It is likely that if you are coping with some form of addiction, there is some aspect of a mental disorder, such as depression, anxiety, trauma, etc., that you are also suffering from.
You are not the only one dealing with such circumstances. The National Institute on Drug Abuse states that nearly half of people suffering from a mental disorder will also encounter some form of substance misuse in their lifetime.
These problems do not merely coexist; they thrive on each other, forming a web that is difficult to disentangle.
If you only treat the addiction, then the mental health problems are left untreated. The anxiety that is manifested triggers panic, depression becomes a constant heavy weight, and the memories of trauma do not disappear.
Many people do not know how to deal with the feelings that arise, and so end up going back to substances to cope.
This is the reason why dual diagnosis treatment is essential, as it provides mental health and addiction treatment at the same time. It provides the necessary outcome to ensure that the recovery is not superficial.
This is why this article will focus on how these co-occurring disorders are diagnosed, treated, and supported in a rehab setting, and why this leads to treating both disorders in the rehab setting.
How Is Dual Diagnosis Defined?
You are said to have a dual diagnosis (co-occurring disorder) if you are suffering from a substance use disorder and a mental health disorder simultaneously.
These conditions do not simply coexist in the same space in silence. They connect in ways that strengthen each condition, creating a cycle almost impossible to escape without professional assistance.
Common Dual Diagnosis Combinations
Alcohol Dependence and Depression
People use alcohol in an attempt to ‘drown’ feelings of sadness and/or emotional pain; however, alcohol is a depressant and thus worsens mood over time.
Anxiety and the Misuse of Benzodiazepines
Medications such as Xanax or Valium are classified as ‘benzos’ and, in the short term, relieve a person of anxious feelings; however, they are highly addictive. Stopping medications results in severe anxiety symptoms.
PTSD and Addiction to Opioids
Survivors of trauma may use opioids to escape memories, flashbacks, or emotional stress; however, opioids negatively and irrevocably alter the brain in ways that worsen symptoms of PTSD, ultimately adding to the trauma.
Bipolar Disorder and Use of Stimulants
Those with bipolar disorder use stimulants during depressive episodes or to enhance the manic high. This increases the cycles of mood volatility, making it even more unstable and dangerous.
How One Condition Fuels the Other
Mental health symptoms spur the use of alcohol and drugs as a form of self-medication. This cycle becomes self-perpetuating: anxiety brings about alcohol and drug usage, and the resulting anxiety worsens the cycle.
To end the cycle, both conditions must be treated simultaneously.
Why It Can Be Difficult To Detect Co-Occurring Disorders
Despite how frequently both conditions are diagnosed, they are still considered to be underdiagnosed. This can be attributed to several factors.
Symptom Confusion
Confusion exists surrounding the diagnosis of insomnia, depression, anxiety, and irritability as symptoms of withdrawal. This, along with the lack of a differential diagnosis, leaves the issue of reverse causation unclear.
People Do Not Talk About Mental Health Issues
The social stigma surrounding mental illnesses means that people tend to downplay and hide their symptoms, even in the context of a therapeutic environment. The focus of such people is on substance abuse, hence they tend to talk very little about the traumatic experiences, mood disruptions, and even suicidal tendencies.
Symptom Relief Does Not Alleviate The Issue
This is because the individual is in the process of actively using the substance, thus their mental symptoms are completely absent at that time.
Disjointed Treatment
In the past, mental health and addiction were treated as separate ailments, and as a result, diagnosed and treated separately. It is common to hear of a person attending depression rehab alongside a psychiatrist, only to be met with a lack of coordination, with either one not being appropriately addressed.
The Solution
The process of diagnosis is not easy and therefore requires an extensive psychiatric evaluation that takes place at the moment of intake. This is done by LPH, considering both the addiction and mental health domains.
Why Focusing on Only Addiction Doesn’t Work
Picture this: you finish detox, go through rehab, learn various coping strategies, and you leave treatment with a good feeling, but in a short time, you start feeling depressed. The panic attacks may come back, or you may have flashbacks of traumatic events.
To feel better, the desire to use comes back; not because you’ve done anything wrong, but because the fundamental issue is never addressed.
The Consequences of Not Mentally Treating the Patient
The Cravings Don’t Go Away
If your depression or anxiety is unresolved, the chances of craving substances are strong because your mental condition still links the use of substances as a form of relief.
