Dual Diagnosis
Treatment of Mental Illness and Substance Abuse
- Dual diagnosis refers to people who suffer from co-occurring disorders -- mental illness and substance abuse. Research has strongly indicated that to recover fully, an individual with a co-occurring disorder needs treatment for both. Focusing on one does not ensure the other will go away. Dual diagnosis services create assistance for each condition, helping people recover from both at the same time.
Dual diagnosis services include different types of assistance that go beyond standard therapy or medication. Personalized transition is viewed as long-term and can be begun at whatever stage of recovery the individual is in.
There is a lack of information on the numbers of people with co-occurring disorders, but research has shown the disorders are very common. According to reports published in the Journal of the American Medical Association (JAMA):
- Roughly 50 percent of individuals with severe mental disorders are affected by substance abuse.
- Thirty-seven percent of alcohol abusers and 53 percent of drug abusers also have at least one serious mental illness.
- Of all people diagnosed as mentally ill, 29 percent abuse either alcohol or drugs.
Continuing studies support that these disorders appear to occur much more frequently than previously realized, and that appropriate transitional living must be developed.
The consequences are numerous and harsh. Persons with co-occurring disorders have a statistically greater propensity for violence, medication noncompliance, and failure to respond to treatment than persons with just substance abuse or a mental illness. These problems also extend out to these individuals’ families, friends and co-workers.
Having a mental illness and a substance abuse disorder often can lead to overall poor functioning and a greater chance of relapse. Individuals are in and out of treatment programs and sober living facilities without lasting success. People with dual diagnoses also tend to have transitional dysfunction more often than those with a single disorder, and they experience more episodes of psychosis. In addition, physicians often don’t recognize the presence of substance abuse disorders and mental disorders, especially in older adults.
As a consequence of their mental illness individuals may find themselves living in marginal neighborhoods where drug use prevails. Having great difficulty developing social relationships, some people find themselves more easily accepted by groups whose social activity is based on drug use. Some may believe that an identity based on drug addiction is more acceptable than one based on mental illness.
Individuals with co-occurring disorders are also much more likely to be homeless or jailed. An estimated 50 percent of homeless adults with serious mental illnesses have a co-occurring substance abuse disorder.
Just the back-and-forth transition alone currently given to non-violent persons with dual diagnosis is costly. Moreover, violent or criminal individuals, no matter how unfairly afflicted, are dangerous. What these persons, as well as those with co-occurring disorders have been shown to do is recycle through healthcare and criminal justice systems again and again. Without the establishment of more transitional programs, the cycle will continue.
Those who struggle both with serious mental illness and substance abuse face problems of enormous proportions. Mental health services tend not to be well prepared to deal with individuals having both afflictions. Often only one of the two problems is identified. If both are recognized, the individual may bounce back and forth between services for mental illness or substance abuse, or they may be refused treatment by each of them. Fragmented and uncoordinated services create a service gap for persons with co-occurring disorders.
Providing appropriate services for these individuals will not only allow for their recovery and improved overall health, but can reduce the effects their disorders have on their family, friends and society at large. By helping these individuals stay in transitional living, find housing and jobs, and develop better social skills and judgment, we can potentially begin to substantially diminish some of the societal problems.
Effective transitional living consists of the same health professionals, providing appropriate attention for both mental health and substance abuse in a coordinated fashion. The caregivers see to it that interventions are bundled together; the individuals, therefore, receive consistent care, with no division between mental health and substance abuse assistance.
Transitional living also requires the recognition that substance abuse counseling and traditional mental health counseling are different approaches that must be reconciled to treat co-occurring disorders. It is not enough merely to teach relationship skills to a person with bipolar disorder. They must also learn to explore how to avoid the relationships that are intertwined with their substance abuse.
It is important to recognize that denial is part of the problem. Some individuals do not have insight as to the seriousness and scope of their problem. Abstinence may be a goal but should not be a precondition for entering a facility. If dually diagnosed clients do not fit into local Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) groups, special peer groups based on AA principles might be developed.
Clients with a dual diagnosis have to proceed at their own pace. A medical model of the problem should be used rather than a moralistic one. Transitional living is effective in conveying an understanding of how hard it is to end an addiction problem and give credit for any accomplishments. Attention should be given to social networks. Clients should be given opportunities to socialize, have access to recreational activities, and develop peer relationships.
Effective programs, through intensive case management, and other methods of developing a dependable relationship with the client, ensure that more individuals are consistently monitored and counseled.
Counseling is a fundamental component of dual diagnosis services. Counseling helps develop positive coping patterns, as well as promotes cognitive and behavioral skills. Counseling can be in the form of individual, group, or family therapy or a combination of these.
Environment has a direct impact on their choices and moods; therefore clients need help strengthening positive relationships and jettisoning those that encourage negative behavior. To be effective, a dual diagnosis transitional living must take into account a number of situations: stress management, social networks, jobs, housing and activities. These programs view substance abuse as intertwined with mental illness, not a separate issue, and therefore provide solutions to both illnesses together at the same time.
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