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Co-Occurring Disorders / Dual Diagnosis

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"Dual diagnosis" and "Co-Occurring disorder" refers to the presence of both a severe mental illness and a substance abuse problem. It is important to get effective treatment for both disorders. An effective treatment model is when one clinician or treatment team provides both mental health and substance abuse treatment.


Dual Diagnosis Treatment or TOLERANT?

Today the term "dual diagnosis treatment" has become common place in substance abuse treatment. But does that mean you will receive effective treatment for both your mental / emotional problem and your substance abuse?

Recent research shows that more than 90% of treatment centers that claim to be "dual diagnosis treatment" really only tolerate or accept patients that have psychiatric or emotional diagnosis, but do not provide psychiatric care, nor do they have Psychiatrists on staff at their centers. Also, if they do provide a visit to a psychiatrist it is brief and infrequent. Most treatment centers only provide a single visit a Psychiatrist mostly just to have medication prescribed. After that the patient is integrated into the Substance Abuse portion of the treatment for the remainder of their stay.

We believe this is only a "tolerant" approach at best and is not an effective TREATMENT for dual diagnosis patients. Treatment of a dual diagnosis is so complex it is safe to say that a certified substance abuse counselor alone is not qualified to provide the level of care needed to help these patients. We are not implying that the substance abuse treatment is not important, it is . It is vital to the overall well-being of every dual diagnosis patient. However, there are many more areas that need to be assessed by a medical doctor.
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How can I find TRUE dual diagnosis treatment?

Lets define what TRUE dual diagnosis treatment includes before we find "treatment". Here is what we define as dual diagnosis treatment:

  • Initial medical detoxification. This is the most critical time for the patient. Most patients have attempted to stop using alcohol or drugs at some time in the past and know first hand that withdrawal is painful; physically, mentally and emotionally. Therefore a medically assisted detox is suggested to help assure the patient that the withdrawal period will be as short and as comfortable as possible.

  • Next, once the patient has successfully completed detox they should immediately enter a 30 day, 60 day or 90 day inpatient treatment center. This can be a hospital or a residential dual diagnosis treatment center.
    (detox alone is NOT effective and is a waste of time if not followed by an inpatient treatment program)

  • THIS IS THE MOST COMMON STEP MISSING IN DUAL DIAGNOSIS TREATMENT.
    Next, within a few days (2-5 days) of entering the treatment center the patient MUST have a complete medical examination and lab work done to determine if there are biological reasons for the psychiatric symptoms. Recent study's show that a very high percentage of patients with psychiatric diagnosis is due to a hormone imbalance caused by "situations" known as PTSD, or environmental reasons. If biological problems exist it is extremely important to correct these conditions before starting antipsychotic or antidepressant medication. Failure to do so will only MASK these conditions and allow them to continue to go untreated.

  • Continued care and monitoring by a M.D. is vital during substance abuse treatment for these types of patients. Biological problems MUST be monitored with additional lab test during their treatment until the M.D., and Psychiatrist effectively stabilize the patient.

  • Finally, the patient must have a continued treatment plan that he/she is confident they can continue after discharge from the treatment program. This usually consists of an outpatient program, 12 step meeting or support groups, continue hormone treatment, and monitoring the biological problem that was discovered by the M.D. and Psychiatrist while in treatment. Usually this means having lab tests done to check the hormone and adrenal system 1-2 time per year.

    Now that we know what a TRUE dual diagnosis treatment looks like, we can now ask any treatment center or program the proper questions.

    Here are some of the questions you should ask to determine if the treatment center is a true dual diagnosis treatment or just dual diagnosis tolerant:

    1. What is the name of the psychiatrist on staff and do they work exclusively with your center? (look up the doctors name the doctor should have a long history of substance abuse research and/or research in a related field.)

    2. What is the typical medication that you use to treat MY dual diagnosis patients? (They should not be able to tell you which medication you or your loved one will receive! Medication is not always the best solution if there is a biological problem)

    3. Ask which tests will be run, if any, once you enter the treatment center. (remember you MUST rule out any biological problems before they can diagnosis you or your loved one with psychiatric problems ONLY)

    4. Ask how they determine when you will be done with the inpatient part of treatment and you are ready to leave?
    (the ONLY answer to this should be, "when the doctor, psychiatrist, and you feel that you biologically, mentally, and emotionally stable.
    Remember the patient can always decide to leave whenever they want, but the treatment center should answer from a medical stand point)

    • Finding a TRUE Dual Diagnosis Treatment Center is difficult.
    We have expert staff willing to help you find treatment 24 hrs a day.
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    How does recovery from dual disorders occur?

  • Recovery must be the individual's choice. People cannot be "pushed" into giving up substances. Over time they can learn to manage both their illnesses and to get on with their lives in meaningful ways.
  • The process of recovery begins as soon as someone enters a dual disorders treatment program or becomes committed to managing their illnesses.
  • Recovery takes time, hope, and courage. For most people, recovery occurs over months or years.
  • People in Co-Occurring treatment programs learn to manage two long-term illnesses and build a new meaningful life without drugs. This process requires time, support, education, courage, and skills.
  • You can help. Everyone in your loved one's life can help by offering support, hope, and encouragement.


    • What are the facts about dual disorders?

    Vulnerability is important.
    People who are affected by a mental illness use drugs for the same reasons people without mental illness do, such as not having jobs, not feeling happy, and not having good skills for meeting people. In many cases, people with mental illness are more sensitive to the effects of alcohol and other drugs.

    Dual disorders are common.
    Study results show that one of every two individuals with severe mental illness has the additional problem of substance use disorder (abuse or dependence related to alcohol or other drugs).

    Integrated dual disorders treatment works.
    People with dual disorders have a much better chance of recovery from both disorders when they receive combined, or integrated mental health and substance abuse treatment from the same clinician or treatment team.

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