Increased Emotional Volatility
If you have mental health issues and you refuse to treat them, the chances are that you’ll have a hard time coping with anything, such as sobriety, anxiety, stress, or relationships.
Increased Risk of Relapse
The risk of relapse is much higher, as pointed out by NIDA studies, when dual diagnosis conditions are not treated together.
The Truth
Although it is possible to leave detox in a sober state, suffering from bipolar disorder, PTSD, or depression that is untreated can be a barrier that will force you to go back to substance use as a coping method.
What Is Included in Dual Diagnosis Treatment
Dual Diagnosis Treatment eliminates the separation of mental health care and addiction care by offering the two in a single, integrated plan. Below is a list of the most common elements in such a case.
Medical Detox
The process of medically supervised and controlled withdrawal (detox) is for the purpose of stabilizing the body and preparing it for therapy.
Psychiatric Evaluation
A mental health professional is tasked with the responsibility of performing a thorough evaluation for the purpose of diagnosing anxiety, depression, PTSD, bipolar disorder, and other associated illnesses.
Medication Management
The use of medications, when clinically indicated, is used to achieve desired objectives such as the stabilization of mood, anxiety reduction, and craving control.
Those medications may include, but are not limited to:
- Combination of tri-cyclic and selective serotonin reuptake inhibitors in depressed patients
- Mood stabilizers for patients diagnosed with Bipolar disorder
- Anti-anxiety medications
- Buprenorphine or naltrexone for patients diagnosed with alcohol or opioid Dependency Syndrome within the framework of Medication-Assisted Treatment (MAT)
Individual Therapy
Evidence-based techniques such as:
- Restructuring negative or dysfunctional thought patterns through Cognitive Behavioral Therapy (CBT)
- Modulation of emotions and impulsivity through Dialectical Behavior Therapy (DBT)
- Trauma-informed care for PTSD or Childhood trauma
- Processing trauma through EMDR Therapy (Eye Movement Desensitization and Reprocessing)
Group Therapy
Engaging with other people in group therapy who have the same or similar problems promotes the reduction of isolation and fosters accountability.
Family Therapy
The entire family is affected by addiction. Families can expect from therapy meaningful improvements in communication, healthier boundaries, and the repair of relationships affected by addiction.
Holistic Care
Mindfulness and yoga, along with counseling on nutrition, exercise and fitness, as well as sleep, serve to help restore balance to an individual’s physical, emotional, and mental health.
Benefits of Integrated Dual Diagnosis Care
Addiction and mental health care combined have better recovery outcomes.
- Treats root causes: Dual diagnosis care focuses on the reasons behind substance use rather than just the symptoms.
- Improves emotional stability: You make sobriety easier to attain by undergoing psychiatric treatment and therapy that helps to enhance mood, lower anxiety, and better manage trauma.
- Reduces cravings and triggers: With mental health symptoms controlled, the self-medication urge to use is much lower.
- Builds better coping skills: By identifying negative thoughts, distress, and emotional pain, and building healthier ways of coping.
- Higher long-term recovery rates: Integrated dual diagnosis care leads to much better outcomes, and over 50% sobriety at the year mark, compared to the 30% for addiction-only treatment.
How You Might Know You Need Dual Diagnosis Treatment
Worried that a dual diagnosis treatment may not be the right step for you? The following indicators suggest that mental health problems and addiction are intertwined:
- Not being under the influence of a substance makes you feel anxious, depressed, or causes panic attacks.
- Using narcotics or alcohol seems like the easiest way to deal with emotional, mental, and or psychological stress.
- Trauma, abuse, or having gone through PTSD
- Experiencing uncontrollable substance-induced disturbances or imbalanced, extreme moods.
- Having gone through rehabilitation and having relapsed during the process.
- Self-inflicted emotional harm and/or suicidal thoughts.
- You have the feeling that your substance abuse is not considered addiction.
If you can relate to any of the above, then treatment seems to be the most suitable option for you.
The process of Dual Diagnosis Treatment during rehabilitation
In most cases, the sequence is as follows:
Assessment during the Registration Process
You will have individual interviews with addiction treatment and mental health treatment professionals, during which you will be asked a series of questions regarding substance abuse, mental health, and coping mechanisms, as well as outlining the problems to be solved.
