Navigation: What is Dual Diagnosis?, Why Do People Self-Medicate?, Integrated Treatment for Co-Occurring Disorders: How Does it Work?, Evidence-Based Therapies in Dual Diagnosis Treatment, Relapse Prevention, Dual Diagnosis Treatment Leads to Improved Outcomes
Because of the complex interplay of genetic, biological, environmental, and psychological factors, addiction and mental health disorders often co-occur.
Those who have pre-existing mental health conditions may turn to substances as a way to self-medicate and alleviate their symptoms. For instance, someone struggling with depression might use drugs or alcohol to temporarily escape their feelings of sadness or hopelessness.
On the other hand, substance abuse can also exacerbate or trigger mental health issues. Drugs and alcohol can disrupt brain chemistry and contribute to the development of conditions like anxiety, depression, or even psychosis.
These two conditions also have shared risk factors like trauma, stress, and genetic predispositions. This means people who have these risk factors are exposed to both addiction and mental health disorders.
As you can see, these two medical conditions have a complicated relationship. When a person has both a mental illness and a substance use disorder, it is called a co-occurring disorder. Unfortunately, this is a common problem among those in addiction treatment. [1]
So which one do you address first? That is what we are going to discuss here today. Let’s take a closer look at co-occurring disorders and dual diagnosis treatment.
What is Dual Diagnosis?
A dual diagnosis is a condition wherein a person experiences both a substance use disorder (SUD) and a mental health disorder at the same time. It’s a complex interaction where both conditions can exacerbate each other, leading to a range of challenges in diagnosis, treatment, and recovery.
The mental health disorders commonly associated with dual diagnosis include depression, anxiety disorders, bipolar disorder, post-traumatic stress disorder (PTSD), attention deficit hyperactivity disorder (ADHD), schizophrenia, and personality disorders, among others. [1]
Meanwhile, the substances involved can vary widely, but some of the most commonly abused are alcohol, illicit drugs like cocaine or heroin, and prescription medications like opioids. [1]
Interestingly, just because they are co-occurring does not mean one problem is causing the other. While that is certainly the case for many individuals, it is also possible to develop both separately. However, when these two conditions do co-occur, they have the tendency to worsen one another.
One of the significant challenges in addressing dual diagnosis is that the symptoms of one disorder can often mask the symptoms of the other. It is therefore more difficult for healthcare professionals to make an accurate diagnosis. It is also harder for them to make an effective treatment plan.
Someone with depression might turn to alcohol to self-medicate, but this can worsen their depressive symptoms over time. Similarly, substance use can trigger or worsen underlying mental health conditions, leading to a vicious cycle of self-medication and escalating symptoms.
Effective treatment for dual diagnosis typically involves an integrated approach that addresses both the substance use disorder and the co-occurring mental health disorder simultaneously.
So to answer the question: you cannot treat one without treating the other if your goal is long-lasting recovery.
Why Do People Self-Medicate?
There are many different reasons people self-medicate. Just like with addiction, there are complex psychological, social, and economic factors at play.
The main reason for this behavior is the desire to alleviate symptoms of physical or mental distress. People don’t necessarily want to seek formal medical assistance. They may have financial constraints, a fear of stigma, or just a lack of access to healthcare options.
So instead they opt to self-medicate with drugs or alcohol. This gives them a sense of control over their health and well-being. This is especially common among those who have become disillusioned or dissatisfied with conventional medical treatments.
Self-medication can also be a response to underlying psychological issues such as anxiety, depression, or trauma.
People may turn to substances like alcohol, drugs, or even over-the-counter medications as an unhealthy coping mechanism to numb their emotional pain or manage stress. The temporary relief provided by these substances can create a cycle of dependence. Instead of addressing the root causes of their problems, they rely on self-medication as a means of escape or avoidance.
There’s also the fact that self-medication behaviors have been normalized in society. Depending on the community, culture, or social circle, people may be encouraged to drink their worries away or take drugs to cope. The media may also glamorize the idea of substance abuse as a way to cope with mental illnesses. We can say that dual diagnosis has social aspects to it as well.
