UNDERSTANDING DUAL DIAGNOSIS AND ITS ROLE IN EFFECTIVE ADDICTION TREATMENT
TABLE OF CONTENTS Co - Occ u rring D is or de r s
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W hat a re Co - Occ u r r i n g D i s or de r s ?
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How d o Co - Occ u r r i n g D i s or de r s H a p p e n ?
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How Co mmo n a re Co-O cc u r r i n g D i s or de r s ?
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W hi c h D is o rd ers Co-O cc u r ?
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Ind ic a to rs of Co -O cc u r r i n g D i s or de r s
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S ig ns a n d S ymp to m s of S u bs t a n ce A bu s e
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S ig ns a n d S ymp to m s of M e n t a l I ll n e s s
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Oth er Risks of Co -O cc u r r i n g D i s or de r s
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Tre a ting Co - Occ u r r i n g D i s or de r s
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S tag ing a n I n terve n t i on
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Integ ra ted D u a l D i a g n os i s Tr e a t m e n t
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W hat to E xp ec t in I n teg r a te d D u a l D i a g n os i s Treat m ent
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Add it io n a l Trea tm e n t S t r a teg i e s
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Takea w a y 2 8 S o u rces 2 9
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CO-OCCURRING DISORDERS If yo u o r s o meo n e you l ove i s s ee k i n g treat m ent fo r a su b s t a n ce a b u s e r e l a te d diso rd er in a d d it i on to a p s yc h i a t r i c diso rd er, yo u w il l com e a c r os s t wo te r m s in yo u r resea rc h : co - o cc u r r i n g d i s o r d e r s a n d du al dia gn o sis. Ri g h t off you m a y b e m or e con cern ed a b o u t s i m p ly g e t t i n g h e l p for yo u r a d d ic t io n . M a y be i t h a s c a u s e d you to lose yo u r jo b a n d you r fa m i l y i s i n t a t te r s . It’s im p o r t a n t to n ote t h a t wh e n s u b s t a n ce abu se a nd men ta l i l ln e s s co-occ u r s p ec i a li zed treat m ent is n eed e d. F i r s t , h oweve r, you m u s t und ersta n d t h e re l a t i on s h i p be t wee n m e n t a l he a l th a n d a d d ic t i on i n or de r to fi n d t h e b e s t treat m ent f a c il ity for you r n ee ds .
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WHAT ARE COOCCURRING DISORDERS? Co - o cc u rring d isor de r s r e fe r s to t h e p r e s e n ce of bo th a su b s ta n ce a b u s e di s or de r a n d a m enta l d is o rd er. T h e s e di s or de r s , wh i le affec t ing o ne a not h e r, ex i s t a n d c a n b e diag no s ed ind ep e n de n t l y of e a c h ot h e r a n d the s ym p to m s a re n ot m e r e l y fe a t u r e s or c lusters of o ne s p ec i fi c di s or de r. [ 1 ]
T his m ea ns th a t a p e r s on m a y fu ll y m ee t the c riteria fo r a l coh ol u s e di s or de r a n d de p ressio n , ra t h e r t h a n de p r e s s i on m e r e l y o ccu rring a s a feat u r e of a lcoh oli s m . T h i s
A CO - OCCURRING DISORDER IS SUBSTANCE ABUSE AND A MENTAL ILLNESS OCCURING AT THE SAME TIME.
indiv id u a l ha s, a t le a s t , t wo s e p a r a te i ll n e s s es tha t b o th req u ire t r e a t m e n t .
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W hat a re co - o cc ur r i n g di s or de r s con t .
Ano t h er p h ra s e m e n t i on e d i n con j u n c t i on wi t h co-occurri ng d i s ord ers i s d ual d i agnos i s . Co-occurring diso r der s and dual diagno sis are es sentia l l y o n e a n d t h e s a m e . W i t h du a l d i agnos i s , a pers on has been d i agnos ed wi t h at l eas t one psychiatr ic diso r der and at le as t o ne s u b s ta n ce di s or de r a t t h e s a m e t i me.
In o rd er fo r th e pe r s on to g e t b e t te r, a du a l t reat m ent p l an whi ch t akes bot h cond i t i ons i nto account must be develo ped by the men t a l hea l th p r ov i de r. J u s t b ec a u s e a p e r s on has bot h d i s ord ers d oes not m ean t hey are equi val en t in their impact . In fact , these con d itio n s c a n v a r y i n h ow s eve r e a n d h ow l ong t he s ym p tom s caus e i m p ai rm ent i n f unct i oni ng. Fur ther mo r e, o ne co nditio n may be mil d a t o ne p o int wh i l e t h e ot h e r i s s eve r e and vi ce vers a.
A CO-OCCURRING DISORDER IS:
A D D I CT I O N
M E N TA L ILLNESS
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W hat a re co - o cc ur r i n g di s or de r s con t .
