Treating patients with a Dual Diagnosis — a mental health condition combined with an addictive disorder — requires an intensive, integrated approach to therapy. Residential rehab facilities provide a structured environment for these individuals who face special challenges in their journey to recovery. At a residential treatment center, where the stressors and distractions of daily life are removed, you can devote all your time and attention to learning new coping skills and building a stronger sense of self-worth.
These residential communities are ideal for patients who need a long-term course of treatment to restore their emotional and psychological health.
Who Can Benefit From Residential Rehab?
It’s not always easy to recognize that you or someone in your life needs treatment for drug or alcohol addiction. With Dual Diagnosis patients, the presence of a mental health disorder like bipolar disorder, depression or post-traumatic stress disorder (PTSD) makes it all the more difficult to recognize the symptoms of addiction. People who struggle with a mood disorder or chronic depression may manage their moods with drugs or alcohol, a form of self-medication. When a Dual Diagnosis is involved, it can be hard to distinguish between the symptoms of a psychiatric illness and the signs of drug or alcohol addiction.
Recognizing the need for treatment is the first step in getting the help you need to restore balance and health to your life. These signs indicate that it’s time for you or a loved one to reach out for help:
- Using drugs, alcohol or compulsive behaviors (gambling, sex, shoplifting, etc.) to relieve intense anxiety, depression or mood swings
- Experiencing psychiatric symptoms like depressive episodes, flashbacks or panic attacks after drinking heavily or using drugs
- Withdrawing from friends, family and social activities
- Experiencing problems with employment, housing or relationships
- Using emergency services for acute intoxication, self-injury or suicide attempts
- Legal difficulties, homelessness or incarceration as a result of behavioral problems and substance abuse
According to Dual Recovery Anonymous, a 12-step group for individuals who suffer from psychiatric and substance abuse disorders, identifying a Dual Diagnosis patient can be challenging for several reasons:
- Symptoms of a mental illness are often very similar to the symptoms of addiction and drug withdrawal.
- Drug or alcohol use can temporarily hide the effects of certain mental health disorders.
- Substance abuse can trigger a psychiatric relapse in patients with severe conditions like schizophrenia or schizoaffective disorder.
- An undiagnosed mental health disorder can precipitate an episode of heavy drug abuse.
When in doubt, it’s always best to be on the safe side — if you have any reason to believe that someone you care about needs treatment, contact an addiction specialist for an evaluation. Your decision to help someone in your life get into residential rehab may help prevent the serious consequences of substance abuse, such as incarceration, loss of key relationships or incarceration.
Residential vs. Outpatient Care
What makes residential treatment so effective for patients with a Dual Diagnosis, or a co-occurring disorder? At a residential facility, fully integrated care may be easier to provide. Integrated care refers to combined treatment for an addiction and a psychiatric disorder. When both conditions are treated at the same time, the patient has a greater chance of making a full recovery, according to the National Alliance on Mental Illness (NAMI).
Here are a few ways that integrated care lends itself to a residential environment:
- Patients who need intensive monitoring for heavy substance abuse or acute psychiatric symptoms can receive clinical care 24 hours a day.
- Clinical professionals and recovery resources are gathered in a single setting, where patients can focus exclusively on their rehabilitation.
- In a residential setting, there’s more time to foster trust between caregivers and Dual Diagnosis patients.
- Patients who have trouble with denial or low motivation can receive specialized attention and encouragement without the distractions of daily life.
- Patients can go through rehabilitation at their own pace in a secure, supportive environment.
- Peer group support is stronger in residential facilities, where Dual Diagnosis patients can share advice and hope with other clients who have similar concerns.
Outpatient treatment programs are useful and effective for patients who require a lower level of supervision. Outpatient counseling and group meetings take place at rehab facilities, mental health centers and clinics in many communities. Services are generally provided during daytime or evening hours, and patients go home at night.
In a study published in Drug and Alcohol Review, researchers at Dartmouth Psychiatric Research Center compared the effectiveness of residential treatment programs with outpatient programs for Dual Diagnosis patients. Their study showed that outpatient care was less effective than residential treatment in up to 50 percent of cases. Participating in outpatient rehab requires a higher level of motivation and compliance, which may not be present in a patient who has a severe mental illness. The structured setting of a residential community provides a sense of security and safety that isn’t available in an outpatient clinic or treatment center.
Medication in Residential Rehab
Pharmacological therapy is a vital component of residential Dual Diagnosis treatment. In a residential treatment program, patients undergo thorough evaluation to assess their recent history of substance abuse, their psychiatric history and their current symptoms. Medications may be prescribed to relieve the symptoms of anxiety or depression, to control flashbacks, or to reduce cravings for drugs or alcohol. Prescription drugs used to support recovery from a Dual Diagnosis include:
- SSRIs. Selective serotonin reuptake inhibitors, or SSRIs, are a class of antidepressants that help to restore healthy levels of serotonin, a neurotransmitter that influences mood, appetite and energy levels. SSRIs like fluoxetine (Prozac), citalopram (Celexa) and sertraline (Zoloft) are prescribed for the treatment of depression, obsessive-compulsive disorders, eating disorders and many other psychiatric conditions.
- Anti-anxiety medications. Medications used to treat anxiety disorders include beta-blockers, which help to manage the physical symptoms of panic attacks, and buspirone, a medication used to treat generalized anxiety disorder. Benzodiazepines like lorazepam (Ativan) and alprazolam (Xanax) are sometimes prescribed for the short-term control of severe anxiety, but because these drugs can be addictive, they must be used with care in Dual Diagnosis individuals.
