Dual Diagnosis treatment is a relatively new innovation in the field of addiction recovery. Until the 1990s, people who were experiencing symptoms of a mental health disorder — anxiety attacks, depressive episodes, delusional behavior or mood swings — were treated separately from those who sought help for drug or alcohol abuse.
When these conditions overlapped, clients were often denied treatment for a mental illness until they got clean and sober. Unfortunately, because substance abuse is often driven by an underlying psychiatric disorder, this meant that many people with a Dual Diagnosis of addiction and a mental disorder never got the help they needed.
If you meet the diagnostic criteria for a mental health disorder (depression, bipolar disorder, anxiety disorders, schizophrenia, a personality disorder, etc.) and for an addictive disorder (alcoholism, drug addiction, gambling addiction, sex addiction or another behavioral addiction), you may be classified as a Dual Diagnosis client when you enter treatment. Effective treatment for a Dual Diagnosis involves considering both your addiction and your mental illness as you go through the recovery process.
To receive a Dual Diagnosis, you must meet the criteria for a mental health disorder as defined by the current version of The Diagnostic and Statistical Manual of Mental Disorders. Published by the American Psychiatric Association, the DSM is a guideline for mental health professionals who are diagnosing and treating patients in a variety of clinical settings.
A dual diagnosis is when a person is diagnosed with both a mental health disorder and a substance use disorder. The conditions are usually treated separately, but when diagnosed in the same person, they are related and can have noticeable impacts on one another.
To have the most effective outcome, a person with a dual diagnosis should receive treatment for both disorders at the same time. Dual diagnosis treatment programs are designed to address each issue individually while keeping in mind how the other disorder may influence the treatment plan. For example, dual diagnosis rehab treats substance use disorder by allowing the person to go through withdrawal and treat their addiction. The person will also receive therapy for their mental health disorder during the addiction treatment process.
When a person has a mental health issue, they may turn to substance use to cope with physical and psychological symptoms. This action is called self-medication, and self-medication is dangerous. It can lead to addiction to the substance as well as making mental health issues worse. For example, a person may use alcohol to ease the symptoms of their depression, but as soon as the alcohol wears off, they feel even more depressed. This process can be a vicious cycle that leads to addiction.
A person with dual diagnosis has both a mental disorder and an alcohol or drug problem. These conditions occur together frequently. In particular, alcohol and drug problems tend to occur with Depression Anxiety disorders Schizophrenia Personality disorders Sometimes the mental problem occurs first. This can lead people to use alcohol or drugs that make them feel better temporarily. Sometimes the substance abuse occurs first. Over time, that can lead to emotional and mental problems. Someone with a dual diagnosis must treat both conditions. For the treatment to be effective, the person needs to stop using alcohol or drugs. Treatments may include behavioral therapy, medicines, and support groups. NIH: National Institute on Drug Abuse.
One of the things that make dual diagnoses so difficult to treat is that it is hard to know where certain symptoms are coming from. For example, if a dual diagnosis patient is suffering from depression, there’s no way to initially know whether the drug addiction or the individual’s mental illness is causing the problem. Depression is a symptom of many things, so the challenge is on the medical professional to find the root cause and treat it.
Dual Diagnosis “Synergy Executive is a 10 bed residential dual diagnosis treatment facility offering a private rehabilitation program for men seeking addiction treatment. This private residential program in Ozark, Missouri provides treatment to men ages 18 and older. Residential treatment ranges from 21 – 30 days, offering 50+ hours of structured, therapeutic activities weekly. Step down care includes partial hospitalization, 5 full days of treatment per week, and IOP services, 3 days per week/3 hour per day. Synergy Executive utilizes a trauma informed, gender specific approach to provide men a full range of effective, holistic therapies aiming to end the addiction cycle. Synergy Executive utilizes a host of treatment modalities built upon evidence-based practices that are proven to be effective. We offer individual, group and family therapy, traditional 12 step classes, holistic health therapies, SMART recovery groups, and medication-assisted treatment. We also provide a host of mental health and trauma services including EMDR therapy. Our methods allow us to address the underlying causes of addiction and to promote a positive lifestyle by focusing on the mind, body and spirit.
