Dual Diagnosis Treatment and Mental Health
For most patients who need dual diagnosis treatment, the public sector is the source of mental health care. There are six types of generic ambulatory mental health treatments provided to outpatient clients in the public sector: medication services, talk therapies, consumer advocacy and referral, crisis interventions, education and training, and psychosocial services. Patients with dual disorders often mix medication with alcohol and drugs. The dual diagnosis treatment that have been effective with dual diagnosis patients have been medication services, talk therapies and psychosocial services.
Medication services are widely used in the public sector. Medication reduces psychiatric symptoms, keeps patients out of the hospital, and may even reduce substance abuse. However, medication effects are not permanent, especially for dually diagnosed patients. These patients will often resume substance abuse to counteract side effects of psychiatric medications. They also are more likely to discontinue using psychiatric medications, which often leads to admission to a dual diagnosis treatment center. Medicating may reduce symptoms in the short run, but may be ineffective or even counterproductive over the long-run.
Talk therapies support the positive effects of other services in terms of prognosis and reduction in hospitalizations. However, both group and individual talk therapies may not be useful for schizophrenic patients, whose thought disorder may be worsened by talk therapy.
Psychosocial factors play a major role in the onset and maintenance of substance use problems. In the context of severe mental illness, stable social networks buffer the individual against stress and repeated breakdown. Psychosocial services, such as instructional courses, basic living skills, social skills, managing symptoms, obtaining work skills and jobs, have been found to be very effective with dually diagnosed patients. These services tend to redirect dual diagnosis patients into structured, constructive, and meaningful activities.
Motivation for change is a pivotal variable and a key proximal outcome for dual treatment programs. The literature on alcohol treatment programs suggests that motivation for change is a key variable in whether alcohol treatment is effective compared motivational and belief variables for persons in programs using 12-step models to persons in programs using cognitive-behavioral models and found significantly greater change in motivation for programs using 12-step-type models. In 12-step-type programs, changes in motivation are the proximal outcomes.
The theory on which most dual diagnosis treatment programs are based argue that changing the person’s motivation to refrain from using substances is an immediate outcome of treatment and a prerequisite for preventing relapse. Thus, the attitudes that persons with dual diagnoses hold about mental illness, substance abuse, and addiction at the conclusion of formal dual diagnosis treatment and alcohol treatment should play an important role in their patterns of community functioning. It has been recommended that conventional substance misuse services be adapted for people with severe mental illness so there is a greater tolerance of relapse and people have access to dual diagnosis treatment and support services even if they are unable to achieve or maintain abstinence.
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