Dual Diagnosis In America

Co-occurring disorders can be difficult to treat due to the complexity of symptoms. Both the mental health and substance abuse disorders have biological, psychological, and social components assessed throughout the treatment process. Co-occurring disorder individuals battle to maintain their sobriety as they need to find services for both mental health and support groups catering to their unique needs.

This clinician wants to open his own dual diagnosis center with substance abuse disorders and mental health disorders. Many individuals with substance abuse issues also suffer from mental health issues. This counselor suffers from the disease of substance abuse and has made it his lifelong goal to help individuals with these types of issues.

The Louis de la Parte Florida Mental Health Institute (2002) states that substance abuse can occur in many clients who also have anxiety/stress disorders. The user believes that using alcohol or drugs will help lessen the feelings they have and somehow enable them to “cope” (The Louis de la Parte Florida Mental Health Institute, 2002). Unfortunately, most users like James are unable to realize the substances are not helping their problems. Most people with alcohol and other drug use disorders who also suffer from other mental health disorders require an integrated care plan for the best chance at recovery (Sterling, Chi, & Hinman, 2011).

Individuals with a mental illness often turn to drugs or alcohol to reduce their symptoms, as opposed to or in addition to seeking treatment for their illness. This problem is much worse than previously imagined, with experts estimating 65 percent of prison inmates suffering from a dual diagnosis. The prevalence in the general population is likely very high also, thus anyone with a mental illness or substance abuse problem may find they need specialized care.

The human and economic toll of co-occurring mental health and substance abuse disorders in this country demands immediate attention. Though the problems associated with co-occurring disorders have long been acknowledged and discussed, there has been little consensus about how to accomplish needed system change. In this time period, there are many different disorders and illnesses that go unnoticed, and unknown.

A statistical piece of information that was interesting is that how the number of mental disorders increases as the number of substance abuse disorders increases as well. Services, U.D. (2005) states the likelihood of mental disorders rises alongside with substance abuse dependencies. With the rise of both abuses at the same time, it complicates treatment for the mental disorder patients that have drug use however, multiple drugs is normal for those who are substance abusers (Services, U.D., 2005). The reason this information is found to be interesting is because with the two disorders rising at the same level, it appears that the challenges will be harder and more co-occurring disorder patients are going to need help with their issues. As a counselor, one must be dually competent to treat these clients or have staff available to treat the clients who have co-occurring disorders to ensure an effective outcome.

The majority of research that exists on 12-step programs often focus on determining the success rate of 12-step programs such as AA. There is little to no research on problems associated with 12-step programs or problematic areas of 12-step programs. The little research that does exist argue that 12-step programs are not structured for comorbid individual, they may not be the best option for mild substance use disorder, and the central theme of powerlessness can conflict with a therapist’s theoretical orientation and be harmful to the therapeutic alliance. (Kelly & Myers, 2007, Laudet et al., 2004, L, Ingvarson, Richard, 1995). The National Institute of Mental Health (2013) has found that 43.6 million adults aged 18 and older have at least one mental illness and 45 percent of individuals with one mental disorder met criteria for two or more disorders. The presence of comorbid disorders can severely affect the treatment and outcome of individuals (Terra et al., 2006). Many studies have found that clients with a dual diagnosis experience increased rates of hospitalization and increased use of emergency services (Helzer & Pryzbeck, 1998). It is easy to imagine how hospitalization can interrupt treatment by making it difficulty for individuals to attend.

Mental illness or substance use is a factor that can have an impact on an individual’s quality of life. With a combination of both disorders, the effects can be more threatening to an individual’s well-being. Mental illness and substance use disorder co-occur at a high rate, and when both are present, the dually diagnosed faces many challenges that can significantly impair the individual’s quality of life. “Individuals who have the presence of co-occurring disorders have more severe symptoms, impairment, poorer functioning and worse prognosis than those who only have one disorder,” (Substance Abuse & Mental Health

Challenges in Adulthood and Aging for the dual diagnosis population are societal and individual. The label dual diagnosis is preferred for individuals with co-occurring mental health illness and substance abuse. Some challenges for the Dual Diagnosis population in Adulthood and Aging are both societal and individual. There are four major challenges one rapid numerical growth, two stigma, three diagnosing, mistreatment, and four lack of adequate support systems for this population. These challenges are manageable with help from competent human service professional like social workers, counselors, and psychologist.