Despite increased awareness of the benefits of integrated services for persons with co-occurring substance use and psychiatric disorders, estimates of the availability of integrated services vary widely. The present study utilized standardized measures of program capacity to address co-occurring disorders, the Dual Diagnosis Capability in Addiction Treatment (DDCAT) and Dual Diagnosis Capability in Mental Health Treatment (DDCMHT) indexes, and sampled 256 programs across the United States. Approximately 18% of addiction treatment and 9% of mental health programs met criteria for dual diagnosis capable services. This is the first report on public access to integrated services using objective measures.
Recent research has examined the difference between self-assessment versus external assessment of program level integrated services capacity (Lee & Cameron, 2009; McGovern, Xie, et al., 2007). These findings are consistent with differences found in psychiatric evidence-based practice fidelity studies that have examined self-report versus independent objective ratings of adherence to the practice in question (Bond, Evans, Salyers, Williams, & Kim, 2000; Brunette et al., 2008). Both sets of research demonstrate a positive response bias associated with provider self-report about their own programs.
In the case of program level dual diagnosis capability, using the Dual Diagnosis Capability in Addiction Treatment (DDCAT) index, Lee and Cameron found close to an average 2-point difference on a 5-point scale of ratings of capacity by program directors and independent evaluators across 13 programs in Australia. Also using the DDCAT, McGovern and Giard found that across 16 addiction treatment programs, 12 program leaders categorized their program as Dual Diagnosis Capable (DDC)(75%) versus 25% Addiction Only Services (AOS) on the DDCAT index. In contrast, objective evaluators rated only 4 of the programs as DDC (25%) and 75% as AOS. The findings from these two studies suggest that at least part of the explanation for the apparent disconnection between provider and prospective patient report about co-occurring services is related to the source of data (source variance). In addition, the variability in how providers are queried about services may likewise account for the discrepancy (method variance).
Dual Diagnosis “Hazelden Betty Ford’s residential alcohol and drug addiction treatment center for men and women is located 25 miles outside of Portland in Newberg, Oregon. Founded in 1990, Hazelden Betty Ford is located in the quiet countryside on a 23-acre campus that promotes an atmosphere of respect, serenity, and support. Hazelden Betty Ford is the recognized expert in treating addiction and co-occurring disorders. Our evidence-based treatment practices and recovery solutions are designed to provide the best chance at lifelong recovery. Our treatment is individualized and delivered by a multidisciplinary treatment team of addiction and mental health specialists as well as spiritual counselors, wellness specialists and medical staff.”.
The integrated treatment model addresses the problem of access by ensuring that one visit, in one setting, is sufficient to receive treatment for both disorders. It addresses the problem of combining messages and philosophies by giving this responsibility clearly to the treatment provider instead of the client.
Integration of Services When both mental health and substance use services are provided by the same person or team, the client has one treatment plan, one set of goals, and one relapse plan. The need for communication across agencies disappears.
When people make progress on some of these goals, they become more motivated to control their substance and mental health disorders. Some professionals argue that this approach enables an addicted person to continue to use and add that, because of this enabling, addicted persons will never experience the pain of their use and “hit bottom” so they can truly recover. For people with co-occurring disorders, however, not attending to the negative consequences of addiction often leads to death. Taking positive steps often increases motivation for recovery.
10 Things You Should Know About Dual Diagnosis Treatment. (2019). Retrieved on August 5, 2019, from https://www.dualdiagnosis.org/10-things-you-should-know-about-treatment/.
Dual Diagnosis Treatment | The Recovery Village. (2019). Retrieved on August 5, 2019, from https://www.therecoveryvillage.com/treatment-program/dual-diagnosis/.
Dual Diagnosis Treatment. (2019). Retrieved on August 5, 2019, from https://www.dualdiagnosis.org/dual-diagnosis-treatment/.
Dual Diagnosis: MedlinePlus. (2019). Retrieved on August 5, 2019, from https://medlineplus.gov/dualdiagnosis.html.
Dual diagnosis capability in mental health and addiction treatment …. (2019). Retrieved on August 5, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3594447/.
Missouri Dual Diagnosis Treatment Centers. (2019). Retrieved on August 5, 2019, from https://www.psychologytoday.com/us/treatment-rehab/dual-diagnosis/missouri.
Seattle Dual Diagnosis Treatment Centers. (2019). Retrieved on August 5, 2019, from https://www.psychologytoday.com/us/treatment-rehab/dual-diagnosis/wa/seattle.
tsharp. (2019). Dual Diagnosis Treatment | Behavioral Health Evolution. Retrieved on August 5, 2019, from http://www.bhevolution.org/public/treatment.page.