The prevalence of dual diagnosis in the population of individuals aged 18 years and older seeking treatment presents a significant problem for traditional substance use and mental health facilities to provide interventions for co-occurring conditions.
We will examine the criteria utilized for effective dual diagnosis treatment and why dual diagnosis clients are challenging to manage in current substance use and mental health treatment facilities.
The ideas for integrated mental health frameworks that can make approaches to dual diagnosis treatment more effective, still faces significant challenges in Mental Health facilities.
According to Gotham et al. (2013), results from the 2007 National Survey on Drug Use and Health (NSDUH, 2007) show approximately 5.4 million adults in the USA with past-year co-occurring severe psychological distress and substance abuse use disorder. They also found that 54% had not received any treatment in the past year, 3% received treatment for substance use problems only, 10% received treatment for substance use/ psychological distress, and 33% received treatment for mental health care only. When comparing the dual diagnosis statistics presented by the National Survey of drug use and health (NSDUH, 2013), we find in 2013 among the 20.3 million adults with a past year substance use disorder, 37.8 percent (7.7 million adults) had co-occurring mental illness in the past year.
NSDUH (2013) mental health findings present among the 43.8 million adults aged 18 or older in 2013 who had a past year with any mental illness (AMI) was 17.5 percent (7.7 million adults) met the criteria for a substance use disorder in the past year. Adults aged 18 years and older who did not have past year mental illness and met the requirements for a substance use disorder was 6.5 percent or 12.6 million adults (NSDUH, 2013).
For adults aged 18 years and older, out of 7.7 million with co-occurring disorders (NSDUH, 2013) and NSDUH mentioned clients with mental illness and substance use were estimated at 3.2 percent. The highest percentage of adults who had co-occurring mental illness and substance use were (NSDUH, 2013) among adults aged 18-25 (6.0 percent), followed by those aged 26-49 (4.5 percent), than those age 50 or older (1.11 percent).
Dual diagnosis is a comorbid condition that consists of a co-existence of substance use problems in collaboration with a severe psychiatric illness (co-occurring disorder). Clients with dual diagnoses face frustration with the lack of treatment for both conditions in the same mental health treatment facility due to the lack of behavioral health integrated frameworks needed to assess, screen accurately, and manage psychosocial issues that contribute to substance use, combined with limitations that are presented by a psychiatric illness that also require treatment simultaneously (Hoxmark & Wynn, 2010).
Are there effective treatment strategies for Dual Diagnosis?
✅Treatment strategies and interventions for clients with dual diagnoses are widely used and utilized for clients with the dual diagnosis but most behavioral health treatment facilities for substance use and mental health face many challenges with getting simultaneous treatment for clients with co-occurring (e. g., schizophrenia and alcohol disorder occurring together) conditions in the traditional substance abuse and mental health facility.
Traditional substance abuses and mental health service facilities have separate service facilities that compete for public funding, educational training, and credentialing procedures that differ between the two systems (Drake & Muser, 2000) mention how the eligibility criteria for the use of mental health or substance abuse services vary as well. While substance use treatment and psychiatric programs' philosophical approaches might vary, dual diagnosis clients require being treated more coherently to help with effective recovery outcomes for their co-occurring condition.
Rassool (2006) mentions that dual diagnosis has been a growing interest for the behavioral health services organizations over the past ten years due to the complexities of treating clients with co-existence of substance abuse problems prevalent with a psychiatric illness or a co-occurring disorder (dual diagnosis).
✅Dual diagnosis is associated with higher rates of specific adverse outcomes (e. g. severe financial problems, unstable housing and homelessness, medication non-compliance, relapse, and re-hospitalization) that result in serious adverse effects of co-occurring disorder and high costs in the treatment of clients with dual diagnosis (Drake & Mueser, 2000).
Gotham, Brown, Comaty, McGovern, & Claus (2013) recognizes there is little relationship between setting expectations for everyday practice in behavioral health organizations that ensures clients with a dual diagnosis receive the best care possible. Substance use and mental health treatment are handled as separate and distinct treatment services in behavioral health settings.
A comparison of the statistics from the NSDUH (2007) and NSDUH (2013) shows a 4% increase in the number of new dual diagnosed clients between 2007 to 2013 a staggering 2.3 million newly diagnosed clients with dual diagnosis and shows the number of dual diagnosis clients with complex needs.
Dual Diagnosis awareness in everyday clinical practice is common in mental health settings (Cleary, Walter, Hunt, Clancy, & Horsfall, 2008) mentions how the clinical challenges with system barriers for treating dual diagnosis problems impede positive treatment outcomes for clients. For example, clients with mental health illnesses will be treated in one facility, and the substance use issue will require a different facility to treat the substance use. The separation of treatment practices for an individual with co-occurring disorders makes treatment for dual diagnosis clients separate and distinct.
(McGovern, Lambert-Harris, Gotham, Claus, & Xie, 2012) mentions that historically the behavioral health treatment delivery system has been bifurcated and is organizationally designed to treat the mental health condition or the substance abuse condition. We can understand why adequate behavioral health integrated psychiatric treatment services are needed for dual diagnosis clients. For example, an addict in recovery has found that their addiction is addressed more by a substance use counselor to help the client focus on abstinence by using support groups (e. g., Alcoholics Anonymous or 12 step program).
A client seeking psychiatric services (e.g., depression or anxiety) is addressed more fully by a mental health professional that uses therapy. The separation of counseling practices between two essential treatment needs for addicts and the mentally ill creates a barrier to treating the large population of dual diagnosis clients who need treatment for mental illness and substance use at once (McGovern et al.,2012).
