Dual Diagnosis Drug Treatment

For dual-diagnosis patients, treating both their mental and addictive disorders simultaneously poses a challenge. But it may also be their only hope for recovery.

Dual diagnosis was not an acknowledged theme of the 13th annual meeting of the American Academy of Addiction Psychiatry last month in Las Vegas. Yet in presentation after presentation, the “double-d word” kept popping up.
Clearly, for the meeting’s nearly 320 attendees, dual-diagnosis patients—specifically those with both a substance abuse and another Axis I mental disorder—are a driving force of their practices. Whether it was adult or adolescent patients that were the topic of discussion, the majority of presentations at the meeting addressed the concept of dual diagnosis, proclaiming it to be “the norm,” “the majority of our patients,” or “the only thing I see.”

Many presenters detailed research supporting the co-occurrence of substance use disorders and mental disorders. Yet not nearly the same level of agreement was reached on how to treat these often complex clinical cases.
Data from the National Institute of Mental Health’s Epidemiologic Catchment Area program, cited many times during the AAAP meeting, indicate that dual diagnosis in adults is not the exception, but the rule. Researchers have estimated that as many as 50 percent of adult general psychiatry patients also have a substance abuse disorder.

The numbers are equally alarming in the opposite direction: 37 percent of adults with an alcohol-abuse disorder are estimated to have another mental disorder, and 53 percent of adults with a drug-related disorder also have another mental disorder.

Diagnosis Becomes Complicated

The co-occurrence of disorders makes diagnosis complicated, and treatment is difficult, even when a psychiatrist is willing to take on the challenge—which few appear to be, according to several meeting presentations.
John Tsuang, M.D., an associate clinical professor of psychiatry at the UCLA–Harbor Medical Center, and Timothy Fong, M.D., an addictions research fellow at UCLA, presented a workshop on dual-diagnosis patients that focused on pharmacological management.

“Nearly 50 percent of persons with schizophrenia have a substance use disorder,” Tsuang said. “Around 34 percent have a co-occurring alcohol problem, and 27 percent of persons are abusing drugs.”
The overlap is not quite as pronounced with unipolar depression patients, about 27 percent of whom have a substance use disorder, Tsuang said. For those with bipolar I disorder, however, 61 percent have a substance use disorder, which most commonly appears during a manic phase. Overall, a patient with anxiety disorder has about a 33 percent chance of abusing or being addicted to drugs or alcohol, he added.

In adolescents, similar trends have been found, according to Paula Riggs, M.D., an associate professor of psychiatry at the University of Colorado School of Medicine.
“Around 90 percent of teens experiment [with drugs and/or alcohol] but don’t progress to substance abuse disorders,” Riggs said. Studies have estimated that anywhere from 3 percent to 9 percent do progress to drug abuse or dependence, and 5 percent to 8 percent will go on to abuse or be dependent upon alcohol. “It’s the so-called ‘vulnerable experimenters’ who progress,” Riggs said. “But what makes some vulnerable and others not?”

Dual Diagnosis Factors Converge

An emerging model, Riggs said, indicates that many factors converge to cause the dual diagnoses.
“It is the culmination of biopsychosocial vulnerabilities and substance use that exacerbates pre-existing dysregulation,” she explained. “It modulates the vulnerable adolescent’s motivation and ends up increasing his or her vulnerability and reactivity to environmental stressors. It impacts their self-esteem and their self-efficacy.”
Regardless of the model used, data indicate that conduct disorders in children and adolescents invariably begin before substance abuse does, while depression is roughly split—half of depression begins before substance abuse, half follows the onset of substance abuse.

With bipolar disorder, Riggs said, there appears to be a variable onset in relationship to substance abuse. She presented data indicating that if bipolar disorder arises in a patient as an adolescent, the risk of a comorbid substance use disorder is eight times that of the general population. Yet there are some data to indicate, she added, that when children are treated for what appears to be bipolar disorder, the risk of comorbid substance abuse may actually decrease.
“But it really doesn’t matter when the comorbidity started or why or how,” Riggs emphasized. The important message is that “the research favors an integrated treatment approach rather than a sequential approach.”