In terrib l y inc a p a c i t a te d i n di v i du a ls , bot h diso rd ers m a y b e ex t r e m e i n s eve r i t y, c a u s i ng maj o r p ro b l ems i n a ll a r e a s of li fe . T h e s e terms b eco m e eve n m or e con fu s i n g wh e n t h ey are u sed to refer to ot h e r con di t i on s occ u r r ing at th e s a m e t ime s u c h a s p os t-t r a u m a t i c s t r es s diso rd er a nd b ip o la r di s or de r.
However, fo r t h e p u r p os e s of t h i s g u i de , coo ccu rring d iso rd e r s a n d du a l di a g n os i s wi ll be referred to str i c t l y wi t h i n t h e con tex t of a men t a l d is o rd er an d a s u bs t a n ce u s e di s or der existing co nc u rre n t ly.
AN EFFECTIVE TREATMENT PLAN MUST TAKE BOTH CONDITIONS INTO ACCOUNT. 6
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HOW DO CO-OCCURRING DISORDERS HAPPEN? W he n tryin g to g e t a g r a s p on ex a c t ly h ow dual d i agnos i s t akes pl ace, t he be st co mp a ris o n i s t h e c h i c ke n or t h e eg g p henom enon. Res earchers and pra c t it io n ers f in d i t di ffi c u lt , for t h e m os t p ar t , to d eterm i ne whi ch one m ay have o cc u rred f ir s t . T h e N a t i on a l I n s t i t u te on Drug A bus e ( NIDA ) of fers t hree pla u sib l e p o s sib i li t i e s for h ow a p s yc h i a t r i c d i s ord er and an ad d i ct i on m ay imp a c t a p erso n.[ 2 ]
1. T he u s e of eit h e r dr u g s or a l coh ol c a n r e sul t i n your ex p eri enci ng t he sym p to m s of a m e n t a l i l ln e s s .
2. T he p res ence of a n u n t r e a te d m e n t a l i ll n es s wi t h s evere s ym ptom s m ay caus e yo u to sel f - m ed i c a te wi t h a l coh ol or dr u g s.
3. La stl y, b o t h p syc h i a t r i c di s or de r s a n d a ddict i on are ground ed i n brai n a b no rm a l ities, g e n e t i c s e n s i t i v i t i e s , a n d c h i l d hood event s t hat caus e t raum a o r excess stress l i ke a b u s e or n eg lec t .
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How d o co - o cc u rr i n g di s or de r s h a p p e n con t .
Differen t p eo p l e m i g h t h a ve a h i g h e r s u s ce p t i bi l i t y, or ri s k , of d evel op i ng ei t her a m ent al i l l nes s o r a substance abuse pr o blem depen d in g o n th e s e fa c tor s . F or ex a m p le , h a vi ng a f at her wi t h s chi zop hreni a m ay l eave one genet i cally pr edeter mined to have the d is o rd er a l th ou g h e a r ly on s e t m a y occ u r as a res ul t of l ong-term s ubs t ance us e. In t he i ns t ance of a phar maco lo gical r isk, c hronic p a in m a y c a u s e on e to deve lop de p r e s s i on and t he d rugs us ed to t reat chroni c p ai n can l ead to an o piate addictio n. Env iro nm enta l l y, a n a n x i ou s tee n m a y s t a r t ex peri m ent i ng wi t h d rugs earl y i n l i fe becaus e hi s or her par ents wer e dr ug user s[3].
CO-O CC U R R I N G D I S O R D E R S CA N B E I N F L U E N C E D B Y: L I F E S TY L E S ENVIRONMENT
P H A R M A C O LO G I C A L
GENETICS
Now th a t yo u u n de r s t a n d t h e com p lex r e la t i ons hi p bet ween m ent al heal t h and ad d i ct i on, keep reading to find o ut how pr ev alent dua l d ia g no s is is , wh i c h di s or de r s te n d to occur s i m ul t aneous l y, and t he i nd i cators of co-occurri ng diso r der s.
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HOW COMMON ARE COOCCURRING DISORDERS? S adl y, t h e exis ten ce of a m e n t a l di s or de r a n d a s ubs t ance abus e d i s ord er o ccu rring a t th e s a m e t i m e i s q u i te com m on. Accord i ng to t he Subs t ance A bus e and M en ta l H ea l t h S e r v i ce s A dm i n i s t r a t i on s ( SA MSHA ) , ap p rox i m atel y 8 . 9 m i l l i on adu l t s in A m eric a s u ffe r fr om co-occ u r r i n g d i s ord ers .
W hat ’s wo rse is th a t 5 5 . 8 p e r ce n t of t h e s e i n d i vi d ual s won’ t get any t reat m ent for t h es e co n d itio n s a t a l l. [ 4 ] I n c i de n ce of co-occurri ng d i s ord ers i ncreas es whe n a n ind iv id u a l h a s a s eve r e m e n t a l di s ord er, wi t h nearl y hal f of t hi s pop u l a t io n rep o r t i n g a s i m u lt a n eou s dr u g or al cohol p robl em . Dual d i agnos i s i s also mo re l ikel y to be fou n d i n m e n , i n a ddi t i on to veteran pop ul at i ons and i n peop l e w it h a n u m b e r of g e n e r a l m e di c a l co nd i t i ons . [ 5 ]
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WHICH DISORDERS CO-OCCUR? D ual d ia g n o s is c a n t a ke p l a ce wi t h v i r t u a ll y any p s ychi at ri c d i s ord er and any sub s ta n ce d is o rde r. N on e t h e le s s , s om e con dit i ons have been found to co-occur mo re f req u en tl y.
