plans developed? Because the of complexity of diagnosis and treatment for dual diagnosis patients, having a proper plan is critical to success.
  • What supplemental services are offered? Other services such as acupuncture, acupressure, yoga, meditation and art, music or animal-assisted therapy can have a huge impact in your experience and overall success in rehab.

Contact our treatment experts to find a dual-diagnosis program that’s right for you.