Unfortunately, self-medicating with drugs or alcohol only leads to even bigger problems in the long run, despite the temporary sense of relief that they may give. Alcohol and drugs can cause various physical and mental health problems. When addiction develops, even more adverse effects can occur. And the worst part is that an addicted person will keep taking the substance even when they are already suffering from its effects. [2]
Integrated Treatment for Co-Occurring Disorders: How Does it Work?
Effective dual diagnosis treatment requires both the addiction and the co-occurring mental health disorder to be treated simultaneously. Otherwise it may be difficult to achieve long-term recovery and stability.
The best approach can vary depending on the person’s specific circumstances. Everyone is affected by addiction differently, meaning patients would have different symptoms, challenges, and treatment needs. Even if two people abuse the same type of substance, the adverse effects, their intensity, and their duration may still vary.
This is why a personalized approach is important in dual diagnosis treatment.
Integrated treatment approaches, such as dual diagnosis treatment programs, are designed to address the unique and complex relationship between addiction and mental health. These programs typically involve therapy, detox, medication management, support groups, and other interventions tailored to meet the unique needs of patients with co-occurring disorders. [2]
Comprehensive Assessment
The first step in dual diagnosis treatment is a comprehensive assessment of the patient’s condition. It is important to recognize the presence of both mental health disorders and the substance use disorder. This comprehensive assessment also includes other relevant factors such as medical history, social support, and environmental stressors that the patient may be experiencing.
In dual diagnosis treatment, this assessment serves as an important step in understanding the unique needs and challenges of individuals with co-occurring disorders. It involves gathering detailed information about the patient’s mental health history, substance use patterns, and other relevant factors that may impact their treatment journey.
This way, clinicians can gain a holistic understanding of the addicted individual’s circumstances, allowing them to develop personalized treatment plans for their condition.
This assessment may uncover past trauma, family dynamics, environmental stressors and other factors that are influencing the person’s substance use and mental health. Recognizing these underlying factors helps healthcare professionals target the root causes of the patient’s struggles rather than just addressing the symptoms.
Coordinated Care
In dual diagnosis, coordinated care refers to the collaborative effort among healthcare professionals from different disciplines to provide comprehensive and integrated care for their patients. This approach recognizes the complex interplay between these conditions and the need for a holistic treatment strategy.
Coordinated care is a patient-centered approach that makes use of individualized treatment plans to address the unique needs and challenges of each patient. It typically involves a multidisciplinary team of professionals, including psychiatrists, psychologists, addiction specialists, nurses, social workers, and therapists, who all work together to treat the patient. This team of professionals will devise a comprehensive treatment plan that addresses both their substance use and mental health disorders.
This collaborative approach ensures that all aspects of the person’s health are addressed in a coordinated manner. This leads to more effective outcomes and better long-term recovery.
Coordinated care is important because it helps ensure continuity and consistency of care throughout the treatment process. By having a team of professionals working together and communicating regularly, patients receive seamless transitions between different levels of care.
This continuity of care helps to prevent gaps or lapses in treatment, reducing the risk of relapse.
Evidence-Based Therapies in Dual Diagnosis Treatment
Just like with traditional addiction treatment programs, dual diagnosis treatment makes use of various evidence-based therapies.
The evidence-based therapies used in dual diagnosis treatment are effective for both mental health and substance use disorders. Examples include cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT), motivational interviewing (MI), and contingency management.
Cognitive Behavioral Therapy (CBT): CBT is one of the most widely used therapies in dual diagnosis treatment. It helps addicted individuals identify and change negative thought patterns and behaviors associated with both mental health disorders and substance use disorders. CBT teaches coping skills, problem-solving techniques, and relapse prevention strategies. [3]
Motivational Interviewing (MI): MI is a client-centered, directive therapeutic approach that helps patients resolve their ambivalence about change and increase motivation for recovery. MI techniques focus on exploring and resolving the person’s intrinsic motivations for behavioral change.
