Dual Diagnosis Drug Treatment

The term dual diagnosis is often used interchangeably with the terms co-morbidity, co-occurring illnesses, concurrent disorders, comorbid disorders, co-occurring disorder, dual disorder, and, double trouble. Professional literature has used a confusing array of terms and acronyms to describe co-occurring disorders or a dual diagnosis. Dual Recovery Anonymous defines “dual diagnosis” as meaning that an individual has two separate but very interrelated diagnoses:

1. A psychiatric diagnosis

2. A substance abuse diagnosis which may include both drugs and alcohol

A dual diagnosis occurs when an individual is affected by both chemical dependency and an emotional or psychiatric illness. Both illnesses may affect an individual physically, psychologically, socially, and spiritually. Each illness has symptoms that interfere with a person’s ability to function effectively and relate to themselves and others. Not only is the individual affected by two separate illnesses, both illnesses interact with one another. The illnesses may exacerbate each other and each disorder predisposes to relapse in the other disease. At times the symptoms can overlap and even mask each other making diagnosis and treatment more difficult.

A person may sincerely try to recover from one illness and not acknowledge the other. As a person neglects his or her mental illness, that illness may recur. This recurrence may, in turn, lead a person to feel the need to “self-medicate” through drug use. Over time, the lack of progress toward recovery on both fronts may trigger feelings of failure and alienation. Perhaps the greatest tragedy is the damage that occurs to the individual’s self-esteem.

There is no single type of dual diagnosis. The reason is, that there are numerous forms of psychiatric illness. There are also many patterns of alcohol or drug abuse. As a result, a variety of different forms of dual or multiple disorders are possible.

A variety of problems are possible as a result of a dual diagnosis. For example:

• Psychiatric symptoms may be covered up or masked by alcohol or drug use.

• Alcohol or drug use or the withdrawal from alcohol or other drugs can mimic or give the appearance of some psychiatric illness.

• Untreated chemical dependency can contribute to a reoccurrence of psychiatric symptoms.

• Untreated psychiatric illness can contribute to an alcohol or drug relapse.

Other problems and consequences that are associated with dual disorder include:

• Family problems or problems in intimate relationships.

• Isolation and social withdrawal.

• Financial problems.

• Employment or school problems.

• High risk behavior while driving.

• Multiple admission for chemical dependency services due to relapse.

• Multiple admissions for psychiatric care.

• Increased emergency room admissions.

• Increased need for health care services.

• Legal problems and possible incarceration.

• Homelessness.

The term “dual diagnosis” can have different connotations and definitions depending upon who is using it. Professionals and service providers may have a narrower definition than that used by Dual Recovery Anonymous. For our purpose in dual recovery it does not matter how long or to what degree we have been affected by either of our no-fault illnesses. Membership in the Fellowship of Dual Recovery Anonymous does not require professional referral and is not dependent upon the extent of social services and professional care a person has utilized. Our Second Tradition states that: “D.R.A. has two requirements for membership; a desire to stop using alcohol and other intoxicating drugs, and a desire to manage our emotional or psychiatric illness in a healthy and constructive way.”

An individual is in dual recovery when they are actively following a program that focuses on their recovery needs for both their chemical dependency and their psychiatric illness.

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When attempting to get off alcohol or drugs, be advised that medical personnel should always monitor any kind of detoxification in order to provide prompt and educated aid to those striving to rid their bodies of the effects of chronic alcohol and drug abuse. An alcohol detox program is only the first of many steps that alcoholics will take on the long road to recovery. 

Alcohol withdrawal is the first process that an alcoholic must take to begin the cleansing process that will ultimately remove all traces of alcohol from their body. With alcoholism or drug abuse, the body becomes dependent on those drugs and during an alcohol detox, withdrawal is the process by which drug or alcohol induced toxins are exorcised from the body. It isn’t easy, and many people aren’t mentally or physically prepared for the process. But with an alcohol detox program, that’s only the first step. 

The term, alcohol detox, is officially defined as the period of time it takes someone to overcome his or her physical dependence and need for alcohol. In an alcohol detox program, this process is carefully and closely monitored by trained medical personnel experienced in dealing with the moods and temperaments of alcoholics on the road to recovery. The end goal of an alcohol detox program is to free the alcoholic of the addictive effect of alcohol on their body. An alcohol detox center will offer expert guidance and advice to those wishing to enroll in their program and to help people get a good start on the road to a long-term recovery. For the most part, an alcohol detox program is located within an in-patient drug rehab so that patients can be closely monitored and helped. 

Experiencing alcohol detox isn’t pleasant. Many who have completed an alcohol detox program claim the experience, though necessary, was challenging and withdrawal from alcohol or drugs can produce both physical and mental manifestations that range from mild to alarmingly severe. That’s why it’s so important for people to go through an alcohol detox process in a licensed facility with fully trained medical staff on hand to oversee the process. Some people experience headaches, the ’shakes’, vomiting, insomnia and even delirium tremors, more commonly known as the ‘DTs’ and even seizures. Supervised alcohol detox is recommended, especially since one in four patients may experience severe withdrawal symptoms like seizures and convulsions. An alcohol detox program can take within three to seven days in most cases, and then the drug rehabilitation process begins. 

