Dual Diagnosis; Eating Disorders, Drug Addiction and Alcoholism
January 2, 2008
The actual definition of dual diagnosis is the co-existence of a mental health disorder and drug addiction or alcoholism. The most effective dual diagnosis treatment generally will take place within a drug rehab or addiction treatment program with a strong psychiatric component. The mental health disorder and drug addiction / alcoholism should be treated simultaneously, while realizing the process of recovery is gradual.
Different Definition for Dual Diagnosis
The type of dual diagnosis I want to bring to light is that of the coexistence of an eating disorder and drug addiction or alcoholism. Patients like this are admitted to drug rehab and addiction treatment each and everyday. Unfortunately, drug rehab programs and alcohol rehab programs are not always equipped to treat the eating disorder and in many cases, do not even diagnose it correctly.
Dual Diagnosis Treatment and Substance Abuse
January 2, 2008
The term “dual diagnosis” may be new to your life and vocabulary or it may be something you are familiar with and have heard about before today. While not particularly well-known, dual diagnosis is more common than you might imagine. According to a report published by the Journal of the American Medical Association (JAMA), “Thirty seven percent of people who suffer from alcohol abuse and fifty-three percent of people who suffer from drug abuse also have at least one serious mental illness, which creates a dual diagnosis. Of all people diagnosed as mentally ill, 29 percent abuse either alcohol or drugs (NMHA, 2005). “Dual diagnosis” is defined as an individual who has two separate but very interrelated diagnoses. For the purpose of this article, dual diagnosis means a person has both:
1. A psychiatric diagnosis
2. A substance abuse diagnosis which may include drug addiction or alcohol addiction
A dual diagnosis occurs when an individual is affected by both chemical dependency and an emotional or psychiatric illness. Both illnesses may affect an individual physically, psychologically, socially and spiritually. Each illness has symptoms that interfere with a person’s ability to function effectively and relate to themselves and others. Not only is the individual affected by two separate illnesses, both illnesses interact with one another. The illnesses may exacerbate each other and at times the symptoms can overlap and even mask each other making diagnosis and dual diagnosis treatment more difficult.
Dual Diagnosis and Families
December 30, 2007
Dual diagnosis and families
The lack of professional knowledge about dual diagnosis can be frustrating for those affected and their families. Common experiences may include:
- Health care providers may blame the client for being difficult and unresponsive to treatment, rather than questioning whether the health care system is failing to provide effective dual diagnosis treatment and support for people with dual diagnosis.
- If a dual diagnosis client first seeks addiction treatment for drug abuse, the drug and alcohol workers may consider their mental illness as a secondary issue or side effect. Similarly, if they first seek treatment for their mental illness, then the mental health professionals may also consider their drug abuse as a secondary issue or side effect. The two problems are often not seen as interdependent and equally important.
- Specialist and early intervention treatments are often not available for dual diagnosis.
- Health care professionals may not involve the family in dual diagnosis treatment, even though the family is frequently much more familiar with the problems and experiences of the person with dual diagnosis.
The future of dual diagnosis treatment
Alcohol rehab and drug rehab services and mental health services are developing ways in which to respond to people with a dual diagnosis. Integrated service delivery and collaborative treatment is becoming core business for most services.
Dual Diagnosis Treatment
December 30, 2007
Integrated dual diagnosis treatment can be difficult
Effective management of either substance use disorders or mental health disorders is challenging. Dual diagnosis can mean an increase in challenging behaviours including self-harm and aggression, avoidance of services, and resistance to or non-compliance with addiction treatment and recovery programs.
Research suggests that people with a dual diagnosis respond well to integrated drug rehab programs that address both their mental illness and their substance abuse. However, these drug rehab programs were uncommon until recent years. Some of the reasons for this include:
- Dual Diagnosis can be difficult, because it isn’t always clear which problem has the more severe symptoms. Health services are now becoming more able to recognize dual diagnosis.
- Mental health services are usually reserved for people with severe problems, so dual diagnosis clients with less severe mental health problems may not get treatment. They should, however, be referred to a suitable service.
- A person with a mental illness may receive treatment, but their drug use problem could be dismissed as a minor side effect of their illness.
- The number of workers trained in dual diagnosis treatment is slowly increasing. The services for mental health and substance abuse generally don’t overlap, so professionals in one field aren’t knowledgeable about the issues in the other field. It is hard to find professionals who are skilled in treating both substance abuse and mental illness.
