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Thursday, December 28, 2017

Dual Diagnosis or Co-Occurring Disorders

dual diagnosis cooccurring disordersDual diagnosis or co-occurring disorders (CODs) refers to one or more disorders relating to the use of alcohol and/or other drugs, as well as one or more mental health disorders. Examples might include Major Depressive Disorder with cocaine addiction; alcohol addiction with Panic Disorder; Borderline Personality Disorder with substance use. There is no single combination, rather there is great variability among combinations of disorders.

More than half of all adults with severe mental illness are further impaired by substance use disorders. Compared to patients who have a mental health disorder or substance use disorder alone, clients with CODs often experience more severe and chronic medical, social, and emotional problems. The existence of two or more disorders causes potential for both substance use relapse, as well as worsening of the psychiatric disorder.

Addiction relapse often leads to psychiatric deterioration, whereas worsening of psychiatric problems often leads to addiction relapse creating a dangerous cycle. Relapse prevention must be specifically designed for patients with co-occurring disorders.

Both substance use and mental health disorders are rooted in biopsychosocial systems.  Sometimes the mental disorder occurs first, which can lead the individual to self-medicate with alcohol or drugs, providing temporary relief. Sometimes, substance use occurs first, which can lead to symptoms indicative of one or more mental health related issues. Mental Health Disorders & Addiction are both dynamic processes, with fluctuations in:

• Severity
• Rate of Progression
• Symptom Manifestation
• Differences in speed of onset

Furthermore, both disorders are greatly influenced by several factors:

• Genetic Susceptibility
• Environment
• Pharmacological influences

Certain individuals have a high genetic risk for these disorders, whereas others may develop them due to environmental situations. It is also important to note that some drugs are more likely than others to cause psychiatric disorders. A common example includes methamphetamine induce psychosis or schizophrenia.

To provide appropriate treatment for CODs, the Substance Abuse and Mental Health Services Administration (SAMHSA) recommends integrated treatment for individuals suffering from CODs. Integrated treatment occurs when a person receives combined treatment for mental illness and substance use from the same clinician or treatment team. Integrated treatment helps individuals develop hope, knowledge, skills, and the support they need to manage their problems and to pursue meaningful life goals.

• Specific methods of integrated treatment include
• Screening, assessment, and referral.
• Mental and physical health consultation.
• The use of a prescribing onsite psychiatrist.
• Medication and medication monitoring.
• Psycho-educational groups.
• Psychotherapeutic groups.
• Individual Therapy Sessions.
• 12-step Based Program and/or spiritual support.
• Peer/Community Support.

When all components of integrated treatment are present, the likelihood of relapse in either mental illness and/or substance use disorders diminishes significantly. Long term recovery from the devastating effects of CODs is available and possible with integrated compassionate care.

Marie Tueller, MED, LPC

Thursday, December 7, 2017

The Influence of Sober Support Networks

importance of sober network
One of the important things to understand about addicts and alcoholics is that drugs and alcohol served a purpose in their lives. It helped the person cope with stress, trauma, and bad feelings or circumstances. It was a friend and it was always there for them. When an addict gets clean and sober they don’t have the skills to cope because they have been using drugs and alcohol to handle all the aspects of their life that they couldn’t. This concept creates a big loss in their life, and the drugs and alcohol have to be replaced with something.

What Alcoholics Anonymous (AA) learned in the 1930’s is that if the alcohol was replaced with a spiritual life, a life lived with the support of other alcoholics, and a way to come to terms with their inner selves they could stay sober. They could do something that the medical field had been unable to do with any consistent success. They needed each other and they needed a Higher Power of their own understanding. This was the beginning of what we have now come to understand as sober support networks.

When a person can learn to ask for help from another alcoholic/addict they have learned a vital skill that will save their lives when things get hard. And, things get hard the minute they are sober/clean. Because they have relied on alcohol/drugs to cope, it will take an outside source to introduce new ideas and skills to use to cope with life. A support network consists of sober individuals who are also learning how to stay sober/clean or who have been sober for a long time and are willing to share with the newcomer how they stayed sober. A sponsor can influence a newcomer and teach them what it takes to stay clean and sober by sharing their experience strength and hope. An AA group or Narcotics Anonymous (NA) group will become a safe place to find support. Treatment centers are a good start and will educate the newly clean/sober individual about sober networks and how to use them to be successful. A sober support system will also be a place of accountability in order to learn how to show up for themselves and others.

In my experience I have seen little success for the addict/alcoholic that doesn’t fully integrate a 12 step (or other of their choice) support network. I have seen addicts replace their drugs with food/relationships/work and their lives become unmanageable because they have resisted using a support network. Most of them either live miserably or relapse on their drug of choice. Without a support network they don’t have a place to learn how to cope with life without their drug. A sober/clean life is better than any addict can imagine alone but with a sober support network the possibilities become endless.

Janet E. Bontrager B.A. Primary Therapist