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Dual Diagnosis
A Comprehensive Guide
What does “Dual Diagnosis” mean?

The term dual diagnosis refers to having both a mental health disorder, as well as a chemical dependency problem.

A person who has a dual diagnosis (also referred to as co-occurring disorders) has two separate illnesses, and each needs it owns treatment plan.

  • When either illness goes untreated, one illness will make the other worse.
  • One out of three persons with a psychiatric disorder has abused drugs
  • When both are given proper medical attention and care, the chances for a lasting recovery are greatly improved, and it is easier to return to a full and productive life.
Mental Health and Addiction

Only 15% of addiction is actually drinking or taking drugs. The substance abuse is the surface behavior that is more easily visible. The other 85% of behaviors and symptoms sit below the surface. This unseen portion often stems from trauma or mental health issues ranging from low self-esteem to advanced schizophrenia.

Studies have shown that more than half of the people who have depression or bipolar disorder, regardless of gender, age, race or socioeconomic status, also abuse alcohol and/or drugs. Therefore, addiction should not be seen as moral issues, but rather a consequence of mental health.
Unfortunately, addicts with a dual diagnosis often have worse physical health and greater levels of disability.

The Cycle of Diseases

Most often, the psychiatric problem occurs first. In an effort to feel better, an individual self-medicates with alcohol or drugs which lead to even worse addiction.

In other cases, the alcoholism or drug dependency is the primary condition that, over time, can lead to depression, anxiety or more severe emotional problems. As an addiction escalates, the desperation to obtain a drug can also put an individual in riskier situations, leading to further mental trauma.

When treating clients with both substance abuse and mental health disorders, both disorders must be treated simultaneously. However, in many scenarios, once the untreated alcoholism or addiction is taken care of, the mental health issues subside.

There are different theories that physicians use as references for making a diagnosis:

  • Past-exposure theory: people who use psychiatric drugs without medication increase their sensitivity to drugs including alcohol.
  • Self-medication theory: people who use medication to alleviate pain and distress from mental conditions or use drugs to gain relief from the side effects of medicines.
  • Multiple risk factor theory: mental health issues and addiction can result from keeping the company of addicts, family tensions, poverty, loneliness, and tragedies in life.

Ending the Cycle

Dual diagnosis can be difficult. The symptom of one disorder often mimics the symptoms of other disorders. For example, many of the symptoms of drug abuse, such as extreme anxiety, depression, paranoia, delusions, and hallucinations are similar to symptoms of mental health.

It is often the case that only one of the two problems is identified. This causes further problems with fragmented and uncoordinated services creating gaps in treatment. However, when both problems are diagnosed, there are often issues with becoming stable on the right non-narcotic medications for that individual.

Old Trial and Error Treatment Method

In the past and at most other treatment facilities, psychiatrists prescribe medication for mental health issues based on general experience, then wait several weeks to hear the patient’s reports about their mood on the medication before deciding:

New Neurofeedback Treatment Method

While the expertise of a psychiatrist is critical, neurofeedback testing has taken much of the guesswork out of mental health medications. This psychiatric treatment approach represents a true breakthrough in treatment of dual-diagnosed clients.

The actual testing of a clients neurotransmitter levels is done using a simple urine test. The sample is tested to assess levels of the 12 neurotransmitters that are most important to mood, such as:

  • Serotonin
  • Glutamate
  • Dopamine
  • Acetylcholine
  • Gaba

Psychiatric medications work by balancing out the levels of these chemicals. With the neurotransmitter results, a qualified psychiatrist is able to understand what medication and in what magnitude will properly balance a specific individual.

In some cases, one over-the-counter supplement will do the trick. In others, several prescription medications are combined to raise the levels of specific chemicals. Either way, the client avoids taking unnecessary medications and gets a diagnosis and treatment that works quickly.

More Questions
What Are The Signs and Symptoms?

In order to get an official Dual Diagnosis, you must be evaluated by a mental health professional or addiction specialist. But there are ways to tell if something is not right with you or someone you care about.

  • Abandoning friends or family in favor of new activities or a new crowd
  • Struggling with school or work
  • Lying, stealing, manipulating in order to continue a habit
  • Changes in sleep and eat patterns
  • Making promises to stop using, drinking, participating in addictive habits, but relapsing repeatedly
  • Expressing guilt about a compulsive behavior
  • Increase in tolerance as well as extreme high-risk behavior
  • Experiencing withdrawal symptoms after trying to quit
      • Symptoms:
    • Believes things that aren’t true (delusions) or has sensory experiences that aren’t shared by others (hallucinations)
    • Expresses feelings of despair, hopelessness or worthlessness for two or more weeks in a row.
    • Has dramatic changes in mood and energy levels
    • Uses drugs, alcohol or compulsive behaviors to manage moods or cope with stress
    How Do I Receive a Dual Diagnosis?
    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, or DSM IV. The DSM is a guideline for mental health professionals who are diagnosing and treating patients in a variety of clinical settings. A qualified psychiatrist, physician, psychologist, counselor or therapist can diagnosis you if you have a mental health disorder and an addiction to drugs, alcohol, or a behavior like sex or gambling.
    How Do I Find a Dual Diagnosis Rehab Program?
    Only those facilities with a psychiatric staff and an emphasis on dual diagnosis are truly equipped to help these individuals with their recovery. Although there is no “quick fix” for drug or alcohol rehab, dual diagnosis treatment may take longer to complete, extended by months or even years. Here are features you should look for that are beneficial for those with co-occurring disorders:

    • A complete dual diagnosis assessment
    • Self-paced treatment plans that reflect the clients needs
    • Cognitive behavioral therapy
    • Group psychotherapy
    • Emotional regulation therapies: hypnotherapy, biofeedback, meditation, and mindfulness
    • Family counseling and support services
    • Relapse prevention
    • Aftercare services
    How Do You Treat Dual Diagnosis?
    The most common method of treatment for dual diagnosis today is integrated intervention, where a person receives care for both a specific mental illness and substance abuse. Because there are many ways in which a dual diagnosis may occur, treatment will not be the same for everyone. Dual diagnosis assessment focuses on cognitive evaluation as well as psychological assessment. These screening tools may include:

    • Standardized multiple-choice test
    • A computer game
    • Structured questionnaire

    Addiction and Co-Occurring Disorders Tests

    • CAGE Questionnaire
    • Structured Clinical Interview
    • Psychiatric Research Interview for Substance and Mental Disorders

    Some tests provide a set of questions for a therapist to ask the patient in a face-to-face interview, while other tests are taken as written exams. The diagnostic instruments listed above allow the practitioner to develop a treatment plan founded on evidence-based research.

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