Best Practices for Treating a Dual Diagnosis | Futures of Palm Beach
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Best Practices for Treating a Dual Diagnosis

National statistics on substance abuse consistently show that people with mental illness have higher rates of drug and alcohol abuse. The 2011 National Survey on Drug Use and Health 2011 confirms this pattern:

  • Over 25 percent of American adults with any mental illness had abused illegal drugs in the past 12 months, compared with nearly 12 percent of Americans without mental illness.
  • Almost 19 percent of Americans with mental illness had used marijuana in the past year, compared with 9 percent of Americans without a psychiatric disorder.
  • Nearly 12 percent of adults with mental illness had abused psychotherapeutic drugs in the past 12 months, compared with 4 percent of those without mental illness.
  • Nearly 9 percent of mentally ill adults had used alcohol heavily in the past month, compared with 6 percent of those without mental illness.

Dual diagnosis treatment acknowledges that there is a strong relationship between substance abuse and psychiatric illness and that when the two coexist, treatment must address both conditions in order to be effective.The best practices for treating a dual diagnosis reflect these principles.

History of Dual Diagnosis Treatment

Before the mid-1980s, the concept of treating substance abuse and mental illness through a single, integrated treatment program had never been implemented. People with mental illness received separate services at mental health centers or psychiatric units, while those with substance use disorders were treated at detox facilities or rehab centers. The professionals who cared for the mentally ill were not well trained in drug or alcohol addiction, and those who treated substance abusers were not usually qualified to address psychiatric disorders.

In 1984, the first dual diagnosis program began at a psychiatric facility in New York State. The need for treatment for dual diagnosis patients — those with co-occurring mental illness and drug or alcohol addiction — became apparent when public officials and mental health professionals realized that recovery rates among addicts with mental illness were lower than average, and outcomes of treatment were poor. It became clear that the traditional approach of separating rehab from psychiatric treatment was ineffective. According to Kathleen Sciacca, M.A., the first dual diagnosis treatment plan was based on the following principles:

  • Actively addicted individuals were accepted into treatment and welcomed, regardless of their level of motivation.
  • Therapists took an encouraging, non-confrontational approach.
  • Therapists accepted all of the clients’ psychiatric symptoms.
  • Clients participated in group therapy, where they were allowed to discuss topics of addiction from their own point of view.

Since the 1980s, the guidelines for dual diagnosis treatment have been refined, but the core principles of acceptance, empathy, encouragement and integrated care have not changed.

Establishing Guidelines

Dual diagnosis treatment is now considered to be the most effective approach to treating individuals with co-occurring disorders. In response to the need for guidelines for developing integrated treatment programs, the Substance Abuse and Mental Health Services Administration established two sets of standards for measuring a program’s dual diagnosis capability:

  • The Dual Diagnosis Capability in Addiction Treatment Index (DDCAT)
  • The Dual Diagnosis Capability in Mental Health Treatment Index (DDCMHT)

These standards apply to seven different areas of treatment:

  1. The structure and focus of the program: Does it address addiction only, mental illness only, or a combination of both?
  2. The program’s milieu. Are people with mental illness accepted and welcomed into drug or alcohol rehab? Or does the program refer mentally ill clients somewhere else? Does the program provide education and peer support for both conditions?
  3. Assessment practices. Does the program screen for both mental illness and substance abuse during the admissions process, or does it focus on one or the other?
  4. Treatment practices. Does treatment address both mental illness and substance abuse throughout the recovery process? Does the program support the use of psychiatric medication for mentally ill clients? Do staff members continually monitor and assess both the client’s recovery progress and psychiatric status?
  5. Aftercare services. Do mentally ill clients receive follow-up care for their psychiatric illness after rehab? Is there continuity of care in the treatment process, or are mentally ill clients just discharged back into the population without transitional services?
  6. Staffing practices. Are therapists equally qualified in substance abuse treatment and mental health care? Is there a psychiatrist or other qualified prescriber on the team who can prescribe and monitor psychiatric medications?
  7. Training practices. Are staff members trained in how to recognize and address the symptoms of psychiatric disorders as well as the signs of substance abuse? Are they able to respond to psychiatric emergencies and deliver appropriate care?

Facilities Must meet Criteria

Facilities that meet the criteria of the DDCAT or the DDCMHT can be designated as “dual diagnosis capable” or “dual diagnosis enhanced.” Facilities that don’t meet these guidelines are designated as offering “addiction only services” or “mental health only services.”

