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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

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