by Lisa Frederiksen
One of the repeated concerns I hear when giving my presentations is the lack of satisfactory treatment for a dual diagnosis, which occurs when a person is diagnosed with both a mental illness (PTSD, Anxiety, Bipolar, ADHD, schizophrenia) and a substance abuse problem (alcohol or prescription/illegal drugs) and/or an addiction (alcoholism or drug addiction). Not only is the common concern about the lack of treatment options expressed, but so it the equally important concern about the confusion surrounding what effective dual diagnosis treatment should look like.
SPECT Surface Scan Showing ADHD, Courtesy Amen Clinics, Inc., www.amenclinics.com
According to the National Alliance of Mental Illness, (NAMI), “Dual diagnosis services [should] integrate assistance for each condition, helping people recover from both in one setting, at the same time. Dual diagnosis services include different types of assistance that go beyond standard therapy or medication: assertive outreach, job and housing assistance, family counseling, even money and relationship management. The personalized treatment is viewed as long-term and can be begun at whatever stage of recovery the consumer is in. Positivity, hope and optimism are at the foundation of integrated treatment.” Looking at the brain scans to the right, showing the brain of a person with ADHD in the top set of scans and the brain of a person who abuses alcohol in the bottom set of scans, helps to explain why treating one without treating the other makes effective, healthy, long-term recovery just about impossible.
SPECT Surface Scan Showing Alcohol Abuse, Courtesy Amen Clincs., Inc., www.amenclinics.com
To address the available treatment options concern, I am reaching out to my contacts for their input and will let you know what they tell me, but I also urge anyone who is aware of such a program to please let us know via the comment feature to this post.
To more comprehensively address the questions about what constitutes effective dual diagnosis treatment, I went to the NAMI website and am cutting and pasting content from their website below:
Why is an integrated approach to treating severe mental illnesses and substance abuse problems so important?
Despite much research that supports its success, integrated treatment is still not made widely available to consumers. Those who struggle both with serious mental illness and substance abuse face problems of enormous proportions. Mental health services tend not to be well prepared to deal with patients having both afflictions. Often only one of the two problems is identified. If both are recognized, the individual may bounce back and forth between services for mental illness and those for substance abuse, or they may be refused treatment by each of them. Fragmented and uncoordinated services create a service gap for persons with co-occurring disorders.
Providing appropriate, integrated services for these consumers will not only allow for their recovery and improved overall health, but can ameliorate the effects their disorders have on their family, friends and society at large. By helping these consumers stay in treatment, find housing and jobs, and develop better social skills and judgment, we can potentially begin to substantially diminish some of the most sinister and costly societal problems: crime, HIV/AIDS, domestic violence and more.
What are the key factors in effective integrated treatment?
There are a number of key factors in an integrated treatment program.
Treatment must be approached in stages. First, a trust is established between the consumer and the caregiver. This helps motivate the consumer to learn the skills for actively controlling their illnesses and focus on goals. This helps keep the consumer on track, preventing relapse. Treatment can begin at any one of these stages; the program is tailored to the individual.
Assertive outreach has been shown to engage and retain clients at a high rate, while those that fail to include outreach lose clients. Therefore, effective programs, through intensive case management, meeting at the consumer’s residence, and other methods of developing a dependable relationship with the client, ensure that more consumers are consistently monitored and counseled.
Effective treatment includes motivational interventions, which, through education, support and counseling, help empower deeply demoralized clients to recognize the importance of their goals and illness self-management.
Of course, counseling is a fundamental component of dual diagnosis services. Counseling helps develop positive coping patterns, as well as promotes cognitive and behavioral skills. Counseling can be in the form of individual, group, or family therapy or a combination of these.
A consumer’s social support is critical. Their immediate environment has a direct impact on their choices and moods; therefore consumers need help strengthening positive relationships and jettisoning those that encourage negative behavior.
Effective integrated treatment programs view recovery as a long-term, community-based process, one that can take months or, more likely, years to undergo. Improvement is slow even with a consistent treatment program. However, such an approach prevents relapses and enhances a consumer’s gains.
To be effective, a dual diagnosis program must be comprehensive, taking into account a number of life’s aspects: stress management, social networks, jobs, housing and activities. These programs view substance abuse as intertwined with mental illness, not a separate issue, and therefore provide solutions to both illnesses together at the same time.
Finally, effective integrated treatment programs must contain elements of cultural sensitivity and competence to even lure consumers, much less retain them. Various groups such as African-Americans, homeless, women with children, Hispanics and others can benefit from services tailored to their particular racial and cultural needs.
To learn more about specific mental illnesses, please click here.
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©Lisa Frederiksen, www.breakingthecycles.com. The information contained in this post may be freely used and copied for education and other non-commercial and non-promotional purposes, provided any use or reproduction of the information be accompanied by an acknowledgment of Lisa Frederiksen, Breaking the Cycles.com, as the source. Please note that scans are courtesy of Amen Clinics, Inc. You may have to secure your own permissions to use and/or reprint.
