Dual Diagnosis Drug Treatment

Substance Abuse: What It Is and How to Quit
Why do people use alcohol and other drugs? Basically, people use substances such as alcohol and other drugs because they like the way these substances make them feel. Pleasure is a powerful force. Your brain is wired in such a way that if you do something that gives you pleasure you will probably want to do it again. All drugs that are addicting can activate and affect the brain’s pleasure circuit.

What is drug addiction?
Addiction is a disease that affects your brain and your behavior. When you become addicted to alcohol or other drugs, your brain actually changes in certain ways. Someone who is addicted uses drugs without thinking of the consequences, such as problems with health, money, relationships and performance at work or at school.

What drugs can cause drug addiction?
People can become addicted to illegal drugs and to drugs that doctors prescribe. People can also become addicted to things they may not think of as drugs, such as alcohol and the nicotine in cigarettes or smokeless tobacco.

Are prescription drugs safe?
When prescription drugs are taken the right way, there is much less chance that you will become addicted to them. But prescription drugs can be dangerous if they are abused (for example, taking too much, taking them when they’re not needed or mixing drugs).

How do I know if I have a substance abuse problem?
You have a problem with drugs or alcohol if you continue to use them even when they cause problems with your health, money, work or school, or with your relationships. You may have a problem if you have developed a tolerance to drugs or alcohol. This means you need to use more and more to get the same effect.

Can drug addiction be treated in a substance abuse program?
Yes, but addiction is a chronic (going on for a long time), relapsing disease. It may take a number of attempts before you can remain free of drugs or alcohol.

What substance abuse treatment is available?
Substance abuse treatment can include counseling, medication or both. Your doctor will help you find the drug treatment that is right for you.

How can I quit abusing drugs or alcohol?
The first step in breaking addiction is to understand that you can take control of what you do. You can’t control all the things that happen in your life or most of what other people do, but you do have control over how you react. So use that control. The following are the next steps to breaking your addiction:
Commit to quitting. Once you decide to quit, make a plan to be sure that you really do it.

Get help from your doctor. Your doctor can give you support and help you find a drug treatment program that meets your needs. Your doctor can also treat withdrawal symptoms and other problems that you may have as you recover from your addiction.

Get support. Ask your family and friends for support. You can also contact one of the organizations listed in the column on the right. These groups can give you the tools and support you need to break your addiction and move on with your life.

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Drug Rehabs

Selecting a addiction treatment center for alcoholism and drug abuse may be one of the most important decisions you will make in your lifetime. Most of us don’t know what to look for in a quality program. Not all addiction treatment centers are the same-they differ greatly in program options, staff qualifications, credentials, cost, and effectiveness. Before you make any decisions-ask questions and get the facts!

Drug Rehabs should offer a variety of programs?

Alcohol and drug addiction is a disease that progresses through predictable stages. It takes a trained health professional, often a doctor specializing in addiction medicine, to make an accurate diagnosis and prescribe the most appropriate addiction treatment. Drug rehabs should offer a variety of addiction treatment programs that meet individual needs. Addiction treatment programs may include inpatient, residential, outpatient, and/or short-stay options.

What do drug rehabs cost?

“How much do drug rehabs cost?” is often one of the first questions asked. All drug rehabs and alcohol rehabs differ in cost and method of payment. Many drug and alcohol rehabs will take your health insurance as a means of payment or you may be asked to pay privately. If you need help locating an addiction treatment center that will take your insurance call the national addiction treatment helpline at 1-800-511-9225.

Is the treatment program medically based?

There is an advantage to including an on-site medical care in a addiction treatment center. Physicians and nurses provide 24-hour medically based services to monitor and ensure the safest drug detox and withdrawal from alcohol and other drugs. In addition, a medical staff specializing in addiction medicine can oversee the progress of each individual and make necessary adjustments to the treatment plan.

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Research has shown us that drug addiction and alcoholism is higher in the LGBT community than in the heterosexual community, so it is not a shock to anyone that many in the gay and lesbian community also suffer from dual diagnosis. Dual diagnosis is the presence of a mental health disorder and drug abuse or alcohol abuse.

