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Dual Diagnosis: Why Integrated Treatment Is the Gold Standard

Many people use substances to cope with, or “self-medicate,” difficult feelings. Unfortunately, using alcohol or drugs to relieve negative feelings can actually prolong them or cause them to recur. This is because alcohol and certain other drugs affect the central nervous system as a depressant, exacerbating symptoms of sadness and fatigue, leading to a vicious cycle. The relationship between substance abuse and mental health disorders is complex. Many people struggle with both issues simultaneously, but due to overlapping symptoms, are not correctly diagnosed. They themselves may be unsure if their depression, anxiety or other challenges first drove them to drink or use, or if alcohol or drug abuse has led to their mental health issues. According to a study published in the Journal of the American Medical Association, over 50% of people in the U.S. who have been diagnosed with a mental illness also have a diagnosable co-occurring substance use disorder (alcohol or other drugs) during their lifetimes. The two-way connection sets up a dangerous pattern that becomes difficult to break. Statistics also show that, of the nearly 8.9 million people in the U.S. who have co-occurring disorders, only 7.4% receive appropriate treatment. Arriving at a correct diagnosis can be difficult, but it is possible.

What Is ‘Integrated’ Treatment?

Research shows people with co-occurring disorders are best served by integrated dual disorder treatment. This approach involves comprehensive care by a multidisciplinary team of treatment providers. The care team combines pharmacological (medication), psychological, educational and social interventions to address all of the patient’s needs. Families are often involved in the treatment process, and patients may also receive support to maintain employment as part of their recovery. Although integrated treatment is widely considered the gold standard for those with dual diagnoses, some mental health care facilities will not accept patients for psychiatric treatment until they are sober or until they have completed medication-assisted treatment for addiction. This forces dual diagnosis patients to choose which disorder to treat — an approach that is less likely to lead to sustainable recovery. Treating addiction but not the underlying mental health disorder(s) means the source of the problem has not been addressed and relapse is extremely likely. Patients with co-occurring disorders are three times more likely to relapse in the year following treatment than individuals with chemical dependency alone. On the other hand, addressing a mental health issue but not the addiction will not be effective because once a person has become addicted, they are dependent on the substance regardless of the underlying causes that brought them there. They cannot simply choose to stop being addicted without developing new coping skills. Both have to be addressed at the same time.

How Integrated Treatment Works

For some patients with dual disorders, medically monitored detoxification is the first step toward recovery. Treatment may include medication and psychotherapy tailored to both mental health disorders and addiction. Cognitive behavioral therapy (CBT) is often incorporated to help the patient identify, understand and change negative thinking and behavior patterns. They may also be given access to residential and employment services to help them stabilize their lives. Many long-term recovery programs will integrate participation in self-help support groups designed for people who grapple with both mental illness and addiction, such as the “Double Trouble in Recovery” fellowship in Alcoholics Anonymous, among others. The length of treatment is determined by factors like the type of co-occurring mental illness, duration and type of addiction, desire to change, and quality of social support system. Recovering from co-occurring disorders is complex but with accurate diagnosis and the type of integrated treatment that has proven effective, people can rebuild their lives.

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