Dual Diagnosis Treatment

  • This SharePost continues where the first one in this two-part series left off on dual diagnosis.  Today begins National Wellness Week.  One of the key factors contributing to a good recovery from schizophrenia is no co-occurring substance abuse disorder.


    You are going to ask me how a family member can determine if his or her loved one is abusing drugs.  I'll talk about this at the end of this news article.


    According to an overview of Dual Diagnosis: Substance Abuse and Mental Illness by the National Alliance on Mental Illness:


    "Abuse of drugs and alcohol always results in a worse prognosis for a person with mental illness . . . perhaps most concerning is that people who abuse drugs and alcohol are more likely to both attempt suicide and to die from their suicide attempts."

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    Persons with a co-occurring disorder have a statistically greater propensity for violence, medication noncompliance, and failure to respond to treatment than individuals with just substance abuse or a mental illness.


    The overview indicates multiple scientific studies have shown that psychiatric treatments are more effective in people who are not actively abusing drugs and alcohol.


    Other research reveals that people with co-occurring disorders need specialized integrated treatment.  Only 7.4 percent  receive appropriate treatment.  Nearly 8.9 million people yearly have a co-occurring mental health condition and substance abuse.


    You cannot go it alone if you abuse drugs or alcohol.  You will need assistance and support.  If you are a family member, your loved one will need assistance and support.  You will need to have empathy and compassion for your loved one and be non-judgmental in your support.


    In consultation with the psychiatrist the person can determine if certain medications can be helpful in maintaining sobriety.


    Multiple studies indicate the following drugs have been safely tested:

    For alcoholism: disulfiram (Antabuse), acamprosate (Campral), and naltrexone (Revia).  For opiate abuse: naltrexone (Revia, Vivitrol), methadone and buprenorphine (subutex, Suboxone).


    You must discuss these management strategies with your psychiatrist.


    Effective treatment must be based on best practices and evidence-based techniques.  Dr. Robert Paul Liberman, M.D., the number-one mental health expert in my estimation, wrote the 600-page bible of psychiatric rehabilitation Recovery From Disability that details treatment strategies.  I bought a copy and will refer to its advice in future SharePosts.


    Table 9-2 lists evidence-based practices that require competencies of team members for integrated treatment of dually diagnosed persons:


    1.  Assertive outreach and engagement in the community.


    2.  Motivational enhancement linked to the stages of treatment involvement.


    3.  Integrated treatment program with the same team, with staff knowledgeable and capable of using interventions for both types of disorder (e.g., psychoactive medications and training in harm avoidance and relapse prevention).


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    4.  Training in relapse prevention and harm avoidance, with flexibility and no extrusion from program for "slips" or relapses-Substance Abuse Management Module.


    5.  Continuous case management by personal support specialists.


    6.  Money management with representative payee.


    7.  Close monitoring with urine tests.


    8.  Safe,, protected and sober living residential environments.


    9.  Vocational rehabilitation-supported employment such as Individual Support & Placement.


    10. Efforts for family reconciliation.


    11. Integration of 12-Step program that accepts "double trudgers."


    12. Spiritual opportunities with inspiration and dedication.


    Empirically validated treatments for dually diagnosed patients involve:


    Integrated treatment services with the same treatment team trained in services applicable to both substance abuse and mental disorders.  Motivational interviewing based on the stages of readiness for treatment.  Social skills training.  Education about mechanisms for substance abuse and dependence.  Training in relapse prevention.  Supported employment. 


    Family psychoeducation.  Illness management, including money management and random urinalysis.  Assertive community treatment consistent with stage of readiness for change, level of functioning, and independence and progress.  Community reinforcement.


    Further details for treating dually diagnosed individuals  continue in Chapter 9 of Recovery from Disability.


    You can research drug abuse treatment at the SAMHSA government Website.   


    SAMSHA offers a Drug Abuse Booklet for Families that tells you how to know if a loved one has a problem with drugs and how to help them.


    The National Council on Alcoholism and Drug Dependence, Inc. offers a Drug and Alcohol Abuse Signs and Symptoms sheet. 


    I'll end here by telling you that as long as there is life there is hope.  No matter how entrenched a person's substance abuse disorder is having hope and taking action to prevent relapses are the keys to maintaining sobriety.


    Individuals with mental illnesses often go undiagnosed for too long after they first exhibit symptoms.  They often begin to self-medicate with drugs and alcohol.


    In the next SharePost: I will re-examine the number-one technique for achieving recovery: early if not immediate treatment of a mental illness with medication and therapy.


    There is hope.  There is power in the union of people with mental health conditions and their family members uniting to promote recovery.


    Silence equals shame.


    Addiction is America's greatest tragedy and no one can afford to go it alone in trying to get clean or sober.


    I urge you to get help because there's no shame in having a mental illness or a co-occurring substance abuse disorder.


    Stay tuned for my SharePost on early intervention next.


Published On: September 16, 2013