In order to provide a foundation for lasting abstinence, treatment therapy must take into account both the client’s mental health and his or her history of substance abuse. Unless substance abuse and psychiatric illness are addressed at the same time, outcomes are likely to be poor. Dually diagnosed patients who don’t receive integrated therapy are likely to drop out of rehab early and relapse more quickly than those who get the specialized care they need.
ALTHOUGH THE PSYCHIATRIC COMMUNITY NOW ACKNOWLEDGES THE IMPORTANCE OF DUAL DIAGNOSIS THERAPY, FEW PEOPLE WITH CO-OCCURRING DISORDERS ARE TREATED FOR BOTH SUBSTANCE ABUSE AND MENTAL ILLNESS AT THE SAME TIME.
According to the 2011 National Survey on Drug Use and Health: Approximately 8 million Americans ages 18 and older met the criteria for a mental illness and a substance use disorder;
- Out of this group, just over 43 percent received substance abuse treatment at a specialized rehab center or mental health facility;
- 32.5 percent of this group received psychiatric care without substance abuse treatment;
- 4 percent received substance abuse treatment without psychiatric care;
- Over 56 percent of the 8 million Americans with co-occurring disorders did not receive treatment at all.
Nationwide statistics indicate that the need for dual diagnosis treatment therapy continues to grow; however, few facilities are providing the appropriate level of care for these challenging patients.
What Is Dual Diagnosis Treatment Therapy?
Dual diagnosis treatment therapy acknowledges the deep connections between mental illness and substance abuse. At one time, addiction treatment professionals believed that if a mentally ill patient could recover from drug or alcohol abuse, his or her psychiatric symptoms would resolve without specialized treatment. Today, more clinicians realize that mental health cannot be separated from substance abuse in treatment therapy. The symptoms of mental illness present serious obstacles to substance abuse treatment. People who suffer from depression, anxiety, personality disorders or bipolar disorder often have difficulty staying with a course of addiction treatment. For instance, in a study of 497 schizophrenic patients published in theSchizophrenia Bulletin, 45 percent met the diagnostic criteria for a substance use disorder, yet only 3 percent had reached the stage of recovery where they were ready to take action regarding their problem. Nearly half (46 percent) were still in the pre-contemplation stage of recovery, where the individual is still not ready to acknowledge the need for rehab. Dual diagnosis therapy has several characteristics that distinguish it from conventional, substance-abuse-only treatment:
- Psychiatric disorders and substance use disorders are treated at the same time, in the same facility.
- Therapists collaborate with patients and their family members to plan the course of treatment and make decisions about care.
- The same team of clinicians (doctors, therapists, nurses and case managers) provides treatment for both substance abuse and the psychiatric disorder.
- Treatment focuses on making comprehensive lifestyle changes that include not only avoiding drugs and alcohol, but also leading a meaningful, healthy life.
For dually diagnosed individuals, it’s not enough to “sober up” in rehab. Dual diagnosis treatment includes life skills that empower the mentally ill client to live more independently in sobriety. These skills include job hunting, financial planning, and relationship building. Case managers act as liaisons to help these clients make the transition from rehab to a productive life in the outside world.
Planning a Course of Treatment
Successful addiction treatment therapy begins with a thorough neuropsychological assessment of the client at the intake stage. In order to develop a personalized treatment plan, the treatment team must develop a profile that includes:
- History of substance abuse
- Recent and past mental health history
- Psychosocial history
- Current psychological status
- Family history of substance abuse and psychiatric illness
- Major personality traits
- Intelligence and cognitive skills
- Level of motivation to recover
This information is gathered through face-to-face interviews with the client, discussions with loved ones, medical records, and a variety of assessment tools. Psychological tests can screen the incoming client for the signs of specific psychiatric disorders, such as depression, anxiety, obsessive-compulsive disorder, or schizophrenia. The treatment plan can then be tailored to reflect the client’s unique psychological profile.
As part of the assessment phase, the treatment team considers the client’s readiness for rehab. Low motivation is common among mentally ill patients seeking substance abuse treatment. Many are admitted by family members, partners, doctors or the criminal justice system. Individuals who aren’t prepared to give up drugs or alcohol may benefit from motivational enhancement therapy (MET), a client-centered approach that helps the individual find his or her internal reasons to change. Determining the proper course of treatment maximizes the client’s chances of finishing a recovery program and remaining sober after rehab. If the content, duration and pace of treatment accommodate the client’s needs, he or she is more likely to stay focused and motivated throughout the program.