In the past there have not been dual diagnosis treatment centers that were committed to the gay or LGBT community. Today there are alcohol rehabilitation, drug rehabs, as well as, dual diagnosis treatment centers that address dual diagnosis and the needs of the gay, lesbian, bisexual and transgender population.

Some of the drug rehabs that effectively treat dual disorders are Lakeview Health Systems, Stepping Stone Center and Freedom Rings.

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Drug Addiction Treatment and Bipolar Disorder

For two decades, we have been treating drug treatment program participants with drug or alcohol addiction and bipolar disorder (sometimes referred to as bi-polar disorder or even manic depression). Bipolar disorder affects approximately 1% of the adult population and manifests itself with mood swings, often rapid and severe. It is an affective disorder, classified similarly to clinical depression. As an affective disorder, it carries the capability to emotionally cripple an individual. By itself, bipolar disorder is quite treatable with medication and therapy. When coupled with drug or alcohol addiction; however, it complicates the drug addiction treatment process and demands a knowledgeable and experienced drug treatment program such as Lakeview Health Systems.
Aside from getting an emotionally crippled addict or alcoholic into drug addiction treatment, the primary difficulty in treating addicts and alcoholics with bipolar disorder is determining which disorder is the underlying condition. Did the individual have bipolar disorder first and then start using, or did they develop bipolar disorder as a result of their substance abuse? In many cases, it is the latter and simply abstaining from drug use or alcohol consumption greatly reduces or even eliminates the symptoms and behaviors associated with bipolar disorder. Whatever the cause, it is not a good idea to self-medicate with drugs or alcohol, as flooding the brain with substances will never lead to a desired outcome.

Lakeview’s drug addiction treatment approach heeds this lesson and treats the drug and/or alcohol use in a primary fashion. For those individuals who do not experience relief from bipolar symptoms with continued sobriety, we are able to treat with therapy or medication (where appropriate). In addition to sobriety, one of our goals is for each participant to “own” their bipolar disorder recovery through hope, personal responsibility and self-care. When an individual completes the drug or alcohol treatment program, they will be able to live a life free of drugs or alcohol and the majority of bipolar disorder symptoms.

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What Is Addiction Treatment?
by A. Thomas McLellan, Ph.D.

Most dual diagnosis addiction treatment programs are designed to do more than simply reduce or remove alcohol or drug use - they focus on getting addicted people to change their lifestyle and even their core life values as a way of preventing return of the problems. Like treatments for other conditions, dual diagnosis addiction treatment can also include medications and forms of talk therapy, but addiction treatment may be provided by a much wider range of personnel (clergy, counselors, social workers, physicians) than most other forms of healthcare.

No available therapy, program, medication or surgical procedure can remove recurrent desire or craving for alcohol and/or other drugs. Eliminating the desire to use drugs or alcohol is not an outcome of rehabilitation. A more reasonable expectation is that medication may reduce this urge and effective rehabilitation will teach a person what they must do to manage and contain their recurrent desires to use, much in the same way as a person with diabetes or hypertension must learn to manage their lives to control their illness.

It is best to think of three stages of dual diagnosis treatment, each with a different function in the larger picture of care:
• drug detox / alcohol detox
• drug rehabilitation / alcohol rehabilitation
• continuing care

Drug Detox and Alcohol Detox
Following a period of heavy and sustained alcohol or drug use, most individuals develop significant physical and emotional symptoms. While some of these physical problems can resolve with just rest, the use of drugs like alcohol, opiates (heroin, OxyContin, Vicodin, etc.) and tranquilizers (Valium, Xanax) usually need medically supervised detoxification or stabilization.
Drug detox and alcohol detox is not drug addiction treatment - only preparation for treatment. Detoxification must be followed by continued rehabilitative treatment for lasting improvement.
Settings of Dual diagnosis Treatment:
Almost always in hospitals or other residential facilities where medical care is available.
Methods of Care:
The treatments involve various medications to reduce withdrawal and physical discomfort.
Duration of Care:
Usually 3-5 days. More severe cases require a few more days.
Desired Results:
1. Reduced physical and emotional instability caused by substance use.
2. The patient is motivated to recognize and accept that there is a problem that she or he can address.
3. The patient is engaged in some form of continued rehabilitative care.