S ub sta n ce a b u se i s r e fe r r e d to i n t h e u p da te d Di agnos t i c and St at i s t i cal M anual of M enta l D iso rd e r s , F i ft h Edi t i on (D S M -V ) a s t he recurrent us e of al cohol and / o r dru g s th a t resu l t s i n c l i n i c a l a n d fu n c t i on al i m p ai rm ent s wi t h an i nd i vi d ual ’s he a l th , d isa b il ity, a n d t h e a b i li t y to fu l fi l l de m and s at work , s chool , or hom e. T hese d is o rd ers a r e di a g n os e d by s eve r i t y de pend i ng on whet her a p ers on m eet s a nu mb er of sp ec i fi c c r i te r i a . [ 6 ]
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W hi c h d iso rd ers co-occ u r con t .
Acco rd ing to th e l a te s t dr u g t r e n ds da t a r e por ted by NIDA , al cohol and m ari juana have t he hi ghes t incidences of abuse of all sub s ta n ces . A p p rox i m a te l y 1 7. 3 m i ll i on p eopl e m et t he cri teri a for al cohol abus e i n 2 0 1 3 . 4 . 2 m i l l i o n met the cr iter ia fo r mar ijuana abu se in th a t sa m e ye a r. [ 7 ] Com m on s u b s t a nce us e d i s ord ers t hat co-occur wi t h m ent al d i s ord ers include:
A LC O H O L U S E D I S O R D E R
OPIOID USE DISORDER
CA N N A B I S U S E D I S O R D E R
HALLUCINOGEN USE
S T I M U LA N T U S E D I S O R D E R
TOBACCOO USE DISORDER
DISORDER
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W hi c h d iso rd ers co-occ u r con t .
Me nta l il l n es ses a r e c h a r a c te r i ze d by c hang es o r d isto r t i on s i n t h ou g h t , be h a v i or, and / o r em o t io n a l p a t te r n s t h a t di s r u p t a pe rso n’s a b il ity to fu n c t i on i n wor k , s c h ool , re lat io n sh ip s , o r s oc i a l a c t i v i t i e s . T h e s e diso rd ers a re d iv i de d i n to v a r i ou s c a teg or i e s: anxiet y d is o rd ers , m ood di s or de r s , p s yc h ot i c diso rd ers , ea t ing di s or de r s , p e r s on a l i t y diso rd ers , etc .[8]
Bas ed o n d a t a f rom t h e N a t i on a l I n s t i t u te of Me nta l Hea l th , in 2 0 1 3 , r ou g h ly 1 0 m i ll i on adu l t s in th e U ni te d S t a te s ove r t h e a g e of 1 8 suffered f ro m a s e r i ou s m e n t a l i ll n e s s i n t h e pas t yea r.[9 ]
MENTAL ILLNESS CAN DISRUPT HOW AN INDIVIDUAL FUNTIONS EVERYDAY. 12
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Commo n m enta l d i s or de r s t h a t co-occ u r wi t h sub sta n ce u s e d is or de r s i n c lu de :
• D ep ressio n • Bi p o l a r D iso rd e r • G enera l ized A n x i e t y D i s or de r • Pa n ic D is o rd er • Ob s es sive- Co m p u l s i ve D i s or de r • Atten tio n D ef ici t H y p e r a c t i v i t y D i s or de r • Po st-Tra u m a tic S t r e s s D i s or de r • S c hizo p h ren ia • E a ting D is o rd er s
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INDICATORS OF CO-OCCURRING DISORDERS If yo u a re wo rried t h a t you or s om eon e you k now m ay be s uf feri ng f rom co-occurri ng m ent al and s ubstance use diso r der s, yo u need to k n ow how to r e a d t h e s i g n s . B e low a r e s om e com m on i nd i cators of bot h s ubs t ance abus e and m e ntal illness.
SIGNS AND SYMPTOMS OF SUBSTANCE ABUSE I n di v i d ual s wi t h a d rug or al cohol probl em m ay ex hi bi t :
• sud d en o r ra p id c h a n g e s i n t h e i r m ood or p ers onal i t y
• d rop out of s chool or m i s s s ever al day s of wo r k
• tr o u b l e fo c u sin g or con ce n t r a t i n g
• negl ect groom i ng and hygi ene
• in c rea se o r d ec r e a s e i n a p p e t i te a n d s lee p
• s t ar t get t i ng i n t roubl e l i ke fights o r theft
• irrit a b il ity
• engagi ng i n ri s ky behavi ors
• sl u rs in sp eec h a n d t r e m or s i n h a n ds
• bad s m el l s or od ors on t he per so n o r his/her belo ngings
• beco me w ith d ra wn fr om fr i e n ds or fa m i ly
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Ind ic a to rs of co - occ u r r i n g di s or de r s con t .