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What is Dual Diagnosis?
Dual Diagnosis is when a person has a drug problem or alcohol problem and psychiatric disorder. To recover fully, a person requires treatment for both problems.

Co-Occurring Disorders: Integrated Dual Disorders Treatment Information
Dual disorders refers to the presence of both a severe mental illness and a substance abuse disorder. Integrated dual disorders treatment has been shown to work effectively. In this dual diagnosis treatment model, one clinician or treatment team provides both mental health and substance abuse treatment services.
Recovery from mental illness and substance abuse

As people with mental illnesses, we are also prone to develop problems with alcohol and drug use. We tend to use drugs and alcohol for the same reasons that people without a mental illness do, but we are often more sensitive to the negative effects of alcohol and drugs.

The result is that one of every two individuals with severe mental illness has the additional problem of substance abuse disorder, (which means abuse or dependence related to alcohol or other drugs).

There is good news
Most of us with dual disorders can achieve recovery. And our lives are much better when we are in recovery. Building a satisfying and meaningful life without drugs or alcohol requires time, support, education, courage, and learning new skills.
How can people with dual disorders achieve recovery from both mental illness and substance abuse?
• Most people with dual disorders are able to achieve recovery. The chance of recovery improves when people receive integrated dual disorders treatment, which means combined mental health and substance abuse treatment from the same clinician or treatment team.
• Relapses do happen, but most people are able to recover from relapses relatively quickly and get back to where they were before they relapsed.
• Families and clinicians cannot force people to give up alcohol and drugs. Family and other supporters can help by providing support and hope, but recovery must be a person’s own choice. It may take a long time for some people to achieve recovery.
• People with dual disorders can learn from peers who are in recovery. Some may benefit from self-help groups like Alcoholics Anonymous, Narcotics Anonymous, and Dual Recovery Anonymous. It is a matter of personal preference.

What is integrated dual disorders treatment?

Integrated Dual Disorders Treatment occurs when a person receives combined treatment for mental illness and substance use from the same clinician or treatment team.
It helps people develop hope, knowledge, skills, and the support they need to manage their problems and to pursue meaningful life goals.
You will know if you are receiving dual diagnosis treatment because your clinician or treatment team will do several things at the same time, including:
• Help you think about the role that alcohol and other drugs play in your life. This should be done confidentially, without any negative consequences. People feel free to discuss these issues when the discussion is confidential, nonjudgmental, and not tied to legal consequences.
• Offer you a chance to learn more about alcohol and drugs, to learn about how they interact with mental illnesses and with medications, and to discuss your own use of alcohol and drugs.
• Help you become involved with supported employment and other services that may help your process of recovery.
• Help you identify and develop your own recovery goals. If you decide that your use of alcohol or drugs may be a problem, a counselor trained in integrated dual disorders treatment can help you identify and develop your own recovery goals. This process includes learning about steps toward recovery from both illnesses.
• Provide special counseling specifically designed for people with dual disorders. If you decide that your use of alcohol or drugs may be a problem, a trained counselor can provide special counseling specifically designed for people with dual disorders. This can be done individually, with a group of peers, with your family, or with a combination of these.

If you are a person with dual disorders, participating in dual disorders treatment is extremely important.
Effective dual diagnosis treatment will help reduce the risk for many additional problems, such as increased symptoms of a mental illness, hospitalizations, financial problems, family problems, homelessness, suicide, violence, sexual and physical victimization, incarceration, serious medical illnesses, such as HIV and hepatitis B and C, and sometimes even early death.
For more information
Information about dual disorders treatment, go to www.recoveryconnection.org.

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Dual Diagnosis and the LGBT Community

With estimates stating that over 60% of drug treatment program admissions last year suffered from a dual diagnosis, it is no wonder a greater emphasis has been placed on effectively treating dual diagnosis. The statistics seem to be even higher relating to dual diagnosis in the LGBT community. With a greater incidence of drug addiction in the LGBT community, coupled with the challenges the gay community faces each day, dual diagnosis treatment for LGBT community is even of greater neccessity.