Medically Safe Detoxification
If you are diagnosed with a substance abuse disorder, then the appropriate treatment is to be stabilized through medical supervision.
Individual Therapy, Group Therapy, and Psychiatric Medication Sessions
All patients are allocated a primary therapist and encouraged to participate in one therapy group per day in addition to daily psychiatric sessions to monitor medication and well-being.
Individualized Care
This treatment integrates addiction and various disorders in a specialized care plan developed specifically for you, utilizing proven methods.
Skill Acquisition
Participants learn practical methods for regulating emotions, controlling stress, and managing triggers that may result in the use of psychoactive substances.
Routines and Processes That Foster Well-Being
A daily program that integrates treatment, nutrition, physical activity, relaxation, sleeping, and brain restorative and emotional stabilizing activities.
Therapeutic Dosage of Medication for the Treatment of Simultaneous Disorders
Medication assists the patient in treatment for diagnosed disorders, especially when the patient is unwilling to engage in therapy.
Medication-Assisted Treatment of Simultaneous Disorders
During this stage, with the use of the ‘softened’ medications, the patient can overcome emotional and psychological wounds without the burden of craving to use and withdrawal distress.
Therapeutic Psychiatric Medication That Enhances Emotional Control
These patients are less reactive to triggers with the addition of antidepressants, emotional stabilizers, and anxiety reducers.
Continuous Evaluation and Care
Continuous patient evaluation helps balance medication doses to achieve optimal patient outcomes while stabilizing brain chemistry, allowing effective therapy and lifestyle modifications to be implemented.
Post-Rehabilitation Transition: Any Necessary Continued Support
The treatment for dual diagnosis does not end upon completion of the rehabilitation program. The need for continued support even after rehabilitation is critical to maintaining balance.
- Outpatient psychotherapy: Attending both individual and group therapy provides the opportunity to address emerging problems and fosters an environment of accountability.
- Medication maintenance: Mental health follow-up appointments track the patient’s progress to determine whether the prescribed medication is effective or requires adjustments.
- Support group participation: Ongoing connection and support are available through groups such as Alcoholics Anonymous, Narcotics Anonymous, and dual-recovery SMART Recovery.
- Substance-free sober living: Transitional housing is an environment devoid of substances and allows the patient to hone practical skills of recovery obtained in rehabilitation.
- Relapse prevention strategizing: Developing anticipatory coping skills for stress management, triggers, and high-risk situations.
- Continued psychotherapy: Therapy treating past trauma, mood disorders, or anxiety is necessary to have emotional balance daily.
Aftercare participation in ongoing research conducted by the CDC and SAMHSA shows that the negation of relapse increases by up to 50 percent.
Why Selecting a Suitable Program is Important
Inappropriate and unsuitable programs do exist for those needing a dual diagnosis approach. Here is how to distinguish them:
What to seek:
- Mental health professionals and psychiatrists with requisite licenses
- Psychiatric treatment is provided on the premises and not merely referred
- Therapy for which trauma-informed approaches are conducted
- Medication-assisted therapy (MAT) is rendered
- Plans for treatments that are customized and deal with both afflictions
- Therapy and involvement from the family
- Transition and aftercare planning that is comprehensive and well devised
What to avoid:
- Treating addiction only with insufficient mental support
- Treating the patient without an appropriate diagnosis from a mental health professional or psychiatrist
- Holistic therapy is not provided
- Diagnosis and assessment are not conducted, and ‘quick fixes’ are offered
Sobriety is fundamentally important, but it is not the only thing deemed essential
Mental health treatment is intertwined with the recovery process. Not only do these tools equip you to manage recovery, but they also enhance emotional stability, leading to a fulfilling, meaningful life.
Your mental health and emotional state do not need to be in a dilemma. With the appropriate tools and team, both issues can be solved while a precautionary approach is established.
As a luxury rehab in Los Angeles, Star City Recovery offers dual diagnosis treatment that tackles addiction and mental health simultaneously and offers comprehensive psychiatric treatment with support.
With evidence-based therapy, drug therapy, and compassionate assistance, we support your recovery. When your body and mind are both well cared for, recovery is achievable.
Get in touch with us and learn how we can help you on your journey towards recovery.