Dialectical Behavior Therapy (DBT): DBT combines cognitive-behavioral techniques with mindfulness-based practices. It’s particularly effective in addressing borderline personality disorder and substance use disorders. This therapy helps people learn how to regulate their emotions, tolerate distress, improve interpersonal relationships, and develop mindfulness skills. [3]
Integrated Dual Disorder Treatment (IDDT): IDDT is a comprehensive approach designed specifically for those who have co-occurring disorders. It integrates mental health and substance abuse interventions into a single, coordinated treatment plan. IDDT emphasizes a team-based approach, medication management, psychoeducation, and supportive services.
Medication-Assisted Treatment (MAT): Just like with other rehab programs, dual diagnosis centers may also use MAT. This treatment involves the use of medications, in combination with counseling and behavioral therapies, to treat substance use disorders. Medications can help keep cravings and withdrawal symptoms under control so that patients can focus on their recovery.
Medications like methadone, buprenorphine, and naltrexone are commonly used in MAT to manage cravings and withdrawal symptoms in individuals with opioid use disorders.
Contingency Management (CM): CM is a behavioral therapy that uses positive reinforcement to encourage abstinence from substance use and promote adherence to treatment goals. It involves providing tangible rewards or privileges for achieving specific behavioral targets, such as submitting drug-free urine samples. [3]
Family Therapy: Family therapy involves the participation of family members in the treatment process. It aims to improve family communication, address dysfunctional dynamics, and provide support for both the individual with dual diagnosis and their loved ones.
Family therapy helps create a supportive environment conducive to recovery and enhances family members’ understanding of mental health and substance use disorders. [3]
These evidence-based therapies can be tailored to meet the unique needs of patients with dual diagnosis, providing them with comprehensive support for recovery and long-term wellness.
Relapse Prevention
Addiction is considered a chronic and relapsing disorder. Unfortunately, it is very common for people to relapse after completing treatment. [4]
It should be noted that a lapse is different from a relapse. A lapse is the initial transgression of problematic behavior after an attempt to quit. Meanwhile, a relapse is the return to a level that is similar to before quitting. [4]
But relapse is so common that it can be considered a normal part of the recovery process. Researchers say that a relapse is a process rather than an event.
This is why relapse prevention is an essential element of dual diagnosis treatment. It is a comprehensive approach aimed at preventing the recurrence of substance abuse or mental health symptoms after they have finished treatment.
During rehab, the root causes of addictive behavior are addressed, teaching patients to recognize harmful patterns and even use healthy coping mechanisms to avoid self-medication. Meanwhile, relapse prevention emphasizes the importance of ongoing support and monitoring even after the patient has returned to their regular life.
Aftercare planning is all about helping individuals in recovery to navigate the challenges of sobriety so that they can stay away from harmful substances and maintain their mental stability.
This may involve regular therapy sessions, participation in support groups such as Alcoholics Anonymous or Dual Recovery Anonymous, and lifestyle changes that promote overall well-being.
By empowering people with the tools and support needed to manage their dual diagnosis, relapse prevention efforts can reduce the likelihood of relapse and other setbacks.
Dual Diagnosis Treatment Leads to Improved Outcomes
Research suggests that treating both addiction and mental health issues together leads to better long-term outcomes compared to treating them separately. By addressing all aspects of a person’s well-being, individuals are more likely to achieve and maintain sobriety while also experiencing improvements in their mental health.
Ultimately, the decision about where to start in the treatment process should be made in consultation with healthcare professionals. If you or someone you love is struggling with addiction and mental health disorders, look for a rehab near you today. The road to recovery begins here.
Sources:
[2]: https://www.helpguide.org/articles/addictions/substance-abuse-and-mental-health.htm
[3]: https://www.nimh.nih.gov/health/topics/substance-use-and-mental-health
[4]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5844157/
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