Dual Diagnosis Treatment
Why do people decide to use drugs? This question has been asked for generations as families, medical professionals and many others have been working with individuals afflicted with the disease of addiction. The truth is that there are many reasons that some individuals choose to use drugs, ranging from peer pressure to mental disease or defect. When an individual suffers from an underlying psychological condition, they are said to suffer from a “dual diagnosis.”
Risk Associated With Drug Abuse
The National Institute of Mental Health conducted a study that looked at the increased risk factors for drug abuse when individuals suffered from other psychological disorders. They found that the condition with the highest increased risk to use and abuse drugs is associated with anti-social personality disorders. Those who suffer from personality disorders are nearly 15 percent more likely to abuse drugs or alcohol. Other conditions that increase risk of drug abuse are:
- Manic episodes (14.5 percent)
- Schizophrenia (10.1 percent)
- Panic disorders (4.3 percent)
- Major depressive episode (4.1 percent)
- Obsessive-compulsive disorders (3.4 percent)
- Various phobias (2.4 percent)
Other studies have shown that almost 50 percent of individuals diagnosed with severe mental illness also suffer from addiction, and roughly half of all individuals addicted to drugs also have a mental illness as a contributing factor. It is easy to see that there is a correlation between drug abuse and mental illness, and at least half of all addicts who seek treatment will discover a psychological issue that must also be treated.
Common Disorders that Get Treated
Are Underlying Conditions More ‘Important’ Than Addiction?
Addiction is a disease. It has its own set of diagnostic parameters, including:
- Inability to stop using drugs or alcohol despite harmful effects
- Tolerance to drugs or alcohol
- Presence of withdrawal symptoms upon the removal of drugs or alcohol from the system
As a disease, addiction must be treated in order for the individual to recover and lead a healthy, normal life.
Underlying psychological conditions are also diseases that need to be treated. Without proper diagnosis and treatment of the dual diagnosis condition, the individual is very likely to relapse and continue to abuse drugs or alcohol. Neither condition is more important than the other. This is part of the reason that they are referenced together as a dual diagnosis, rather than as primary and secondary (or contributing) conditions.
Does the Addiction Cause the Mental Illness, or Vice Versa Versa?
In the same roundabout discussion as, “Which came first – the chicken or the egg?” It is possible to debate the issues of whether mental illness or addiction came first in each individual. Ultimately, however, the answer is different for every individual, and sometimes, there is almost no way to determine the answer at all.
Some individuals suffer from depression, anxiety or other mental health issues and spend the majority of their lives not recognizing the symptoms or seeking treatment. Many of these people may turn to drugs or alcohol in an attempt to alleviate the symptoms they experience.
For instance, they may feel sad but not realize they suffer from depression. Drugs make them feel euphoric and happy so they feel normal.
Does a Dual Diagnosis Require Inpatient Treatment?
The decision to enter an inpatient or outpatient treatment program is a very personal one. It is based, generally, on several factors:
- Severity of the addiction problem
- Severity of the dual diagnosis condition
- Availability of various treatment programs
- Responsibilities outside of treatment, such as a job or children
- Insurance coverage or other cost concerns
The most important of these factors is the severity of the addiction and co-occurring condition. In some cases, inpatient treatment will be highly recommended in order to stabilize both the conditions that make up the dual diagnosis. Simply having a dual diagnosis, however, does not necessarily require an inpatient hospital stay.
Common Treatments for Dual Diagnosis
One of the most effective treatments for dual diagnosis patients has been the model of Cognitive Behavioral Therapy (CBT). This treatment program is a concise, regulated therapy that is based upon mutual communication, participation and trust between a provider and the patient. Rather than spending endless hours talking about and analyzing an individual, CBT is a 16-week program that includes self-assessments and homework assignments to teach the patient new ways to think (cognitive) and act (behavioral) without the use and abuse of drugs in their lives. The program takes place in both private sessions and groups, with role-playing activities and practical applications as important overall aspects. The program can be extended should the provider and the recovering addict decide more time is needed; however, when followed with adequate support, CBT has proven to be effective.
In addition to group and private therapy session, medications can be used to mitigate the effects of a dual diagnosis condition. Many of the psychological conditions that can lead to drug abuse, such as depression, anxiety or schizophrenia, can be managed with the proper diagnosis and medication. If the addict maintains their medications and uses them properly, it is possible that some of the feelings that originally drove them to abuse drugs can be assuaged. If these symptoms are no longer present, the likelihood that the addict will feel compelled to use drugs for the same reasons as in the past is greatly reduced.
Alternative Therapies for Dual Diagnosis
Many treatment centers today offer myriad alternative therapies for addictions involving dual diagnosis. An alternative therapy is one that does not follow a traditional “provider-patient” model of treatment, but instead uses other sources to instill new thought patterns or treatments to an affected individual.
A few types of alternative therapy include:
- Equine-Assisted Therapy: The use of horses to teach problem-solving skills and non-verbal communication skills
- Reiki: For the discomfort and pain associated with withdrawal
- Meditation: To establish directions for otherwise unhealthy thought patterns
- Yoga: To help individuals regain dexterity and physical fitness after long-term drug use
- Martial Arts: For discipline of mind and body, as well as healthy conflict resolution and release of pent-up emotions
- Art and Music: The effects of art and sound on the human mind have been well documented and can provide an outlet for emotions for the recovering addict
All of the above therapies develop the recovering addict’s abilities to problem-solve as well as their skill at avoiding interior and exterior conflicts in healthy and pragmatic ways. Many addicts suffering from dual diagnosis have a problem being alone due to the causes or effects of their underlying psychological condition. Some of these alternative therapies will help an individual learn that peaceful, quiet, alone time can be healing and provide solace from a troubled world.
When alternative therapies are used in conjunction with traditional treatments, the opportunities for success are greatly increased.
Causes of Dual-Diagnosis
When problems arise in our lives, it is natural to want to place blame and point fingers to a distinct cause. While there are many potential causes for the underlying psychological conditions of a dual diagnosis, it is almost impossible to point to one of them and claim it is the cause of the condition. For instance, many individuals who suffer from a dual diagnosis of drug addiction and other mental conditions have experienced:
- Severe trauma, such as returning combat veterans
- Childhood physical abuse
- Childhood sexual abuse
- Separation from parents or family, resulting in anxiety
It is not possible to know why one individual who suffered abuse turns to drugs or alcohol while others do not, nor is it possible to state with certainty which events during childhood might actively contribute to mental distress or irregularity. However, any of the situations mentioned above can result in anxiety, panic disorders, major depression or other conditions that an individual may feel the need to “self-medicate.”
Co-Morbidity vs. Dual Diagnosis
When an individual suffers from chronic addiction, he or she may also have physical ailments due to excessive drug use. Cirrhosis is common among alcoholics, for instance, while hepatitis is common among IV drug users. These conditions are referred to as “co-morbidity” issues rather than dual diagnoses. Dual diagnosis is a term that is used exclusively in the diagnosis of psychological issues related to an individual suffering from drug or alcohol addiction.
Individuals who suffer from drug addiction are unique and separate from their disease. The most successful treatment centers and programs will treat the individual, not just the addiction or the dual diagnosis. When this happens, it is possible for an addict to enter recovery and live a remarkable and exciting life filled with family, hope and good health.