War ning sig ns of s u bs t a n ce a bu s e m a y i n c l u d e: an i nd i vi d ual p ers i s tent l y t ryi ng to qui t but bei ng unable to ; exper iencing with d ra w a l sym p tom s a fte r s u dde n l y s top p i n g us e; havi ng to us e m ore and m ore of t he s ubs t ance to achieve the same desir ed effec t ; co n sta n tl y t h i n k i n g a bou t u s i n g s u b s t ances or obt ai ni ng s ubs t ances ; f ai l i ng to f ul f i l l res p onsibilities; and co ntinuing to use eve n th o u g h it c a u s e s n eg a t i ve con s eq u e n ces i n t he p ers on’s l i fe. [ 1 0 ] In s om e cas es , m ent al i l l nes ses may pr esent in a phy sical, o r soma t ic , w a y in th e for m of p e r s i s te n t h e a daches , back aches , or ot her pai ns . [ 1 1 ]
SIGNS AND SYMPTOMS OF MENTAL ILLNESS A n i n d i vi d ual af fected by a ps ychol ogi cal d i s ord er m ay: • di s p l a y su d d en or e r r a t i c c h a n g e s i n m ood or p ers onal i t y
• ex hi bi t a l ow m ood or s ad ness
• sh ow excessive or i n ex p l i c a bl e a n g e r, a g g r es s i on or vi ol ence
• ex hi bi t i ntens e energy
• see v isio n s o r h e a r s ou n ds t h a t n o on e e l s e s ees and hears
• s l eep m ore or l es s t han us ual
• exp ress il l o g ic al ly s ou n d be li e fs or t h ou g h t s
• ex peri ence changes i n s ex d rive
• feel inc a p a b l e of h a n dl i n g eve r y da y a c t i v i t i es or
• have probl em s concent rat i ng at scho o l o r wo r k
re s p o nsib il it ies
• have s ui ci d al t hought s
• have d if f ic u l ty s oc i a l i z i n g
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OTHER RISKS OF CO-OCCURRING DISORDERS T here a re a d d it io n a l wa r n i n g s i g n s t h a t cor r el ate wi t h co-occurri ng d i s ord ers , and often com pl i cate the assessment , diagno sis, and treat m ent p ro ces s . I n di v i du a l s wi t h a co-ex is t i ng s ubs t ance abus e probl em and m ent al heal t h conditio n ty pically ar e at r isk of:
F INANCIAL DIF F ICULTIES
HI V AND OT HE R D I SE ASE S
VIOLE NCE
L EGA L P RO B L EMS
I SOLATI N G FROM OTH ERS
H AVI N G A RELA P S E
H O MEL ES S N ES S
H O S P ITA L I Z E D
I N CA RC ERAT I O N
F A M I LY / M A R I TA L D I SCO R D
P R E M ATUR E D E ATH
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TREATING CO - OCCURRING DISORDERS If yo u a re co n cern e d t h a t you or a fa m i l y m em ber or f ri end m ay have coo ccu rring co nd iti on s , you p r ob a bl y fee l u n ce r t ai n about how to acces s t he se rv ices yo u need . T h e on l y wa y you c a n e n s ure you get ad equate t reat m ent i s to ide ntif y a nd co n fi r m t h e p r e s e n ce of co-occ urri ng d i s ord ers . Thi s i s t he f i rs t and mo s t centra l step towa r ds you r r ecove r y.
Many s u b s ta n ce us e di s or de r s i n vol ve s y m p tom atol ogy pat terns t hat overl ap with v a rio u s m en t a l di s or de r s . You n ee d to s ee an ex peri enced p s ychi at ri s t or o th er t ra in ed m e n t a l h e a l t h p r ov i de r t h a t c an p erform a d i f ferent i al d i agnos i s to d etermin e w h a t , i f a n y, m e n t a l i ll n e s s e s o r s ubs t ance p robl em s you are sufferin g f ro m.
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Tre a ting co - o cc u r r i n g di s or de r s con t .
Onl y a fter verif yi n g you r di a g n os i s c a n you cond uct t horough res earch to f i gure out w hic h trea tm e n t fa c i l i t i e s m ee t you r u n ique need s . If you are, i nd eed , suffering f ro m co -occ u r r i n g s u bs t a n ce u s e a n d ps ychi at ri c d i s ord ers , you wi l l req u ire s p ec ia l ize d t r e a t m e n t t h a t foc u s e s on bot h cond i t i ons . Thi s t ype of tre a t m ent l en d s a be t te r p r og n os i s a n d a ls o cos t s l es s t han enteri ng t wo sepa ra te trea tm e n t p r og r a m s .
