Dual Diagnosis Drug Treatment

For those struggling with a dual diagnosis, there are most certainly many challenges to diagnosis and dual diagnosis treatment. First and foremost, even identifying both conditions presents problems. One study found that only 2 percent were detected of those with a substance problem among severely mentally ill patients seen in a university hospital emergency room. The state hospital did only slightly better, detecting 15 percent (Wolford, et al., 1999). This problem occurs for a number of reasons. Emergency rooms are just not often able to do structured interviews about drug and alcohol use. Patients tend to underestimate the problems caused by the drugs, and they rarely disclose that they have a problem with substance abuse (Wolford, et al., 1999). Practitioners should also keep in mind that illicit drugs and alcohol can cause the development, the reemergence, or even worsen the severity of mental disorders. These drugs can also present symptoms that parallel those of mental disorders or even cover them up. Furthermore, Dr. Brady points out that “acute intoxications as well as withdrawal states can mimic affective illness” (1992).

In addition to these hurdles, there are many physical complications to dual diagnosis treatment itself. Douglas Polcin outlines some major challenges in his article entitled “Issues in the Treatment of Dual Diagnosis Clients Who Have Chronic Mental Illness.” He cites poor dual diagnosis treatment response, high rates of re-hospitalization, aggravated psychotic thoughts, and changes in neurophysiology. He also notes that those dually diagnosed are often less responsive to medications than those who do not abuse substances, specifically stating that cocaine users have problems with lithium (Polcin, 1992).

Another issue with dual diagnosis treatment is that “systems have not been well designed with this population in mind. Typically a community has treatment services for people with mental illness in one agency and treatment for substance abuse in another. Clients are referred back and forth between them in what some have called ‘ping-pong’ therapy” (NAMI). Often the very treatment approach of one service may cause problems for the other side of the condition. For example, substance abuse workers traditionally consider the use of medications to be a crutch for those struggling with addiction. However, psychiatrists rely on prescriptions to treat the mental illness, and while psychiatrists rarely give much credence to spiritual or self-help approaches, those working with addictions place a great deal of emphasis here (Polcin, 1992). Poor communication is yet another problem. Those struggling to reach stability with their mental illness and to achieve sobriety are, more often than not, shuffled between different practitioners. Even when these counselors and doctors work within the same facility, there is seldom good, if any, communication between offices (Zweben, 1993).

The US Department of Health and Human Services outlined some specific areas for research. The first area relates to decision-making with regard to dual diagnosis treatment plans. Second is the use of psychotropic medications. Accurate diagnostic tools is another area greatly needing research (Zweban, 1993). There is currently no good instrument for detecting or classifying substance use disorders in the mentally ill, in that those available were developed for use in the general population (Wolford, et. al., 1999).

In conclusion, a final question needs to be considered. With these facts and figures, the outlook for those with dual diagnosis seems grim. What is the long-term prognosis? Is there any hope for stability and sobriety? The lifetime prevalence of substance use disorders is as much as seven times greater for those with bipolar disorder than those in the general population (Knowlton, 1995). However, Linda, a member of our Forum Community, shares a ray of hope in this message: “My life is quite manageable today with the proper medication, therapy, a wonderful support program and recovery program. And no booze … not a drop. Works the best I have ever had it.”

Technorati Tags: addiction, bipolar, bipolar disorder, dual diagnosis, dual diagnosis treatment, dual-diagnosis, mental disorders, mental illness, patient, recovery, relapse, substance abuse, symptoms, therapy, treatment, treatment services

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This entry was posted on Wednesday, April 25th, 2007 at 7:02 am and is filed under Dual Diagnosis Drug Treatment. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.