Dual diagnosis treatment programs differ from the typical addiction treatment program. The dual diagnosis program will place as great an emphasis on the psychiatric problem as they do on the drug addiction or alcohol addiction. Drug addiction or alcohol addiction with a psychiatric illness is challenging enough to treat and recover from, but when you add the issues associated with sexual orientation, it is even more complex. It is not unusual to find a member of the LGBT community that has developed depression and drug addiction in their attempt to deal with internalized homophobia, shame or the fear associated with “coming out”.

Gay Friendly Dual Diagnosis Treatment

While there are a few gay friendly drug treatment programs, there are even fewer gay friendly dual diagnosis treatment programs. By gay friendly, we refer to the dual diagnosis treatment program’s ability to deal with “gay specific” issues. Is the staff properly trained and have any homophobic attitudes been resolved on the part of the addiction treatment staff. The one thing a dual diagnosis treatment program can ill afford to do is add to the shame and alienation the person already feels.

If you are looking for a gay friendly drug rehab or gay friendly dual diagnosis treatment program you can call the national gay friendly drug addiction treatment helpline at 1-800-511-9225.

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Dual Diagnosis Treatment

How many times have you heard about someone who has been through dual diagnosis treatment relapsing and returning to their drug addiction? It happens more often than you may think and there’s a reason for this. Most dual diagnosis treatment centers utilize a common 12-step program that tends to focus mainly on detoxification (drug detox) and teaching patients how to manage their impulses and compulsive cravings for the substance of their addiction. Most dual diagnosis treatment centers do not have the necessary tools nor dual diagnosis staff to effectively evaluate, and therefore, appropriately address the underlying issues that may have been responsible for- or led to- the drug addiction and dual diagnosis. They have to rely on the information they receive from the patient and assume it’s accurate, then they’ll presribe a standardized 12-step method for recovery. More than half of those with a dual diagnosis that are treated using this method will relapse since the root of the dual diagnosis problem has not been sufficiently addressed. Most dual diagnosis treatment programs tend to use counselors and/or group sessions only instead of utilizing qualified doctors in one-on-one, coordinated dual diagnosis therapy sessions.

There’s more to dual disorders than just substance abusea and a psychiatric disorder.

Few people realize that there’s more to what causes drug addiction and relapses than just cravings for a substance like cocaine, heroin, methamphetamines, crystal meth, alcohol or other types of drugs. Substance abuse and drug addiction is usually an indicator that there is a deeper problem involved. For some it may be a physical ailment such as a chemical imbalance or deficiency of certain chemicals or nutrients in the body. For others it may be a deep-seeded emotional or psychological issue or trauma from their past that needs to be identified, with the help of a professional, and individually resolved or addressed. We often find that some individuals may even be using drugs or alcohol to fill a void or need that’s missing in their life. Many addicts may have a combination of these factors working together driving them towards their alcohol or chemical dependency.

To locate an effective dual diagnosis treatment program you can always call the national dual diagnosis helpline at 1-800-511-9225.

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Dual Diagnosis; Alcoholism, Drug Addiction and Psychiatric Disorders

Establishing an accurate diagnosis for patients in drug addiction programs and dual diagnosis treatment programs is an important and multifaceted aspect of the dual diagnosis treatment process. Clinicians must discriminate between acute primary psychiatric disorders and psychiatric symptoms caused by Alcohol and Other Drugs (AODs). To do so, clinicians must obtain a thorough history of AOD use and psychiatric symptoms and disorders.

There are several possible relationships between alcohol and other drugs and psychiatric symptoms and disorders. AODs may induce, worsen, or diminish psychiatric symptoms, complicating the diagnostic process.

The primary relationships between alcohol abuse, drug abuse and psychiatric symptoms or disorders are described in the following classification model (Landry et al., 1991a; Lehman et al., 1989; Meyer, 1986). All of these possible relationships must be considered during the screening and assessment process.

AOD use can cause psychiatric symptoms and mimic psychiatric disorders. Acute and chronic alcohol abuse and drug abuse can use can cause symptoms associated with almost any psychiatric disorder. The type, duration, and severity of these symptoms are usually related to the type, dose, and chronicity of the AOD use.

