Individuals who have both a mental illness and an addiction to drugs or alcohol present a challenge for medical professionals. Treatment is complicated by the overlapping symptoms of the addiction and the mental illness. Complete recovery takes time and great care due to the delicate nature of the individual. Because these patients have a mental illness, getting them to comply with the rules and regulations of a conventional drug rehab program can be difficult. It may be hard to persuade patients with co-occurring disorders to take their medications, attend counseling or participate in other activities associated with success in a rehab program.
The most successful approaches for Dual Diagnosis patients are integrated programs that treat all aspects of the illnesses in a single location.
Mental health professionals and addiction rehab counselors work together in these programs to provide well-rounded care that encompasses everything involved in the diagnosis.
The Dual Diagnosis treatment process may include:
- Assessment of psychiatric health. This stage will help identify which disorder or disorders the individual is suffering from. Medication may be prescribed at this point, as well as general psychiatric counseling to address the illness.
- Integration of addiction rehab. Using the knowledge gained from the psychological evaluation, counselors will begin working with the individual to address his drug or alcohol addiction. This process may move at a more deliberate pace than “stand alone” rehab because of the complications caused by the mental illness.
- Treatment for the mind, body and spirit. Programs that employ holistic treatments such as massage therapy, yoga, nutritional counseling and meditation help the individual find balance in their lives (often for the first time). Not all Dual Diagnosis rehab programs offer holistic care, but those that do enjoy high rates of success and low relapse rates.
- Behavioral modification therapy. Individuals are taught new methods for coping with their mental illness and shown how to avoid the triggers that can cause relapse. In this final phase of the Dual Diagnosis rehab, the individual learns to master the tools needed to succeed in the outside world.
- Relapse prevention education. Aftercare programs provide a support structure and accountability for the individual. The period after leaving rehab can be difficult, and indeed, scary for the recovering addict with a mental illness.
There is a lot to do (take meds regularly, avoid triggers of addiction) and even more to rebuild (personal relationship, careers, finances) but the aftercare program lets the individual know that they are not alone during this part of their journey, and provides much needed structure.
Treatment for a Dual Diagnosis
Clinicians who specialize in addiction recovery now recognize the need for compassionate, supportive care in the treatment of Dual Diagnosis patients. Therapy sessions for these patients must encourage the patient to find the motivation to heal. This process begins by building a trusting relationship between the therapist and the patient. Once trust has been established, the therapeutic process involves helping the patient learn new coping skills, build self-confidence and manage the symptoms of mental illness.
Treating a Dual Diagnosis demands more than one therapeutic strategy. As part of your rehabilitation program, you may take part in:
- Individual counseling sessions. Intensive therapy with a psychiatrist, psychologist or counselor will address both your psychiatric diagnosis and your addictive disorder. Because mental illness and addiction are deeply related, you should be treated for both conditions simultaneously. Therapists should have training and credentials in treating Dual Diagnosis patients.
- Mutual support groups. Group therapy is extremely important in Dual Diagnosis treatment. The isolation and social withdrawal of mental illness can worsen the symptoms of depression or social anxiety. Meeting with the members of a supportive group can help you restore your trust in others and enhance your sense of competence.
- Pharmacotherapy. Managing the symptoms of anxiety, depression, bipolar disorder or schizophrenia often requires pharmacological support. In Dual Diagnosis treatment, the importance of psychiatric medications is widely accepted, and meds are considered to be an essential part of recovery for many patients.
- Couples counseling and family therapy. Addiction and mental illness rarely affect only one individual. Your spouse, children and other significant individuals in your life should play an active part in your recovery by attending individual and group counseling sessions through your rehab facility.
- Assistive services. For those who struggle with chronic anxiety, post-traumatic stress disorder or depression, keeping up with the practical tasks of life can be challenging. In a Dual Diagnosis treatment program, services like vocational counseling, relationship counseling and nutritional counseling are often provided. Assistance with food, housing and childcare can make the difference between whether or not many Dual Diagnosis individuals get help.
Residential treatment is often recommended for Dual Diagnosis patients, who can benefit from living in a supervised setting. While outpatient care may be appropriate for clients who are relatively stable, many patients with co-occurring disorders need intensive rehab services and clinical monitoring while they go through recovery.
Recovery may take longer for Dual Diagnosis patients, who often struggle with low levels of motivation and high levels of denial.
Treatment should last long enough to reinforce the skills and strategies acquired during the rehabilitation process; however, many patients are discharged before they can reap the full benefits of their recovery program.
The Centers for Disease Control and Prevention, for example, recommends that clinically supervised treatment for opiate addiction last at least 12 months yet most patients leave or are discharged before the year is over. Developing an individualized treatment plan that addresses the patient’s needs is one of the most critical steps in the recovery process. After the initial rehabilitation period, many Dual Diagnosis patients can benefit from transitional housing at a sober living facility or residential community where they can practice their new skills in a safe environment.
Dual Diagnosis Rehab
Drug or alcohol rehabilitation for Dual Diagnosis patients should be integrated with mental health care if the patient is to achieve a complete recovery, according to Mental Health Services Research. In the early stages of treatment, patients who have been using drugs or alcohol heavily may need to go through detoxification, nutritional supplementation and fluid replacement as part of the stabilization process. Patients with co-occurring psychiatric disorders may experience anxiety, agitation, severe depression or flashbacks as the toxic substances leave their system.
These symptoms can be controlled with medications or with non-pharmacological interventions to make the detox process more comfortable.
One of the primary goals of detox is to prepare the patient for the next stage of rehab. Rehabilitation is where the real work of recovery begins, as patients learn how to create a life that’s free from drugs and alcohol. Individual counseling sessions, group therapy, medication and family counseling are the cornerstones of an addiction treatment program. Psychotherapy for Dual Diagnosis patients addresses the sources of addiction as well as strategies for managing cravings and triggers. Participation in support groups and 12-step programs helps to build coping skills and generate hope for the future.
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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.
Reviewed by: Kim Chin and Marian Newton