- Antipsychotic medications. Antipsychotic medications like aripiprazole (Abilify), clozapine (Clozaril) and risperidone (Risperdal) are used to treat severe, persistent mental health disorders like bipolar disorder and schizophrenia.
- Anti-addiction medications. For Dual Diagnosis patients who are addicted to alcohol or opiates, drugs like naltrexone (ReVia, Vivitrol) and buprenorphine (Suboxone) are prescribed to help reduce cravings and maintain long-term abstinence. Methadone may be prescribed to minimize withdrawal symptoms in patients who are addicted to heroin or other opiates.
Approaches to Therapy
Therapeutic strategies for addiction treatment have changed in the past few decades. At one time, therapists practiced a confrontational style with substance abusers. Today, that aggressive approach is no longer supported, especially in Dual Diagnosis patients. Therapists and their clients attempt to develop a collaborative relationship that focuses on improving the client’s sense of competence and self-esteem. Instead of “breaking through denial” or “tearing down the ego,” therapy centers on helping clients strengthen their internal motivation and build a stronger sense of self-worth. At a residential treatment program, individual therapy sessions may be modeled on one or more of these therapeutic schools:
- Cognitive Behavioral Therapy (CBT). The goal of CBT is to change destructive thought patterns and behaviors that interfere with the patient’s desire to lead a more productive, fulfilling life. CBT can be used in the treatment of mental disorders like depression or anxiety, as well as in the treatment of addictive behavior. The coping skills that patients learn in CBT can empower them to manage their moods, fears or flashbacks without the help of drugs or alcohol.
- Motivational Interviewing (MI). Motivational interviewing arose from the need to provide a more supportive, compassionate form of therapy to Dual Diagnosis patients. According to Professional Counselor, MI is designed to help patients with low levels of motivation and compliance find a reason to recover. MI is a nonjudgmental school of therapy that accepts the client’s level of readiness to change instead of attempting to force recovery.
- Dialectical behavior therapy (DBT). Originally developed for the treatment of chronically suicidal patients, the principles of DBT have been applied successfully to addiction treatment and rehabilitation. Dual Diagnosis patients can benefit from this innovative approach to therapy, which focuses on mindfulness, self-acceptance and the regulation of emotional responses.
What to Expect From Rehab
Entering a residential rehab facility can be a scary prospect, especially for those with a Dual Diagnosis. Depression, anxiety and emotional instability can create an intense fear of the unknown. Patients with social phobias may be terrified of group meetings, while those with obsessive-compulsive disorder may have difficulty living in an unfamiliar environment. At a residential facility that specializes in Dual Diagnosis treatment, staff members are trained to expect these responses and to provide the most comfortable atmosphere possible.
Assessment and evaluation are the first stages of the rehab process. When you enter a facility, you’ll be evaluated by an addiction specialist (a psychiatrist, psychologist, counselor or social worker) who will gather information about your recent substance use, your current and past medical history, and your psychiatric symptoms. The assessment phase is crucial for developing an individualized treatment plan that addresses both your mental health condition and your substance use disorder.
Residential facilities are tailored to the needs of patients who require long-term recovery services. At a quality facility, accommodations are comfortable and home-like, with areas dedicated to counseling, group meetings, dining, exercise therapy and recreation. Many residential facilities offer areas for quiet meditation or worship. Depending on your living arrangements, you may have a private room or share your living quarters with a roommate. Nourishing, balanced meals are provided to counteract the effects of substance abuse and help you restore your nutritional status and hydration.
Patients in residential rehab usually receive a weekly or monthly schedule of activities. Your days will be filled with individual counseling sessions, group therapy and recreational activities. You may have a choice of holistic activities like yoga, massage or tai chi, as well as the opportunity to participate in creative therapy through art, music or dance. Family counseling sessions with partners, spouses or children are an important part of your recovery as well.
A residential rehab facility provides a structured living environment to help clients focus on their rehabilitation. There will be certain rules and guidelines to follow, such as avoiding all use of illicit drugs or alcohol, attending meetings and counseling sessions, remaining on the grounds at designated times and following curfews. Access to telephones, television and the Internet is often limited to certain times of the day. Regulations vary from one facility to another, and it’s important to find a level of supervision that you can live with comfortably as you recover.
What to Bring to a Rehab Facility
When you’re admitted to a rehabilitation facility, you’ll need to bring certain personal items to make your stay more comfortable. You may also be presented with a list of prohibited items.
Below are some of the basics you’ll need:
- Personal identification, such as a driver’s license or passport
- A contact list of family members, friends and physicians
- Comfortable clothing, footwear and workout gear
- Personal toiletries, such as soap, shampoo, contact lens cleanser and lotion (products containing alcohol are prohibited)
- Electronic devices, such as clocks, hair dryers and CD players
- Reading material(pornography may be prohibited)
Cameras, clothing that advertises drugs or alcohol, incense, candles and cigarette lighters are not allowed at some facilities. The use of cell phones and laptop computers may be limited, but most facilities will allow you to bring these items with you. Your admissions team will advise you on what to bring to the facility before you enroll.
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David W. Newton is a board certified pharmacist and also has been a board member for boards of examiners for the National Association of Boards of Pharmacy since 1983. His areas of expertise are primarily pharmaceuticals as well as cannabinoids. You can read an article about his expertise in CBD on the National Library of Medicine.