Dual Diagnosis Treatment

Mental Health
Dual Diagnosis Treatment

Dual Diagnosis Treatments and Co-Morbid Diagnosis: Relationship and Differences

Is there a difference between a Dual Diagnosis treatment and a Co-Occurring Disorder treatment?

To get right to the point, No.  A dual diagnosis and a co-occurring disorder are two terms for the same condition.  There is no difference.  It is simply a way to state that a person has both a substance abuse issue and also struggles with one or more of the following; depression, anxiety, trauma, PTSD, mood disorders, panic attacks, eating disorders, bipolar, ADHD, ADD, personality disorders, etc…

As mental health professionals continue to observe, research, learn and reviews its knowledge, standards, practices, and principles, the mental health field evolves.  As the field evolved from a practice focused on treating “hysteria” in women and “compulsions” in men; as it shifted in perspective from Freudian to Jungian and everything between and after;  the demographics and needs of the mentally ill have also evolved and shifted.  The constant evolution of the mental health profession has brought significant changes in its practice, from diagnosing to treatment plans; some changes are viewed positively, while others are less so.  One such change has been in the diagnostic perspective.

Previously, the most acceptable and widely-held belief was that people who developed substance  dependence or addiction, are making a daily choice to either use or not; although this perspective lacked supportive research, it satisfied the social views of those within and outside the psychiatric professional community.  Thus, developed the stigma that many with addiction face from those without the current knowledge of addiction as a disease: that their decision to repeatedly make the same “wrong choice” justified the legal, personal, financial, physical, and emotional consequences they received.   The general apathy shown towards addicts was detrimental to their willingness to seek help; their belief that they deserved their circumstances, and gradually reduced their belief that professional help was available.  Furthermore, the belief that addiction and substance abuse disorders were not the same as mental illness led to overwhelmingly undertreated mental illnesses, such as mood disorders, major depression, anxiety disorders, and PTSD.

Starting in the 1980’s, a proliferation of studies focused on the prevalence of co-morbid cases of mental illness and addiction.  These studies led to the most important treatment changing fact: addiction is a mental illness recognizable by symptoms of compulsivity, uncontrollable craving, drug seeking, and an impaired judgment leading to the disregard of the known devastating consequences of substance use.  Addiction is directly linked to changes in brain structure and function; many of the changed areas are the same ones related to mood disorders, anxiety, schizophrenia, and bipolar disorder.

The empirical evidence also supported the increased efficacy of addiction treatment when an accurately recognized mental illness is properly treated in conjunction with addiction treatment.  Today, some of the best addiction treatment centers provide high quality psychiatric care of general mental illness, including depression, mood disorders, PTSD, and anxiety disorders, resulting in greater chances of long-term recovery and lower rates of relapse.  The most common approach to dual-diagnosis treatment involves the combination of medication and cognitive behavioral therapy.

Greatest Challenges in Dual Diagnosis Treatment

The relationship between substance abuse and mental illness is a complex topic and one of the highest priorities of the National Institute of Drug Addiction (NIDA) research.  Evidence gleaned from multitude of studies have provided some answers and while raising many other questions.

Question 1: Correlation and Causality?

The most challenging question facing addiction specialists and psychiatric professionals is that of correlation vs. causality.  Correlation refers to the common presence of co-morbid substance abuse disorders or addiction with personality and mood disorders.  The question raised by the high rate of correlation is that of causality; was the mental illness the cause of substance use and eventual addiction or did substance abuse and addiction lead to changes in the brain that caused the development of a secondary mental illness?  Unfortunately, causality is one of the most difficult questions to answer.  Some generally accepted theories within the mental health field is that some people are genetically predisposed to a mental illness, through family history, traumatic experiences, or heredity.  These predispositions are significantly higher risk factors for drug use, general interest in drugs and their effects, and first-time drug use.

Question 2: How to Untangle the Web of Factors?

There are innumerable factors that influence a person’s willingness to either try an illicit drug or abuse prescription medications for recreational purposes.  One’s environment (particularly living areas, including one’s home or low-income/high crime neighborhoods, where drugs are easily accessible and substance abuse is witnessed on a consistent basis) can de-sensitize some people to the dangers of drug use or create a higher interest in drugs than in environments where drug use and addiction are not openly visible or easily accessible.  Social factors, including “social-norms”, like drinking alcohol, can affect many people by either triggering an inherited predisposition to alcoholism or progress from social drinking to binge or frequent drinking, which may change the structure and function of the brain.  One’s own neural brain structure could also be the precipitating factor that is responsible for an interest in drugs, in altering their state of mind; exposure to numerous explicit images of drug and alcohol use by peers, celebrities, or musicians could be influential to one’s interest in mind-altering substances without being influential to another’s.  Finally, there are too many internal and external factors and their entanglements or compounding influences for researchers to determine why some people, when exposed to substances, become addicted while others do not.  Research and specialists have not been able to untangle the web of factors that result in alcoholism and drug addiction yet.

Question 3: How reliable are research subjects as self-historians to solve the causality problem?

The co-morbidity of mental illness and drug addiction has led many people to accept that addiction is almost inevitable due to one’s mental illness.  However, there is an almost equivalent amount of research showing that drug use itself causes the functional damage of the brain responsible for mental illness.  Therefore, there is a reliance on the accurate historical account of one’s emotional well-being and drug use (most importantly, first-time use and early pattern of substance use).  An important truth about the human mind is that it instinctively recalls memories and processes emotions while attempting to preserve self-esteem.  With few exceptions, people are naturally inaccurate self-historians because the brain is hard-wired to protect one’s emotional well-being to the best of its ability; when one consciously attempts to recall events against this instinct, it often has the opposite effect of minimizing environmental, situational, social, and emotional factors and creating a negative distortion, which overemphasizes individual control.  The unreliability of people as self-historians has proven to be one of the most difficult hurdles in understanding the direction of causality in dual-diagnosis cases.

Current Dual Diagnosis Treatment

The above information is but a snapshot of a very complex topic in addiction research and dual diagnosis treatment, the full scope of which exceeds the purpose of this article.  By presenting a panoramic view of co-morbidity cases involving addiction and introducing a sample of the complex questions that hinder current research, it is hoped that a greater appreciation and understanding of dual-diagnosis treatment can be achieved.  Clinicians typically tailor their treatment plans according to the severity of symptoms and behaviors distressing the patient at the initiation of treatment.  For some patients, an inpatient setting is necessary to detox the patient safely.  For less severe substance abuse disorders, the patient may receive outpatient treatment, focused on treating the underlying mental illness with medication and behavioral therapy and providing individual and group therapy and support for the related substance abuse disorder.  In most cases, the initial goal of treatment is stabilization of the patient, the introduction of structure and routine self-care, and the modification of behaviors and patterns that lead to relapse.  Long-term recovery is dependent upon finding the appropriate combination of medication, therapy, support, and lifestyle changes.  Dual-diagnosis facilities have proven to be one of the biggest steps forward in mental health and addiction treatment in the last thirty years owing to their ability to provide the comprehensive services that were previously unavailable.

If you suspect that you or a loved one may have a co-occurring or substance abuse issue, please call on of the professional Nsight admissions counselors at 888-557-8091 or send a confidential email to info@nsightrecovery.com.

stefieStefie Dias Ruivo, Staff Writer, B.S. Psy, focused on providing the most current Mental Health and Addiction Recovery Research, Information, and Insight.