Basic Principles of Treatment

The Integrated Dual Diagnosis Treatment (IDDT) model promotes individualized care that gives equal importance to treat the psychiatric disorder and the addictive behavior. To provide continuity for the client, therapy is administered by the same, cross-trained staff members, and treatment is provided at one location.

The IDDT model

According to Case Western University, the IDDT model can help prevent the negative consequences of a co-occurring condition, including relapse, hospitalization, incarceration, and homelessness.

Regardless of their specific structure or orientation, integrated dual diagnosis programs reflect the following principles:

  • Co-occurring disorders are expected and welcomed.
  • Treatment is based on an attitude of hope and empathy, with a commitment to maintaining continuity of care throughout the recovery process.
  • Each diagnosis should be treated as a primary diagnosis, with equally intensive care.
  • Treatment plans must be individualized according to the patient’s diagnosis, level of functionality, and other factors.
  • Clinicians receive equal training in substance abuse treatment and mental health.
  • Clients are treated according to their readiness to change. Therapists accept that patients with mental illness may be slower to accept the need for rehab, and they adjust the treatment plan accordingly.
  • Therapy is collaborative, with client and therapist working together throughout the treatment process.
  • Therapists adopt a motivational attitude, encouraging their clients through compassionate listening.
  • Clients receive substance abuse education and counseling along with psychotherapy.
  • Aftercare programs and intensive case management are provided to ensure continuity of care and prevent relapse.

Evidence-Based Interventions

Dual diagnosis practitioners are encouraged to draw from a wide range of resources to help their clients through the recovery process. Here are a few of the evidence-based therapies that have proven to be most effective at treating these clients:

  • Motivational interviewing (MI). Motivational interviewing is a client-centered treatment philosophy that approaches the therapist-client relationship as a collaboration. Taking a non-judgmental, accepting attitude, the therapist works with the client to address thoughts and behavior.
  • Cognitive behavioral therapy (CBT). CBT is a therapeutic modality that teaches the client how to replace self-destructive thoughts and behaviors with positive, productive ones. CBT has been used successfully in the treatment of both mental illness and substance abuse.
  • Dialectical behavior therapy (DBT). Originally developed to treat severely suicidal patients, DBT has also been applied successfully to the treatment of addiction, personality disorders, depression and other disorders. DBT teaches clients how to deal with painful emotions through practices that involve mindfulness and acceptance.
  • Intensive case management. Case management services are an important part of dual diagnosis treatment. A case manager follows the client from the assessment stage through rehab and beyond to ensure quality of care, provide continuity after rehab, and advocates for the client if necessary.
  • Trauma resolution therapies. Past trauma is at the root of many co-occurring conditions. Adults who have experienced childhood abuse, sexual assault, military combat, natural disasters or other devastating incidents may be psychologically and emotionally scarred by these experiences. Dual diagnosis therapy offers treatment modalities that target trauma, including eye movement desensitization and reprocessing (EMDR), and grief/loss therapy.
  • Holistic therapies. People who suffer from undiagnosed anxiety or depression often use drugs and alcohol to control stress. Holistic therapies can help these individuals manage their stress and cope with the emotional triggers that lead to substance abuse. These alternative modalities include hypnotherapy, biofeedback, massage, yoga, guided meditation, exercise therapy and more.

Treatment for Dual Diagnosis

Although the dual diagnosis treatment model has been widely accepted by addiction treatment specialists and psychiatric professionals, many individuals with co-occurring disorders are still not getting the help they need. The Office of Applied Studies (OAS) reports that out of the nearly 9 million people in the US who are living with a psychiatric disorder and a substance use disorder, just over 7 percent were treated for both conditions. Over half (55.8 percent) did not receive any treatment at all.

How can you ensure that you or your loved one get the integrated care you need to recover from mental illness and substance abuse? Look for a facility that upholds the core principles of dual diagnosis treatment, from the assessment/screening phase through the aftercare stage. Don’t hesitate to ask targeted questions about the facility’s qualifications and background in treating dual diagnosis patients.

Futures of Palm Beach

The individualized rehab programs at Futures of Palm Beach reflect the principles of dual diagnosis care. We are committed to providing fully comprehensive, integrated recovery services for individuals trying to overcome substance abuse and psychiatric disorders. With a complete range of therapies, we offer intensive rehab services in a supportive setting, complete with spa-like amenities and luxury accommodations. Call us today to find out whether our dual diagnosis recovery program could meet your needs.

If you or someone you love needs dual diagnosis treatment for addiction and a co-occurring disorder, contact Futures of Palm Beach today for the care necessary to overcome addiction and mental health issues.

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