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The Challenges Associated with a Dual Diagnosis

The Journal of the American Medical Association reports that 29% of all people diagnosed with mental illness abuse alcohol or other substances.  The two conditions of substance abuse and mental illness are commonly found linked; therefore, many drug or alcohol abusers must be concurrently treated for mental health issues.  This type of simultaneous therapies is called dual diagnosis treatment.

The prevalence of substance abuse among individuals struggling with depression, anxiety, schizophrenia or other psychiatric disorders can often obscure the origin of the patient’s disorders.  In some cases, a substance abuser may develop related psychiatric issues as a result of physiological changes in the brain derived from extended alcohol or drug usage.  In other cases, the psychological condition may not be related to brain or chemistry alterations, but may be a result of frustration, guilt or shame relating to the substance abuse.

On the other hand, many patients with mental health issues develop drug or alcohol habits as a form of self-medication.  Individuals with a severe mental health issue like schizophrenia are considerably more likely to develop a substance misuse habit than those individuals not suffering from a psychotic condition. Some studies have found that almost a third of chronically mentally ill individuals engaged in some form of substance misuse.

Although determining the underlying causes of the patient’s condition are important to treatment, it is more important for these individuals to find the resources necessary to accurately diagnose the condition and facilitate recovery.  Many traditional treatment options for mental illness and substance abuse are incompatible.  While many psychiatric remediations are supportive and non-confrontational, the typical approach to treating alcohol or drug dependency is actively adversarial

The problem of dual diagnosis treatment is also compounded by a willful ignorance on the part of many diagnosticians.  A large portion of patients seeking psychiatric treatment do not disclose their drug or alcohol habits, while many seeking relief from substance abuse do not tell their treatment team of underlying mental issues.  Some medical teams are not well equipped to handle a dual diagnosis situation and do not probe sufficiently to correctly make a dual diagnosis.

This problem has received considerable attention from the medical community and the general public.  More rehabilitation centers are employing more accurate diagnostic tools and more patients are receiving the proper treatment.  Once properly diagnosed, patients with co-occurring disorders may begin to receive the proper therapies.

Dual diagnosis treatment centers now offer a wide range of remediation options that can be customized to the needs of the individual.  A variety of medications, counseling and alternative treatments may be introduced at various stages of the recovery process.  The medical and counseling professionals may suggest a long term therapeutic strategy that gradually weans the patient off of alcohol or narcotics while implementing a program to address mental issues.

Many patients may wish to avoid medications if it interferes with substance abuse recovery, but with careful monitoring, anti-anxiety or anti-psychotic medications may be safely used.  There are also new drugs like clozapine that reduce drug cravings while helping to treat psychotic conditions.

Dual diagnosis is a much more widely recognized issue than it once was, but many patients and families need to understand that even with an accurate diagnosis, the road to recovery can be a difficult one.  Most remediation strategies require long term commitments and often involve a trial and error approach.  Despite the frustration and periods of seemingly insignificant progress, the challenges of reigning in a substance abuse problem as well as mental health conditions are surmountable.


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