Drug Rehabilitation and Alcohol Rehabilitation

Drug rehabilitation and alcohol rehabilitation is appropriate for patients who are no longer suffering from the acute physical or emotional effects of recent substance use. Alcohol rehabilitation care typically offers an array of treatment components to help to address the many health and social problems associated with substance use.
Settings of Dual Diagnosis Treatment:
Most rehabilitative care for addiction occurs in specialty “drug treatment programs” that include the components described above. If a person has very serious substance use and/or a life situation that has gotten so out of control that they cannot become sober even with treatment in their living situation - they should seek residential rehabilitation. Most other, less severe forms of substance use can be rehabilitated in outpatient settings that provide essentially the same components of care.
Methods of Treatment:
Medications can help reduce craving for drugs and/or help with co-occurring medical or emotional illness. Individual, group and family therapy helps assist with understanding the specific issues that may have led to the addiction and that will have to be faced again following treatment. Assistance and guidance in developing a new drug-free lifestyle are also important parts of rehabilitation.
Duration of Dual Diagnosis Treatment:
Most residential rehabilitation programs last 21-30 days, 8-12 hours per day. Outpatient rehabilitation programs are typically 60-90 days, where patients spend 2-8 hours per day, 2-5 days per week.
Desired Results:
1. Sustained elimination of alcohol and other drug use.
2. Improved health and social function.
3. Engagement in continuing care, personal therapy, mutual help groups and/or other healthy lifestyle changes to sustain the improved health and function.

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• What are the four most common types of dual diagnosis addiction treatment?

The four most common types of addiction treatment programs are outpatient methadone programs, outpatient drug-free, long-term residential addiction treatment programs, and short-term inpatient addiction treatment programs. Outpatient methadone programs administer the medication methadone to reduce cravings for heroin and block its effects. Counseling, vocational skills development, and case management to help patient’s access support services are used to gradually stabilize the patients functioning. Some patients stay on methadone for long periods, while others move from methadone to abstinence. Long-term residential addiction treatment programs offer around-the-clock, drug-free treatment in a residential community of counselors and fellow recovering addicts. Patients generally stay in these drug treatment programs several months or up to a year or more. Some of these drug treatment programs are referred to as therapeutic communities. Outpatient drug-free programs use a wide range of approaches including problem-solving groups, specialized therapies such as insight-oriented psychotherapy, cognitive-behavioral therapy, and 12-step programs. As with long-term residential treatment programs, patients may stay in these drug treatment programs for months or longer. Short-term inpatient addiction treatment programs keep patients up to 30 days. Most of these drug treatment programs focus on medical stabilization, abstinence, and lifestyle changes. Staff members are primarily medical professionals and trained counselors. Once primarily for alcohol abuse treatment, these programs expanded into drug abuse treatment in the 1980s.

• Is dual diagnosis addiction treatment effective?

The four most common forms of drug abuse treatment are all effective in reducing drug use. That is the major finding from a NIDA-sponsored nationwide study of drug abuse treatment outcomes. The Drug Abuse Treatment Outcome Study (DATOS) tracked 10,010 drug abusers in nearly 100 drug treatment programs in 11 cities who entered drug treatment between 1991 and 1993.

• What makes patients stay in dual diagnosis addiction treatment?

DATOS researchers found that the major predictors were high motivation, legal pressure to stay in treatment, no prior trouble with the law, getting psychological counseling while in treatment, and lack of other psychological problems, especially antisocial personality disorder. The investigators found that drug treatment programs with low retention rates tended to have patients with the most problems, particularly antisocial personality disorder, cocaine addiction, or alcohol dependence.

• Do short term inpatient dual diagnosis treatment programs work?

Short-term inpatient addiction treatment programs in the DATOS study yielded significant declines in drug use, even though patients stayed in these drug treatment programs no more than 30 days.

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Common characteristics of Dual Diagnosis or Co-Occurring Disorders

According to experts in the field, a typical person with dual diagnosis or co-occurring disorder is likely to have the following characteristics and experiences:
• May be alienated and lack support from family and friends
• Won’t cooperate with their health care providers