A dual-diagnosis patient is an individual who has a SUD and some form of mental illness at the same time (Doweiko, 2015). Dual diagnosis is not uncommon, individual with a mental disorder are twice as likely to have an SUD (Clinton & Scalise, 2013). Currently there are 4 million people in the United States who are suffering from some sort of dual-diagnosis. (Doweiko, 2015). According to the text if an individual has a mental illness they are 270% more likely to have an SUD. Studies further indicate that the more serious the mental illness the harder it will be for the individual to abstain from drug use. (Doweiko, 2015).
There are four theoretical models for dual diagnosis patients. The first one suggests that the dual diagnosis points to a common yet undiscovered pattern within these individuals. At this point there is not much research to validate this theory (Doweiko, 2015). The second model suggests that individuals are trying to self-medicate. (Doweiko, 2015). This need to self-medicate is also a trigger for the additive cycle (lecture) individuals with a dual-diagnosis will self-medicate as a way to escape some of the symptoms of their mental condition. (Lecture).
Some of these symptoms include, anxiety or worry, the need to avoid pain (both physical and emotional), feel a sense of belonging or to reduce the confusion or disorder that can be caused by the disorder (Lecture). The third model suggests that the substance abuse is secondary to the primary condition. (Doweiko, 2015) This model can be challenging because some of the symptoms seen in common mental disorders can be brought on by the addiction, (Doweiko, 2015). It will be helpful to ascertain if the symptoms of the mental condition existed before the development of the SUD (Doweiko, 2015).
The final model suggests that individuals with a mental disorder are more sensitive to the effects of substances of abuse and as a result they are more apt to use them (Doweiko, 2015). The addictive cycle can offer an explanation of how this could be possible. The steps of the addictive cycle begin with the individual feeling pain and hitting bottom before they begin to seek relief. Since A dual-diagnosis individual may not have a healthy support system, nor proper access to medical care. (Doweiko, 2015). This need to use or do could serve as a trigger for relapse within the addictive cycle. (Lecture). The means the individual must do something to alleviate the pain they are feeling. Then instead of feeling bad about the relapse the individual feels good, because they have relief from the pain. However the individual will crash hard and cycle back to pain, increasing the tolerance to the substance of abuse.
THE STAGES OF TREATMENT
Addressing substance abuse with a dual-diagnosis patient can be difficult for a variety of reasons. Some include the fact that substances of abuse can interact negatively with prescribed drugs (Hamilton,2013), Also some patients who use illicit substances may have additional concerns from contracting other medical conditions such as Hepatitis B or Hepatitis C (Hamilton, 2013). Because of these factors, some individuals with a dual-diagnosis will have problems with metabolizing medications, leading to an increased risk of adverse reactions or toxicity (Hamilton, 2013).
The stages of treatment for a dual-diagnosis client include the first goal of establishing a good relationship between the client and the medical professional (Doweiko, 2015). This will take time and patience on behalf of the medical professional. The second phase is the motivational phase. This stage consists of the medial personnel making the client aware of the relationship between the two diagnoses and how one effects the other. (Doweiko, 2015)The third phase is active treatment. During this phase the medical staff will help the client to find suitable resources and the appropriate environment of care. (Doweiko, 2015).
The outcome of treatment is greatly affected by the environment the client will be discharged into. If the client is discharged into an unstable environment, or one where drug use is present the individual will be at a greater risk of relapse (Doweiko, 2015). It is also important to consider the support system of the client. Those who participate in group therapy will have a greater chance at succeeding, because they have the support of peers, and additional accountability. (Doweiko, 2015) WCC=719
Clinton, T., & Scalise, E. (2013). Additions and Recovery Counseling. Grand Rapids, MI: Baker Books. Doweiko, H. E. (2015). Concepts of Chemical Dependency (9th Edition ed.). La Crosse, WI: Cengage Learning. Hamilton, I., & Pringle, R. (2013). Drug interactions and dual diagnosis. Advances in Dual Diagnosis, 6(3), 145-150. doi:http://dx.doi.org/10.1108/ADD-04-2013-0010
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