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Effective Drug Addiction Treatment

Scientific research since the mid-1970s shows that addiction treatment can help many people change destructive behaviors, avoid relapse, and successfully remove themselves from a life of substance abuse and drug addiction. Recovery from drug addiction is a long-term process and frequently requires multiple episodes of addiction treatment. Based on this research, key principles have been identified that should form the basis of any effective drug addiction treatment program:

· No single addiction treatment is appropriate for all individuals.

· Addiction treatment needs to be readily available.

· Effective drug rehab treatment attends to multiple needs of the individual, not just his or her drug addiction.

· An individual’s drug rehab treatment and addiction treatment services plan must be assessed often and modified to meet the person’s changing needs.

· Remaining in drug treatment for an adequate period of time is critical for addiction treatment effectiveness.

· Counseling and other behavioral therapies are critical components of virtually all effective treatments for drug addiction.

· For certain types of disorders, medications are an important element ofaddiction treatment, especially when combined with counseling and other behavioral therapies.

· Addicted or drug-abusing individuals with coexisting mental disorders should have both disorders treated in an integrated way.

· Medical management of drug withdrawal syndrome is only the first stage of addiction treatment and by itself does little to change long-term drug use.

· Treatment does not need to be voluntary to be effective.

· Possible drug use during addiction treatment must be monitored continuously.

· Addiction treatment programs should provide assessment for HIV/AIDS, hepatitis B and C, tuberculosis, and other infectious diseases, and should provide counseling to help patients modify or change behaviors that place themselves or others at risk of infection.

· As is the case with other chronic, relapsing diseases, recovery from drug addiction can be a long-term process and typically requires multiple episodes of treatment, including “booster” sessions and other forms of continuing care.
 

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Dual Diagnosis Treatment
Ideally, the drug addiction and mental health problem should be treated simultaneously.  For any substance abuser, however, the first step in dual diagnosis treatment must be detoxification  or drug detox- a period of time during which the body is allowed to cleanse itself of alcohol or drugs.  Ideally, drug detoxification should take place under medical supervision.  It can take a few days to a week or more, depending on what substances the person abused and for how long.
Until recently, alcoholics and drug addicts dreaded detoxification because it meant a painful and sometimes life-threatening “cold turkey” withdrawal.  Now, doctors are able to provide those persons in a medical detox program select detox medications which can substantially ease withdrawal symptoms.  Thus, when detoxification is done under medical supervision, it’s safer and less traumatic.
After Drug Detox in a Dual Diagnosis Treatment Program
Once drug detoxification or drug detox is completed, it’s time for dual diagnosis treatment; rehabilitation for the alcohol or drug problem and treatment for the psychiatric problem.
Drug rehabilitation for a substance abuse problem usually involves individual and group psychotherapy, education about alcohol and drugs, exercise, proper nutrition, and participation in a 12-step recovery program such as Alcoholics Anonymous.  The idea is not just to stay off booze and drugs, but to learn to enjoy life without these “crutches.”
Treatment for a psychiatric problem depends upon the diagnosis.  For most disorders, individual and group therapy as well as medications are recommended.  Expressive therapies and education about the particular psychiatric condition are often useful adjuncts.  A support group of other people who are recovering from the same condition may also prove highly beneficial.  Adjunct treatment, such as occupational or expressive therapy, can help individuals better understand and communicate their feelings or develop better problem-solving or decision-making skills.

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A person who has both an alcohol or drug problem and an emotional/psychiatric problem is said to have a dual diagnosis.  To recover fully from dual diagnosis, the person needs treatment for both problems. Dual diagnosis is more common than you might imagine.  According to a report published by the Journal of the American Medical Association: Thirty-seven percent of people who suffer from alcohol abuse and fifty-three percent from drug abuse also have at least one serious mental illness. Of all people diagnosed as mentally ill, 29 percent have a drug abuse or alcohol abuse problem.

What Kind of Mental or Emotional Problems are Seen in People with Dual Diagnosis?

The following psychiatric problems are common to occur in dual diagnosis - i.e., in tandem with alcohol or drug dependency.
·                                 Depressive disorders, such as depression and bipolar disorder.
·                                 Anxiety disorders, including generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, and phobias.
·                                 Other psychiatric disorders, such as schizophrenia and personality disorders.

Which Develops First - Substance Abuse or the Emotional Problem?
 It depends.  Often the psychiatric problem develops first.  In an attempt to feel calmer, more peppy, or more cheerful, a person with emotional symptoms may drink or use drugs; doctors call this “self-medication.”  Frequent self-medication may eventually lead to physical or psychological dependency on alcohol or drugs.  If it does, the person then suffers from not just one problem, but two.  In adolescents, however, drug or alcohol abuse may merge and continue into adulthood, which may contribute to the development of emotional difficulties or psychiatric disorders.
In other cases, alcoholism or drug dependency is the primary condition.  A person whose substance abuse problem has become severe may develop symptoms of a psychiatric disorder:  perhaps episodes of depression, fits of rage, hallucinations, or suicide attempts.

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