Treat m ent p ro g ram s t h a t c a te r to p eop l e l i ke you m us t cros s a t wo-fol d barri er: indi v id u a l s w ith dr u g or a lcoh ol p r ob le m s t hat have not qui t wi l l have t roubl e fo ll ow in g tra d it io n a l t r e a t m e n t a p p r oa c h e s for m ent al i l l nes s es ; on t he ot her han d , a p ers o n w i t h a n u n t r e a te d m e n t a l i ll n es s wi l l l ack t he cogni t i ve and e mo tio n a l a b il it y to r ecove r fr om a s u bs t a n ce p robl em . [ 1 2 ] Therefore, t he bes t outco m es req u ire t h a t a p e r s on e n te r a fa c i li t y t hat wi l l p rovi d e t he neces s ary serv ices to sa fel y a n d e ffec t i ve l y de tox fr om s ubs t ances and al l evi ate t he sym p to m s of a m e n t a l di s or de r con c u r r e n t ly.
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STAGING AN INTERVENTION Yo u r l oved o ne m a y n ot r ecog n i ze t h e n ee d for hel p wi t h co-occurri ng d i s ord ers . If yo u c a n see t h a t t h i s p e r s on i s i n t r ou b le , i t m ay be neces s ary to i ntervene o n t h eir b eha l f. T h e r i s k s of co-occ u r r i n g di sord ers --hom el es s nes s , job l os s , financ ia l d if f ic u l t y, H I V, e tc .-- a r e too h i g h for you to jus t s t and by and watch yo u r l oved o n e co n t i n u e down a da r k p a t h .
Plus , co nsid ering t h a t n e a r ly h a l f of i n di v i dual s wi t h a d ual d i agnos i s recei ve no trea tm ent a t a ll , t h e on l y wa y you r love d one m ay end up get t i ng hel p i s throu g h yo u . B rie f i n te r ve n t i on s , a lt h ou g h n o t an as p ect of t reat m ent , have been show n to b e ef fect i ve i n h e lp i n g a n i n di v i dual recogni ze t he need for hel p and possib l y g a ining t h e m ot i v a t i on n ee de d to s eek hel p. [ 1 3 ]
Once yo u o r yo u r love d on e h a s m a de t h e deci s i on to go i nto t reat m ent , you sho u l d s ta r t l o o k i n g u p fa c i l i t i e s i n you r a r ea t hat as s i s t t hos e wi t h a d ual diag no s is . S ince t r e a t i n g bot h a n ex i s t i n g m ent al d i s ord er and s ubs t ance us e diso rd er req u ires com p l ex t r a i n i n g , t h e s e ce nters m ay be d i f f i cul t to f i nd .
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STAGING AN INTERVENTION S om e t i p s for s t agi ng an ef fect i ve i ntervent i on i ncl ud e:
1. SECURE A N E U T RA L LO CAT I ON TO H O L D T H E I NT E RV E NT I O N.
I f t h e p er s on i s v i ol e n t , m a ke s u r e t h ere are no potent i al weap ons wi t hi n reach.
2. ASK A PASTO R O R TH E RA P I S T TO H E L P
H a ve a p r ofe s s i on a l fa c i li t a te t h e i n tervent i on to be abl e to d e-es cal ate any hos t i l i t y.
3. REQ UEST TH AT KE Y F A M I LY M EM B E R S O R C LO SE F R I E ND S B E P R E SE NT D ISCRE E TLY.
The p u rp os e of t h e g a t h e r i n g s h ou l d be a s urp ri s e to t he i nd i vi d ual who need s hel p.
4. ALLOW EAC H P E RS O N P RE S E NT TO E X P R E SS CO NC E R N
G ive ever yon e i n volve d a c h a n ce to ex pres s t hei r concern about t he behavi or of t he i nd i vi dual and how he/she has
h a rmed t h e m . T h e fa c i l i t a tor s h ou l d d eci d e t he ap p rop ri ate way to s hare t hes e concerns while minimizing anger o r
feel ing s of b e t r a y a l .
5. PO IN T OU T H OW M U C H YO U CAR E AB O U T T H E P ER SO N.
Let th e in v i di v u a l k n ow h ow m u c h yo u care about t hem and how you are wi l l i ng to s up p or t them thr o ugh tr eatment .
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INTEGRATED DUAL DIAGNOSIS TREATMENT T he m o s t ef fec tive t r e a t m e n t a p p r oa c h for co-o cc u rring d isor de r s i s c a l le d i n teg r a te d dua l d ia g no s is tr e a t m e n t , or I D DT. T h e IDDT a p p ro a c h is di r ec te d a t t r e a t i n g a n indiv id u a l ’s su b s t a n ce a b u s e wi t h i n t h e con text of th eir m e n t a l i ll n e s s .
T he co re fo c u s of i n teg r a te d du a l di a g n os i s treat m ent strives to p r ov i de b ot h c li n i c a l a nd re ha b il ita tive s er v i ce s a t t h e s a m e t i m e wi t h the o b jec t ive of : e n h a n ce d m a n a g e m e n t of psyc hia t ric co n d i t i on s ; dec r e a s e d s u b s t a n ce
THE IDDT APPROACH AIMS AT TREATING THE PERSON AS A WHOLE .
abu se; l ess h o s p i t a l i z a t i on s ; le s s a r r e s t s ;
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Integ ra ted d u a l d i a g n os i s con t .
g re a ter ho u s ing s t a b i li t y ; a n d a n ove r a ll b e t ter qual i t y of l i fe for i nd i vi d ual s with co - o cc u rrin g di s or de r s . [ 4 ]
W he n a m enta l ill n e s s a n d s u bs t a n ce a bu s e occur at t he s am e t i m e, t he symp to m s a re inte r t wi n e d. T h e r e for e , i n or de r to ef fect i vel y t reat t hes e con d itio n s, th e in te r ve n t i on s , too, m u s t be i n ter t wi ned . Res earchers have found tha t l o o k ing a t th e t wo di s or de r s s e p a r a te l y proves to be m os t l y i nef fect ual .
