a woman in need of substance abuse treatment

Treatment Options for Dual Diagnosis

The National Survey on Drug Use and Health (NSDUH) estimates that 45% of people in the United States struggle with a dual diagnosis. With so many people having a dual diagnosis, it’s paramount that rehabilitation facilities effectively treat it.

Historically, clients with dual diagnoses received sequential treatment. This treatment focused on treating one condition at a time. Often, these treatments did not occur at the same facility and were not related to each other.

Parallel or integrated treatment now treats both conditions simultaneously.

The SAMHSA recommends integrated treatment, which combines care for a client’s mental health and substance abuse challenges. Clients receive treatment for both disorders at the same time and in the same facility. Psychiatrists and clinical staff trained in mental health and substance abuse provide treatment.

Integrated Residential Treatment

During integrated residential treatment, clients live onsite as they receive treatment. Often, inpatient rehabilitation works best for clients with a severe dual diagnosis.

Once admitted, clients undergo detox. During inpatient detoxification, medical staff monitor clients 24 hours a day. Depending upon the severity of the addiction, they may administer medications to help wean a person off the substance and lessen the effects of withdrawal.

After detox, psychotherapy, often cognitive-behavioral therapy (CBT), begins. CBT helps dual diagnosis clients learn how to better cope and change unhealthy patterns and ways of thinking. Eventually, as clients learn to manage both disorders, they attend self-help and support groups.

Integrated Outpatient Treatment

In many ways, integrated outpatient treatment mirrors the inpatient experience. Still, instead of living onsite at the rehab facility, outpatient clients receive treatment while living at home or with family members or friends.

During this time, clients attend individual therapy sessions alongside group counseling and other therapeutic activities. While outpatient treatment can be just as effective as inpatient treatment, it is often recommended with individuals with a less severe dual diagnosis.

Challenges of Dual Diagnosis

Denial

  • The first and perhaps most difficult challenge regarding dual diagnosis is denial. It’s not easy for people to admit that they’re addicted to drugs and alcohol. It’s also difficult for people to accept and admit that they have a mental health challenge. Instead of seeking help, many people with dual diagnosis ignore their problems and hope they go away. Over an extended period of time, this makes both conditions more difficult to treat.

High Risk

  • Living with an addiction and a mental health issue at the same time can lead to a high risk of self-harm. A 2009 study that analyzed 3,433 men and women aged 18-65 years for two years revealed that individuals with dual diagnosis are more likely to commit suicide than people without.

Treatment Takes Longer to Complete

  • Rehabilitation for drug and alcohol abuse takes a considerable amount of time. In fact, rehab for severe SUD can take years to complete. But when combined with a mental health condition, the length of treatment often increases greatly. In fact, in some cases, the time needed for rehabilitation doubles.

Difficulty Pinpointing Symptoms

  • In a dual diagnosis, identifying the root causes of symptoms is grueling and time-consuming. That’s because it’s hard to know where the symptoms are coming from. Are they related to a client’s mental health, or are they related to a client’s SUD? For example, a client whose symptoms include erratic behavior and mood swings could be experiencing the effects of intoxication or signs of a mental health condition like schizophrenia, bipolar disorder, schizoaffective disorder, or anxiety. Not knowing the root cause makes treating symptoms more challenging.

Other dual diagnosis challenges include:

  • Environmental factors triggering health conditions
  • Misdiagnosing substance abuse as a mental health issue or vice versa
  • Physical effects on the body caused by both conditions (i.e., heart and blood disease, lung disease, stroke, Hepatitis B and C, nutritional and metabolic disorders)
  • Emotional effects on the body caused by both conditions (i.e., stress, disconnectedness, suicidal thoughts and behavior, lower self-esteem, increased anxiety, and depression)
  • Relapse and temptation to self-medicate

Although a dual diagnosis comes with many challenges, treatment is possible.