✅Some of the complications dual diagnosis clients face during treatment (McGovern et al., 2012) address how clients with mental health problems associated with substance abuse problems are socially isolated and tend to be problematic to treat. Some health care facilities find managing these clients difficult due to non-compliance with treatment goals, homelessness, low socioeconomic status with unemployment, low-income family supports, exposure to violence, and the potential to commit suicide. For example, a homeless client for over 15 years, unemployed, has low socioeconomic status (SES) with co-occurring disorders, may need homeless outreach services to help manage their daily lives or obtain stable housing to gain sobriety.
What are some of the causes of dual diagnosis?
Most mental illnesses are a result of conditions that help formulate or fuel the the likelihood that a person will struggle with the presence of co-occurring disorder.
Life Center of Galax talks about how decades of research strongly points the finger at genetic components that impact the development of addiction and mental health problems. Influences both internal (i.e., genetic) and external ( i.e., environmental influences) are factors that can significantly increase the likelihood that a person will struggle with the presence of co-occurring disorders. For example, growing up with parents that have a history of depression or addiction establishes high chances of you suffering from the same problems. Life Center of Galax also identified recent scientific inquiries into the genetics of addiction have identified both individual genes and gene networks that appear to function differently in individuals who are struggling with addictions than they do in people who have not struggled with this disease.
When complexes of Genetic components to mental health problems are accompanied with environmental factors, for example, an individual who grew up in houses where alcohol or other drugs are freely used. The child or individual may feel freely using drugs is an acceptable behavior and contributes to causes of dual diagnosis.
The Embryo Project Encyclopedia focus on teratogens can explain how being exposed to alcohol or another drug, certain viruses and toxins while in the womb can increase a person's odds of facing mental health concerns later in life.
Mental illness can also have several environmental influences, including exposure to certain drugs or chemicals, accidents that involve damage to the brain, traumatic experiences (including combat, severe traffic accidents, and physical or sexual abuse), and stressful events (including financial pressure, death of a loved one, divorce, or similar experiences).
More sutle causes of dual diagnosis are drinking due to social anxiety. For example, people who need a few drinks fo feel relaxed in social situations to reduce self awkwardness may be inclined to develop drinking problems or become dependent on alcohol to function around other people. Social Anxiety is a mental illness and the use of alcohol to help you get through the social situation can become a habit or addiction that exacerbates the mental illness (i.e., social anxiety).
Post traumatic Stress Disorder(PTSD). develop psychosis from a disorder in which a person has difficulty recovering after experiencing or witnessing a terrifying event. For example, veterans who experience the horrors of war.
Beachside Rehab talks about how PTSD victims may start self-medication in order to manage the symptoms of PTSD which in turn may result in them developing a substance abuse problem. The reverse is also true; someone who has a substance abuse problem may develop a mental illness as a result of his or her addiction. For example, it has been proven that marijuana can increase the chances of developing psychosis or paranoia, so someone who has no previous history of mental illness may develop a psychotic disorder because of their previous marijuana dependence.
What are the short and long term effects of co-occurring disorders?
✅The actual effects of co-occurring disorders or dual diagnosis can differ from individual to individual. Lack of proper treatment when dual diagnosis is present can result in adverse effects listed below:
Overall decline in one’s psychological health
Overall decline in one’s physical health
Disturbances within one’s relationships with friends and family
Decline in work performance and attendance, potentially resulting in job loss and ongoing unemployment
Financial distress
Homelessness
Interaction with law enforcement as the result of abusing illegal substances
Social withdrawal and isolation
Onset of self-harming behaviors
Suicidal ideation
The impact of both mental health and substance abuse disorders on each other can be devastating to individual overall health if treatment is not administered. It is important to get professional care from a provider who is able to treat all of the disorders from which an individual is suffering.
Conclusion
Analysis for effective treatment interventions for dual diagnosis included reflection from the stakeholder’s perspectives and opened a look into how the utilization of those treatment services outlined in this paper show implications on the validity how some effective treatment practices for dual diagnosis work from the stakeholder perspective.
Complications arise in dual diagnosis treatment from lack of stakeholder participation in proper self-administration of medication and avoiding clinical participation that will contribute to the personal development or change in the lifestyle of the stakeholder in recovery treatment.
Behavioral health systems that should provide a framework for dual diagnosis treatment through a range of settings around individual treatment plans, intake assessments, recovery process, relapse prevention and medication management and clinicians who develops in-therapy relationships that open engagement and insight to each encounter towards recovery.
References:
Cleary, M., Walter, G., Hunt, G. E., Clancy, R., & Horsfall, J. (2008). Promoting dual diagnosis awareness in everyday clinical practice. Journal of Psychosocial Nursing.46(12), 43-49. doi:10.3928/02793695-20081201-02
Drake, R. E., & Mueser, K. T. (2000). Psychosocial approaches to dual diagnosis.
Schizophrenia Bulletin, 26(1), 105-118. doi: 10.1093/oxfordjournals.schbul.a033429
Gotham, H. J., Brown, J. L., Comaty, J. E., McGovern, M. P., & Claus, R. E. (2013). Assessing the co- occurring capability of mental health treatment programs: The dual diagnosis capability in mental health treatment (DDCMHT) index. The Journal of Behavioral Health Services & Research, 40(2), 234-241. doi:10.1007/s11414-012-9317-8
McGovern, M. P., Lambert-Harris, C., Gotham, H. J., Claus, R. E., & Xie, H. (2012). Dual diagnosis
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Rassool, G. H. (2006). Dual diagnosis nursing. Oxford: Wiley-Blackwell.
Results form 2010 National Survey on Drug Use and Health: Mental Health
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