IDDT a ims a t trea t i n g t h e wh ole p e r s on i n a n at tem p t to regul ate t he psyc ho l o g ic a l , em ot i on a l, s oc i a l, a n d e n v i r on m ent al f actors t hat m ay have l ed to a n a d d ic t io n . A l l a r e a s of a p e r s on ’s li fe are ex am i ned and cons i d ered d uri ng treat m ent . I D DT i n cor p or a te s a p p r oa c h e s fr o m a m ul t i d i s ci pl i nary team of prov id ers w ho wo r k col la b or a t i ve ly a t t r e a t ment pl anni ng. [ 1 ]
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WHAT TO EXPECT IN INTEGRATED DUAL DIAGNOSIS TREATMENT Integ ra ted d u a l d i a g n os i s t r e a t m e n t a p p r oa ches are s t ruct ured s o t hat , no m at ter where an i nd i vi dual enter s the sy stem (fo r treat m ent of eith e r t h e s u b s t a n ce a b u s e or the m ent al i l l nes s , or s om e ot her cond i t i on) , you can get access to the car e yo u need. W he n yo u ta ke a dv a n t a g e of t h i s t r e a t m e n t approach, you can ex pect to recei ve a com bi nat i on of the fo llowing eight ser vices[3]:
S U P PO RT G RO U P S D u a l di a g n os i s t r e a t m e n t fa c i l i ti es t yp i cal l y of fer you acces s to Doubl e Troubl e group s o n-site that last fr o m 6090 m i n u te s . A da p te d fr om t r a di t i onal 1 2 -s tep program s , t hes e group s al l ow cl i ent s to inter act and handle per so nal pro b l ems in a g ro u p s e t t i n g wi t h t h e fa c i li t at i on of a t herapi s t or couns el or. M any f aci l i t i es m ay a lso featur e family o r mar ital sup p o r t g ro u p s, i n wh i c h l ove d on e s m a y a t tend and d i s cus s s t rategi es for as s i s t i ng t he i nd i vi d ual thr o ugh r ecover y and also selfc are tip s fo r l iv in g wi t h a n d l ov i n g s om eon e wi t h d ual d i agnos i s .
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GROUP THERAPY G ro up t h e r a py p r ov i de s you wi t h t he chance to work t hrough i s s ues rel at i ng to recover y with o ther s who ar e cur r ently exp e r i e n c i n g t h e s a m e di ffi c u lt ies . Thi s t ype of t herapy hel ps d ual d i agnos i s p at i ent s r eco gnize that they ar e no t alo ne in t heir s u f ferin g a n d a ll ows t h e m to wi t n e s s ot hers ’ p rogres s i n recovery as i t happens . [ 1 7 ]
R E F E R R A L A N D C O N S U LT A T I O N After g a i n i n g t h e i n i t i a l i n for m at i on, a referral i s m ad e to a qual i f i ed m ent al heal t h p rov ider. The initial co nsultatio n invo l ve s wor k i n g wi t h t h e c l i e n t to es t abl i s h tent at i ve t reat m ent goal s and t he p reci s e ser vices needed fo r yo ur con d itio n , ta kin g i n to con s i de r a t i on i n di v i dual s t rengt hs and weak nes s es as wel l as s oci al s uppor t .
M E D I C AT I O N M A N A G E M E N T W I T H A N O N - S I T E P S YC H I AT R I S T The m os t i de a l I D DT fa c i li t i e s w i l l of fer acces s to a s t af f ps ychi at ri s t who can pres cri be medicatio ns that help with eith e r de tox i fi c a t i on fr om s u b s t ances , prevent i on of acute wi t hd rawal s ym p tom s , and /o r stabilizatio n fo r psychiatr ic sym p to m s. The o n -s i te p s yc h i a t r i s t wi l l con st ant l y m oni tor and revi ew your progres s to eval uate t he r isk level fo r abuse, the severity of t h e m e n t a l di s or de r, a n d h ow t h e d ual d i s ord ers i nteract wi t h one anot her. [ 1 2 ]
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P S YC H OT H E RA P E U T I C I N T E RV E N T I O N I n a ddi t i on to p h a r m a col og i c a l intervent i ons , IDDT p res ent s an oppor t uni t y for d ual d iagno sis clients to r eceive muchn eed e d cog n i t i ve be h a v i or a l t h erapy techni ques t argeted toward s hel p i ng an i nd i vi d ual develo p adaptive co ping mec ha n is m s fo r p r eve n t i n g r e l a p s e a n d m a n agi ng t he m ent al i l l nes s i n ad d i t i on to al teri ng m al ad aptive tho ught patter ns o r be h a v io r p a t terns t h a t con t r i bu te d to b ot h . Therapy can be cond ucted i n an i nd i vi d ual , group, or f amily fo r mat . While v ir tually ever y c lie nt w il l p a r tici p a te i n on e -on -on e t h e r a py wi t h a p rovi d er, ot her form at s you par t i ci p ate i n wi l l depend o n yo ur per so nalized treat m ent n eed s.