If you are looking for a quality and effective dual diagnosis treatment program, go to www.steppingstonecenter.org or call the national dual diagnosis helpline at 1-800-511-9225.
Dual Diagnosis and Drug Rehab
December 25, 2007
Dual Diagnosis and Drug Rehabilitation: The New Hybrid Disorder and Addiction Treatment
Written by Rachel Hayon, MPH
Dual diagnosis is defined by the presence of both mental health disorders and substance abuse disorders (alcohol and/or drug dependence or abuse) [1]. There are a variety of different mental health disorders that can be associated with substance use and labeled dual diagnosis. Some of these disorders include: schizophrenia, bipolar disorder, anti-social personality disorder, narcissistic personality, and depression. A big question among the experts is which comes first- the mental health problem or substance use? It’s a difficult question to answer because so many of the symptoms associated with mental health disorders resemble the by product of substance use and vice versa. This is also an important topic right now because of the overwhelming amount of substance use cases and mental health disorders that overlap.
In a recent study conducted by the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), it was estimated that 17.6 million American adults meet the criteria for an alcohol use disorder and approximately 4.2 million meet the criteria for a drug use disorder [2]. In addition to this, 19.2 million adults can be diagnosed for independent mood disorders (major depression, dysthmia, manic disorder, and hypomania) and 23 million meet the criteria for independent anxiety disorders (including panic disorder, generalized anxiety disorder and specific social phobias) [2]. The NESARC also reported that approximately 20% of those individuals reporting a mental health disorder also reported a substance abuse disorder. Conversely, 20% of those individuals with a substance abuse disorder also displayed mental health problems [2].
When alcohol use is observed along with mental health disorders, alcoholics usually report that they “self-medicate” in order to alleviate symptoms of their psychiatric condition, such as depression [3]. One of the problems with using drinking as an emotional balm are the negative effects of heavy drinking as well as withdrawal from drinking- both can worsen an already negative mood state [4]. Having said this, it is interesting to see how different mental health disorders manifest themselves when substance use enters into the equation. Depending on what the disorder is, substances use is reported to be used for different reasons and also to either alleviate or bring on certain symptoms. For instance, in the case of bipolar disorder, though drinking may occur in both the manic and depressive phases, drinking is more prevalent during the manic phase [4]. Similarly, drinking may also produce symptoms that are similar to the manic phase of bipolar disorder such as grandiosity, irritability or physical agitation. In regards to anxiety disorder for instance, alcoholics usually report intense symptoms such as palpitations, sweatiness, and fear of objects or social situations which usually disappear with the discontinuation of alcohol use. However, individuals with agoraphobia or social phobia might drink in order to reduce the amount of anxiety they feel [5].
Understanding Dual Diagnosis
December 22, 2007
The term dual diagnosis is a common, broad term that indicates the presence of two independent medical disorders. Recently, within the fields of mental health, psychiatry, and addiction medicine, the term has been popularly used to describe the coexistence of a mental health disorder and drug addiction / alcohol addiction problems. The equivalent phrase dual disorders also denotes the coexistence of two independent (but invariably interactive) disorders, and is the preferred term used in this Treatment Improvement Protocol (TIP).
The acronym MICA, which represents the phrase mentally ill chemical abusers, is occasionally used to designate people who have an drug addiction / alcoholism disorder and a markedly severe and persistent mental disorder such as schizophrenia or bipolar disorder. A preferred definition is mentally ill chemically affected people, since the word affected better describes their condition and is not pejorative. Other acronyms are also used: MISA (mentally ill substance abusers), CAMI (chemical abuse and mental illness), and SAMI (substance abuse and mental illness).
Dual Diagnosis Treatment
November 30, 2007
Regardless of which disorder an individual experiences first, SAMHSA emphasizes that “both disorders must be considered as primary and treated as such.” Unfortunately, according to NCS findings, of those with co-occurring disorders, only 49 percent are treated for serious mental illness, 29 percent for substance use, and a mere 19 percent for both. Putting it another way, citing other studies, of an estimated prevalence rate of 4.8 percent for co-occurring disorders, only 0.2 to 0.9 percent are getting the full range of treatment.
Those who do get dual diagnosis treatment generally wind up in the hospital. In 1996 there were 87 hospital stays per 1,000 for individuals with mental illness only and 23 hospital stays for those with substance use only. Having both disorders, however, resulted in a rate of 457 (no typo) hospitalizations per 1,000. Meanwhile, those with co-occurring disorders comprise 10 percent of the homeless population but use nearly half of all homeless emergency assistance resources.
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