A co-occurring disorder, also known as dual diagnosis, refers to a case involving a confirmed diagnosis of substance use disorder (SUD) and another mental health condition. Although it’s hard to determine which one caused the other, researchers agree that these conditions often go both ways, worsening each other’s effects on the individual.
The National Institute on Drug Abuse estimates around eight million American adults have a dual diagnosis. More cases seem to involve adults diagnosed with SUD also suffering from a mental health condition than the other way around. Whatever the case, over half of these cases get no treatment for both conditions. (1)
Treating a dual diagnosis requires treating both SUD and the mental health condition, regardless of which one caused the other. It may be a tall order for specialists at treatment facilities such as healtreatmentcenters.com and others but it’s not an impossible task. Here are three treatment options for dual diagnosis:
- Integrated Dual Diagnosis Treatment
Most treatment programs typically separate treatment for SUD and the accompanying mental health condition. In this case, patients would undergo treatment for one problem before shifting to another, each with its own set of specialists. This setup isn’t without its drawbacks; there’s a risk of creating an unnecessary hiatus after the first treatment, negating its effects over time. (2)
To mitigate this, researchers have developed a multidisciplinary model known as the Integrated Dual Diagnosis Treatment (IDDT). By having a dedicated team of specialists work on providing simultaneous treatment, IDDT can reduce the following:
- Probability of the SUD or mental health condition relapsing
- Cost of services shouldered by the patient
- Need for prolonged hospitalization or arrest
- Overhead expenses on the facility’s part
- Need to employ high-end treatment systems(3)
IDDT becomes more promising when considering that typical treatment methods still involve substances. For example, managing schizophrenia warrants antipsychotic drugs like clozapine, olanzapine, risperidone, and quetiapine, on top of nonpharmacological procedures. In this case, these drugs should go hand in hand with cognitive behavioral therapy (CBT). (2)
Randomized trials found that integrated treatment produced significant improvements among patients. One such study involving schizophrenia and dual diagnosis patients discovered that the group that underwent integrated treatment saw an improvement in their overall quality of life a year later. While still substantial, the dropout rate for said group was lower than the other. (2)
- Combined CBT and motivational interviewing
Practitioners and patients alike are more or less familiar with CBT; it’s one of the most widely employed methods for managing mental health conditions. Its extensive use stems from the abundance of research available and the fact that it’s the ‘gold standard’ the community has, at least as of this moment.
But by no means does ‘gold standard’ imply flawlessness—and CBT in mental health isn’t any different. It’s constantly evolving, along with more modern treatment models that’ll serve to augment than replace it.
One example can be found among dual diagnosis treatments: CBT augmented with motivational interviewing. According to William Miller, Emeritus Distinguished Professor of Psychology and Psychiatry at the University of New Mexico, the purpose of motivational interviewing is to help people commit to change through various communication techniques. (4)
Motivational interviewing is versatile enough to be applied in a broad range of cases. However, its fullest potential comes out when faced with patients who have:
- Mixed feelings about changing for the better
- Doubt about changing to the best of their ability
- Little to no desire to change their status quos
- No reason to believe change will bring about significant benefits (5)
Since both methods involve striking a conversation, CBT and motivational interviewing make a solid pair. In one study involving youths afflicted with SUD and depression, the group that underwent this combined approach reported a reduced prevalence of SUD (namely cannabis) three and six months after the treatment. (2)
- Parallel treatment
If integrated treatment isn’t possible, practitioners can still set their patients up for an alternative known as parallel treatment. Whereas integrated treatment involves a single team providing care, parallel treatment features different providers or systems giving care.
Contrary to popular belief, parallel treatment provides concurrent care like integrated treatment. One setup can have patients undergo medication in their treatment center and be referred to a support group for intervention within the same timeline. Experts believe parallel treatment works on patients suffering from a severe case of one disorder and a mild case on the other.
Dual diagnosis is far more common than one may think. Its complicated nature—suffering from two conditions with little to no knowledge of the underlying cause—warrants treatment methods that deal with them. No matter the case, it pays to know that help is always available in one form or another.
- “Comorbidity: Substance Use and Other Mental Disorders”, Source: https://nida.nih.gov/sites/default/files/infographic-comorbidity.pdf
- “Treatment of dual diagnosis disorders”, Source: https://sci-hub.se/https://pubmed.ncbi.nlm.nih.gov/22395768/
- “Integrated Dual Disorder Treatment”, Source: https://case.edu/socialwork/centerforebp/practices/substance-abuse-mental-illness/integrated-dual-disorder-treatment
- “Understanding Motivational Interviewing Effectiveness: Contributions From Rogers’ Client-Centered Approach”, Source: https://www.researchgate.net/publication/271993284_Understanding_Motivational_Interviewing_Effectiveness_Contributions_From_Rogers%27_Client-Centered_Approach
- “Understanding Motivational Interviewing”, Source: https://motivationalinterviewing.org/understanding-motivational-interviewing