Acute and chronic AOD use can prompt the development, provoke the reemergence, or worsen the severity of psychiatric disorders.

AOD use can mask psychiatric symptoms and disorders. Individuals may use AODs to purposely dampen unwanted psychiatric symptoms and to ameliorate the unwanted side effects of medications. AOD use may inadvertently hide or change the character of psychiatric symptoms and dual disorders.

AOD withdrawal can cause psychiatric symptoms and mimic psychiatric syndromes. Cessation of AOD use following the development of tolerance and physical dependence causes an abstinence phenomenon with clusters of psychiatric symptoms that can also resemble psychiatric disorders.

Psychiatric and AOD disorders can coexist. One disorder may prompt the emergence of the other, or the two disorders may exist independently. Determining whether the disorders are related may be difficult, and may not be of great significance, when a patient has long-standing, combined disorders. Consider a 32-year-old patient with bipolar disorder whose first symptoms of alcohol abuse and mania started at age 18, who continues to experience alcoholism in addition to manic and depressive episodes. At this point, the patient has two well-developed independent disorders that both require dual diagnosis treatment.

Psychiatric behaviors can mimic behaviors associated with AOD problems. Dysfunctional and maladaptive behaviors that are consistent with AOD abuse and addiction may have other causes, such as psychiatric, emotional, or social problems. Multidisciplinary assessment tools, drug testing, and information from family members are critical to confirm AOD disorders.

The symptoms of a coexisting psychiatric disorder may be misinterpreted as poor or incomplete “recovery” from AOD addiction. Psychiatric disorders may interfere with patients’ ability and motivation to participate in addiction treatment, as well as their compliance with treatment guidelines.

For example, patients with anxiety and phobias may fear and resist attending Alcoholics Anonymous or group meetings. Depressed people may be too unmotivated and lethargic to participate in treatment. Patients with psychotic or manic symptoms may exhibit bizarre behavior and poor interpersonal relations during treatment, especially during group-oriented activities. Such behaviors may be misinterpreted as signs of treatment resistance or symptoms of addiction relapse.

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Mental Health Accessibility Exacerbating Rural Crystal Meth Problem

Researchers in Nebraska have released a comprehensive new study that examines methamphetamine addiction from the perspective of urban addicts and rural addicts. Methamphetamine is a major problem across the Midwest, having spread into the area from the west. Coupled with the increase in cases of addiction is a relative lack of proper support services, in the form of mental health treatment centers and therapists trained to address the powerful addiction of methamphetamine.

Discussing the study’s results, the AP reported:

The study showed that rural addicts began using crystal meth at a younger age, were more likely to use the drug intravenously and were more likely to also be dependent on alcohol or cigarettes. They also exhibited more signs of psychosis than urban addicts — 45% vs. 29%, according to the study.

[Lead researcher Dr. Kathleen] Grant said the findings, released in the March/April edition of The American Journal on Addiction, suggest rural addicts are at higher risk for psychiatric and medical problems such as infectious diseases and lung and liver cancer.

That’s troubling, she said, because addicts living in rural areas have less access to care — because of distance and transportation issues — than those living in cities.

While meth has become a growing problem for many states, Nebraska has been one of those harder hit. The Drug Enforcement Association calls methamphetamine the single greatest concern for drug officers in the state of Nebraska. That fact is made all the scarier by the knowledge that often the treatments and services most desperately needed are those that are unavailable.

As this state funded study shows, individuals in rural areas are affected to a greater extent than are those in more densely populated areas who have access to a wider range of services. While efforts at prevention through disrupting both supply and demand must continue, we cannot forget that many are already in the clutches of the powerful methamphetamine addiction. As there is so much variation nationwide, states are best served by assessing their own needs when it comes to dealing with meth and deciding the best course of action. Using public funds to draw more mental health professionals is one strategy, but can often be a costly one. Technology also offers new options for alleviating situations created by lack of support. Addiction Treatment and counseling services over the web, combined with chat groups and message boards, can provide options for those who don’t want to leave their homes or commute unnecessarily for treatment. Clearly, there is a need for new ideas and new options. We need to be thinking creatively about how to deal with, what can often seem a terrifyingly large proposition.

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