Characteristics of Successful Therapy
Addiction treatment therapy can take place at an inpatient facility, such as a specialized residential rehab center or hospital, or at an outpatient treatment center. While inpatient and outpatient therapy both play important roles in the recovery process, inpatient rehab is often recommended for people with co-occurring mental illness and substance use disorders. There are several advantages to an inpatient setting for this population:
- A residential environment offers more structure and supervision.
- Medical personnel are available in case the client experiences a worsening of psychiatric symptoms.
- External substance abuse triggers are reduced or removed altogether.
- The client can focus completely on recovery in a supportive, sober environment.
Dual Diagnosis Therapies
Dual diagnosis treatment therapy incorporates a blend of traditional and alternative modalities. This approach to treatment is frequently called “holistic,” because it promotes the healing of the addict’s mind and spirit as well as the body. Following a period of medically supervised detoxification, therapies like these are brought into the treatment plan:
Motivational enhancement therapy/motivational interviewing (MET/MI)
Motivational interviewing is a philosophy of treatment as well as a therapeutic style. This form of therapy engages the client in the recovery process by encouraging him or her to accept the need for rehab and embrace the need to change.
Dialectical behavior therapy (DBT)
DBT is a form of cognitive behavioral therapy that helps the dually diagnosed client learn to live with painful emotional states without relying on drugs and alcohol. DBT teaches the client healthy coping strategies to replace the maladaptive behaviors of addiction.
Clients are introduced to the principles of the 12 steps, which underlie successful programs like Alcoholics Anonymous and Narcotics Anonymous. In these self-help support groups, participants share experience and hope, acquire new coping skills, and build a spiritual foundation for recovery.
Relaxation and recreation therapies
Addiction takes a devastating toll on the mind, body and spirit. Alternative therapies like yoga, acupuncture, massage, guided meditation, and hypnotherapy teach dually diagnosed patients how to manage emotional and spiritual distress in healthy ways. Experiential therapies, including adventure therapy, and art therapy, reinforce the lessons learned in therapy in an active, expressive environment.
Family education and counseling
Family support can greatly increase the chances of successful outcomes in dual diagnosis treatment. Educational programs for parents, spouses and partners help family members understand the nature of mental illness and how it relates to addiction. At the same time, family members learn how to communicate in healthy ways, build trust, and set boundaries.
Relapse prevention training
The reality of relapse must be taken into consideration in every rehab program. Falling back into addictive behaviors or unhealthy psychological symptoms is common after dual diagnosis treatment. Relapse prevention treatment teaches practical skills for identifying triggers in order to avoid a relapse, or to minimize the damage if a relapse occurs.
Continuing the Recovery Process
Many dually diagnosed individuals struggle for years without adequate social support or psychiatric treatment. They often live with low self-esteem and a sense of powerlessness.
Focus on Restoring
Addiction therapy must focus on restoring a sense of competence and self-worth in the dually diagnosed client, so that she or he can lead a meaningful, productive life.
What’s next after detox and addiction therapy? A comprehensive treatment program involves a long-term, time-unlimited commitment to helping the client stay sober and psychologically healthy. With that goal in mind, services like the following are provided:
Transitional housing. Sober living homes offer a safe, supportive environment where recent graduates of dual diagnosis programs can test their newly acquired coping skills in a real-world setting. Case management. Case managers offer valuable links to services and resources in the community, such as self-help groups, vocational counseling, housing support, transportation services, medical clinics, childcare providers, and continuing education. Family support. Parents and spouses need moral support and professional guidance long after the initial phase of rehab ends. Aftercare services should support the family as well as the individual in the months after treatment. Alumni activities. Alumni programs give rehab graduates the opportunity to maintain connections with other recovering addicts for years after treatment. Through alumni weekends, support groups, and networking opportunities, dually diagnosed clients can sustain a strong support system. The dual diagnosis treatment programs at Futures of Palm Beach are based on the latest evidence-based research about effective treatment for addiction and mental illness. With a highly educated, cross-trained staff of clinicians, we support each of our clients from the intake phase through rehab and aftercare. Call our toll-free number to find out more about the intensive recovery services we offer at our exclusive facility in Palm Beach County, FL.
Some services listed may not be included in our core program. An admissions counselor will be able to provide you a complete list of core services. Information provided for educational purposes. Premium services or programs may be arranged through your therapist or case manager.