Dual Diagnosis Overview
Dual diagnosis therapy targets co-occurring disorders which are usually tied to addiction. If the psychological disorder is not treated then the addict has a higher risk of just transferring their addiction to a different source. It is extremely important to address the underlying issues when dealing with an addict.
Drug abuse and psychological disorders usually co-exist in many cases of individuals who are substance dependent. A survey by the National Survery on Drug Use and Health (NSDUH) in 2010 found that 20% of adults with mental illnesses in the US are also drug-dependent. This condition wherein substance addiction and mental disorders exist simultaneously is commonly reffered to as dual diagnosis.
Dual diagnosis is common but may be more challenging to address, taking into consideration the coexistence of a drug problem and a psychological problem. This may require a different approach. Scientific studies in the recent years have established that drug abuse may lead to development of mental illnesses. However, recent studies show that some forms of psychological conditions may also predispose an individual to acquiring and addiction to drugs and alcohol.
Drug abuse often leads to development of psychological disturbances and illnesses, resulting to dual diagnosis. In a report by the Substance Abuse and Mental Health Services Administration (SAMHSA), they identified metamphetamine as a cause of permanent structural changes in the brain that may cause disturbances in memory and motor coordination. According to studies, metamphetamine decreases the transporters of dopamine, an important chemical substance that regulates cognition, emotions, and body movements.
Other drugs that have been identified to cause long-term psychological problems include stimulants such as cocaine, amphetamines, and ecstasy, which increases brain activity by altering chemical substances in the brain such as serotonin and dopamine. Depressants such as alcohol and tranquilisers, on the other hand, decreases brain activity by increasing GABA levels, a chemical that generally inhibits the brain. Hallucinogens such as LSD, ketamine and phencyclidine produce hallucinations by also altering activity of neurotransmitters in the brain such as serotonin and dopamine.
Studies show that severity of psychiatric disorders acquired as a result of substance abuse is directly related to intensity of the substance, as well as duration of the active addiction.
Effect of Psychological State on Probability of Acquring Substance Dependence
In a recent study by the American Psychological Association, a pattern of drug abuse may be seen among patients with mental illnesses such as schizophrenia, anxiety problems, unipolar and bipolar disorders, and other personality disorders. They attributed the likelihood of acquiring dual diagnosis to developmental changes in the area of the brain in charge of emotions, fear and anxiety known as the amygdale. According to their study, dual diagnosis may not only be caused from chronic effects of drug abuse but may also be attributed from brain structure of some individuals with mental illnesses that predispose them to acquiring a substance addiction.
Challenges in Addressing Problems Related with Dual Diagnosis
Treatment of individuals with dual diagnosis is more challenging than treating substance abuse alone because the psychological problem should also be given intervention as well. It is important to note that treatment of both aspects of the diagnosis should be done simultaneously but should not be treated entirely as separate entities. A common challenge in treating dual diagnosis is not being able to provide intervention for both aspects holistically, with a greater tendency of treating the psychological problem or the substance addiction alone.
Patients with dual diagnosis have a greater tendency to relapse to substance abuse even after undergoing drug rehabilitation due to the complications of the coexisting psychiatric disorder. This becomes a vicious cycle that worsens the dual diagnosis in such a way that the relapse increases the likelihood of worsening the mental illness, and the mental illness increases likelihood of worsening the substance addiction and so on.
Treatment Program to Address Dual Diagnosis
The UK Department of Health defined a framework that should guide treatment of individuals with dual diagnosis. The process starts with a comprehensive assessment and screening of an individual with psychiatric disorders for possible drug or substance abuse. Assessment should determine severity and range of symptoms of the psychiatric disorder that should be addressed, as well as severity of the drug or substance abuse .
Risk assessment for individuals with dual diagnosis should also be conducted to determine the possibility of an overdose as a result of psychological instability or tendency to harm others due to behaviours brought on by the dual diagnosis. In this way, individualized intervention programs may be designed for the said individuals that would best address their special needs.An engaging and motivating relationship should also be established between the individual with dual diagnosis and the health care provider. Also, a safe environment, including basic needs such as food, shelter, and clothing should also be provided for these individuals.
The treatment environment should also be non-confronting and empathic of the needs of the client with dual diagnosis. Healthcare providers should be enabling and involve the client in the planning of the course of the treatment program as much as possible.Active treatment programs include provision of medications that should address the psychological problems of the client with dual diagnosis as well as manage symptoms from withdrawal from drug or substance abuse. A complete and comprehensive history of drug intake should be taken to avoid adverse drug interactions since the problem of clients with dual diagnosis is multi-faceted.
Treatment programs that are not medication-based include individual counselling, social support interventions, and motivational sessions. These may help ensure effective management of dual diagnosis, along with provision of medications to address immediate needs of the clients.
Dual diagnosis treatment programs should also focus on relapse prevention by removing the clients from situations and environment that would encourage them to go back to substance abuse. Coping strategies should be formulated to help the client resist a relapse. Also, devising an action plan in case the client goes back to substance abuse is also highly recommended.
A co-occurring disorder is a serious condition that requires immediate attention with the help of highly-skilled and professional care providers. If you know someone who needs help contact the Hawaii Island Recovery at 866-515-5032.