F A M I LY I M P A C T B o t h s u bs t a n ce a bu s e a n d p s yc h i at ri c d i s ord ers can have p rofound i m p act s on t he f amily. V iewing the family as a syste m , i n wh i c h e a c h i n di v i du al i s i nnatel y connected to al l ot her i nd i vi d ual s , f am i l y ther apy gives yo u and yo ur loved o ne s a sa fe p l a ce to di s c u s s h ow co-occ u r r i n g d i s ord ers have changed t hat f am i l y d ynam i c. Therapists also educate families abo ut the n a tu re of d u al di a g n os i s a n d eve r yon e learns hel pf ul s t rategi es t hat cont ri bute to your recover y, and, ultimately, the r ecover y of the w ho l e s ystem . [ 1 8 ]
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P S YC H O E D U C AT I O N B a sic I D DT p r og r a m s p r ov i de a cce s s to ed ucat i onal cl as s es i n whi ch you can l earn t he foundatio ns of bo th addictio n a n d m e n t a l i l ln e s s , h ow dr u g u s e can ex acerbate a pre-ex i s t i ng ps ychi at ri c d i s ord er, and how to identify and over co me re lap s e t rig g ers t h a t g i ve you a n u r g e to dr i nk or us e d rugs . Ps ychoed ucat i on arm s t he i nd i vi d ual with the knowledge needed to take a n a c tive a n d i n for m e d r ole i n t h e i r r ecovery f rom co-occurri ng d i s ord ers .
INITIAL SCREENING AND ASSESSMENT Yo u r i n i t i a l p oi n t of con t a c t m a y be when s eek i ng hel p for ei t her t he s ubs t ance abus e o r the mental illness. Regar dless, ef fect i ve p r og r a m s i n vol ve t h or o ugh s creeni ng t hrough i nventori es and / or ques t i onna ir es of behavio r al and emo tio nal symp to m s to id en t i fy wh e t h e r co-occ u r r i n g di s ord ers are pres ent . A not her f acet of t he i ni t i al i nt ake pr o cess is assessment .
T he a im of a s ses s m e n t i s to de te r m i n e t h e severi t y of t he co-occurri ng d i s ord ers ; col l ect es s ent i al backgr o und info r matio n o n the indiv id u a l , in c l u d i n g fa m i ly a n d p e r s on a l m ed i cal and ps ychi at ri c hi s tory, hi s tory of abus e, f i nanci al, legal, and educatio n status, as wel l a s reso u r ce s t h e i n di v i du a l h a s a v a i l abl e; and s erve as t he found at i on for t reat m ent . You may go thr o ugh the assessment pro ces s severa l ti m e s du r i n g t h e cou r s e of t r eat m ent to d eterm i ne p rogres s . [ 1 5 ]
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ADDITIONAL TREATMENT STRATEGIES In a d d itio n to th e t r e a t m e n t a p p r oa c h e s , du al d i agnos i s f aci l i t i es m ay al s o of fer a num ber of al ternative tr eatments. Similar to the overa l l g o a l of in teg r a te d du a l di a g n os i s t r e at m ent , t hes e m et hod s s t ri ve to t reat t he whol e i nd i vidual, maximizing o n str engths and ta l en ts inh er e n t i n t h e i n di v i du a l . T h e s e hol i s t i c t reat m ent opt i ons i m p rove t he m i nd , bod y, and so ul of the indiv idual, helping yo u b u il d u p o n th e p r og r e s s m a de wi t h t r a di t i onal m ed i cat i ons and ps ychot herapy. Som e al ternat i ve tr eatments that may wo r k well with d u a l d ia g n os i s i n c lu de :
YOGA
PRAYE R
AC U P U N CT U RE
N U T RI T I O N
MEDI TATI O N
E X E RC I SE
Hav in g a cces s to s oot h i n g a c t i v i t i e s s u c h a s t hes e can be a m ot i vator for get t i ng t reat m ent . Thes e appr o aches ar e no t effective at treat ing co - o cc u r r i n g di s or de r s a l on e , bu t t h ey can s erve as pos i t i ve act i vi t i es for copi ng to t ake h o me after tr eatment ends.
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TAKEAWAY Add ic t io n is p rese n t i n n e a r ly h a l f of a l l indiv id u a l s w ith s e r i ou s m e n t a l i l ln e s s , and v ice vers a . Th i s m e a n s t h e r e’s a 5 0 / 5 0 c hance t h a t if yo u a r e s t r u g g li n g wi t h e i t h e r a su b s ta n ce u s e d i s or de r or a p s yc h i a t r i c diso rd er, yo u co ul d deve l op t h e ot h e r.
