06 January 2018 Posted By : Administrator

Unraveling The Challenges Of Dual-Diagnosis Treatment

Have you ever wondered why drug addiction is so hard to treat, compared with other disorders? Well, one of the core reasons is that addiction frequently occurs in tandem with mental health issues. Known as dual-diagnosis, the Substance Abuse and Mental Health Services Administration (SAMHSA) reports that as many 53% of drug abusers also have a serious mental health disorder. In total, about 29% of those with mental health issues end up abusing drugs or alcohol, often as a way of self-medicating their illness.

In order to properly address rising rates of drug abuse, we also need to address the mental health crisis and connect those affected with proper treatment before their symptoms worsen. We also need to develop new approaches to treatment for these patients, an issue that has stymied researchers for years.

Identifying Dual-Diagnosis Cases

The first step towards proper treatment of dual-diagnosis patients is right in the name – diagnosis. Because drug abuse can mirror symptoms of mental illness and vice versa, harried professionals regularly dismiss patients without addressing the full scope of their issues. Without both pieces of the puzzle, though, the odds of recovery are slim.

Proper treatment for dual diagnosis patients involves both detox and psychiatric treatment, and providers typically develop individualized plans for these patients featuring therapy, pharmaceutical treatment for psychiatric issues, and management of addiction behaviors.

Psychiatrists have to be especially careful when treating dual-diagnosis patients that they do not prescribe drugs that could encourage addiction-related behaviours. Trading a methamphetamine addiction for a “legal” benzodiazepine addiction isn’t an improvement.

Body, Environment, And Addiction Medicine

Another challenge for professionals treating dual diagnosis patients is that, in managing drug craving and psychiatric symptoms, it’s easy to overlook other physiological concerns. Mental and physical health are closely intertwined, and mental health issues can cause physical discomfort. Similarly, chronic pain can, over time, cause serious depression or anxiety. As with so many things, health becomes a chicken-or-the-egg problem for patients with addiction issues.

Many addicts grew up in traumatic or high-stress environments, and this may also contribute to their issues – but environmental stress may also cause mental health issues. While some professionals believe substance abuse can cause mental health disorders, essentially flipping a biological switch in predisposed individuals, others suffer from substance abuse as a result of their mental health issues, as noted above.

Preemptively protecting children from trauma, or what’s known as adverse childhood experiences (ACEs). Children with a higher number of ACEs are more likely to suffer a range of health problems, including mental illness and addiction, as adults. The current theory is that this occurs because trauma rewires the brain in harmful ways and addiction and mental illness areboth fundamentally brain disorders. They rely on common pathways and brain dysfunction can, thus, push an individual into addiction, mental illness, or both.

Rethinking Treatment

Beyond pairing psychiatric treatment and addiction treatment, what does it take to help dual-diagnosis patients recover? Many require long-term care after inpatient treatment to help them abide by their treatment plan, particularly those who have psychotic symptoms. These patients may not recognize that they’re sick at all, a symptom known as anosognosia, making treatment and recovery that much harder.

Many dual-diagnosis patients choose substances that worsen their psychosis and make it hard for them to consent to treatment. Some must be court mandated to enter detox while simultaneously receiving psychiatric medications to stabilize psychotic symptoms, while others should receive psychiatric treatment first, with detox and addiction management as a later aspect of care. Flexibility is paramount for dual-diagnosis patients.

Having a dual-diagnosis shouldn’t be a barrier to proper care when, in fact, such patients are like so many in our healthcare system – complex. While other fields accept that no two cases are alike, addiction medicine has struggled to adopt this view. It’s time for providers to catch up.

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