Many individuals suffer on a daily basis with one mental disorder let alone multiple. Few have the resources needed to cope and can turn to other methods of improvement without thinking about the potential outcomes of addictions and worsen their condition. Mental disorders are often than not linked to substance abuse because of the stigma placed over humanity. Society places such a constricting grasp on what is considered normal that people are hiding their symptoms and attempting to mask them to get by; only causing chaos to their lives. It is easier to try an attempt to mask symptoms with alcohol and other narcotics. I chose to focus on Borderline Personality Disorder (BPD) mixed with Substance Abuse for the focus of this piece. All of this can be alleviated by erasing the stigma we 've placed and given these people the many methods of help they seek. One of the first things to think about is the comorbidity between abuse disorders and other mental disorders from an epidemiological standpoint. What is comorbidity exactly? The term was introduced to “refer to any distinct additional clinical entity that has existed or that may occur during the clinical course of a patient who has the index disease under study.” Which basically means when two or more medical conditions ensue simultaneously or consecutively in the same individual they are commonly said to be comorbid. 1

This assessment is used to substance use disorders and mental disorders that could be co-occurring (Cellucci, 2010). Although the assessment seems to be effective, there is not a computerized version of the assessment (Cellucci, 2010). The manual is needing to be more thorough when discussing administration and how to use the assessment (Martin, 2010). It has been suggested that there be should be more evidence of concurrent and predictive validity (Martin, 2010). Because of these disadvantages, this assessment may not be appropriate to

Effective treatment is needed for multiple needs. Treatment must be accommodated by not just the drug abuse but also any other associated problems or disorders

Assessment has five steps when working with clients with dual disorders. The five steps include: detection, classification, functional assessment, functional analysis, and treatment planning. Each of the five steps incorporate specific goals, instruments, and strategies. The first step detection goal involves recognizing clients with a drug problem. “The instrument most commonly used is The Dartmouth Assessment of Lifestyle Instrument (DALI), and the strategies incorporate casting a wide net, helping to explore the past drug abuse, lab testing, and screening all clients” (Mueser, K.T., Noordsy, D. L, Robert, D.E., & Fox, L., 2003, p.51). The second step classification

Substance abuse complicates almost every aspect of care for the person with a mental disorder. When drugs enter the brain, they can interrupt the work and actually change how the brain performs its jobs; these changes are what lead to compulsive drug use. Drug abuse plays a major role when concerning mental health. It is very difficult for these individuals to engage in treatment. Diagnosis for a treatment is difficult because it takes time to disengage the interacting effects of substance abuse and the mental illness. It may also be difficult for substance abusers to be accommodated at home and it may not be tolerated in the community of residents of rehabilitation programs. The author states, that they end up losing their support systems

Researchers have found that a link exists between mental illness and substance abuse, which may have complications on the actual treatment for mental illness. It is very important for the addiction counselor to properly understand both the differences between acute primary psychiatric disorders and any underlying psychiatric symptoms, caused by alcohol and other drugs. Sometimes the addiction needs to be treated first in order for the mental illness to be properly identified and successfully treated. Also addiction counselors need to understand mental health disorder treatments. Clients with co-occurring substance abuse and mental health illness problems may benefit from substance abuse treatments, even those with serious mental health symptoms. This can set the foundation for the addiction counselor to provide a good integrated treatment strategy which can offer a lower relapse rate and achieve long term abstinence. When a counselor is a assessing a client, the client must understand how a co-occurring disorder may effect there addiction. Counselors must perform a thorough assessment in order to identify the proper criteria for each diagnosis that is identified.