Firs t , yo u n eed to s ee a doc tor to de te r m i n e i f yo u a re s u f ferin g fr om co-occ u r r i n g di s or de rs . T hen , eith er th ro u g h r e fe r r a l or you r own re se a rc h , l o c a te a n i n teg r a te d du a l di a g n os is fac i l ity w it h exp e r t s t r a i n e d i n t r e a t i n g the u niq u e n eed s of i n di v i du a ls wi t h b ot h sub s ta n ce a b u se a n d p s yc h i a t r i c p r ob le m s . T hese a re t h e f irs t s te p s towa r ds a c h i ev i n g
HALF OF ALL PEOPLE WITH DUAL DIAGNOSIS WILL NEVER GET THE HELP THEY NEED.
the recovery yo u lon g for.
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SOURCES [1] Co- occurring dis or d e r s a nd integ r a te d d ua l d ia g n o s i s t reat m en t ( I DDT ) . N at i o n al A l l i an ce o n M en t al I l l n es s . F e brua ry 2012. [2] W hy do drug us e d is or d e r s ofte n co- occur w it h o t h er m en t al i l l n es s es ? N at i o n al I n s t i t u te o n Dru g A b u s e. S ep te m be r 2010. [3] Co- occurring dis or d e r s . Ps ycholog y Tod a y. N ovem b er 2 0 1 4 . [4] About co-occurring . S ub s t a nce Ab us e a nd M e ntal H eal t h S erv i ces A d m i n i s t rat i o n . [5] Dual diagnos is . Na t iona l Allia nce on M e nt a l Il l n es s . [6] Sub s tance us e d is or d e r s . S ub s t a nce Ab us e a nd M en t al H eal t h S erv i ces A d m i n i s t rat i o n . J u n e 2 0 1 5 . [7] Drug facts : Nationw id e t r e nd s . Na t iona l I ns t it u te o n Dru g A b u s e. J u n e 2 0 1 5 . [8] Mental dis orde r s . S ub s t a nce Ab us e a nd M e nt a l H eal t h S erv i ces A d m i n i s t rat i o n . J u n e 2 0 1 5 . [9] Se rious m ental illne s s a mong U. S . a d ult s . Na t i o n al I n s t i t u te of M en t al H eal t h . [10] Signs and s y m p toms . Na t iona l Council on Alco h o l i s m an d Dru g Dep en d en ce, I n c . [11] Mental illne s s . M a yo Clinic. M a y 2014. [12] Dual diagnos is : S ub s t a nce a b us e a nd me nt a l i l l n es s . N at i o n al A l l i an ce o n M en t al I l l n es s . J an u ary 2 0 1 3 . [13] Brief inte rvent ion for s ub s t a nce a b us e : A ma n u al fo r u s e i n p ri m ary c are. Wo rl d H eal t h O rg an i zat i o n . 2 0 0 3 . [14] 5 s trategie s for wor k ing w it h clie nt s w it h co-o cc u rri n g d i s o rd ers . N at i o n al Cen ter fo r Bi o tec h n o l o g y I n fo rma t ion . 2005. [15] Scree ning and a s s e s s me nt . S ub s t a nce Ab us e a n d M en t al H eal t h S erv i ces A d m i n i s t rat i o n . [16] Double trouble in r ecove r y. S AMS HA’s Na t ional Reg i s t ry of E v i d en ce- b as ed Pro g ram s an d Prac t i ces . J an u ary 2014. [17] Sub s tance ab us e t r e a t me nt : G r oup t he r a py. N at i o n al Cen ter fo r Bi o tec h n o l o g y I n fo rm at i o n . 2 0 0 5 . [18] Sub s tance ab us e t r e a t me nt a nd f a mily t he r a py. N at i o n al Cen ter fo r Bi o tec h n o l o g y I n fo rm at i o n . 2 0 0 4 . [19] Waletzky, L .R. & a mp ; Ha nd e l, M . J. Holis t ic a pp ro ac h to t h e ad d i c t i o n recovery p ro ces s . A m eri c an H o l i s t i c H e a lth A ssoc ia tion .
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C h e ck o u t o u r ot h e r E Books !
T he A scend D if fer e n ce , s i m p ly de fi n e d, i s t h at i t ’s a t reat m ent pro g ra m d riven by v a l u e s a n d a t r u e p a s s i on for recovery. Thi s star t s w ith th e v i s i on of A s ce n d’s fou n de r, Ry an Sal ter. A s cend is ow n ed a n d o p e r a te d by c l i n i c i a n s wh o work d i rect l y wi t h c lie nts to d el iver t h i s v a l u e -b a s e d ex p e r t i s e i n a way not s een at l a rg er co rp o ra te p r og r a m s . W h e n you r l oved one com es to Ascend t h ey w i l l becom e p a r t of a fa m i l y, not jus t par t of a pro g ra m . This di ffe r e n ce i s wh a t e m p owe r s our cl i ent s to ac h ieve so b riet y.
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