Dual Diagnosis: Treatment and Medication

Dual Diagnosis is one of the more complex disorders in the substance abuse landscape; yet despite its challenges, its treatment has become more and more successful over the past dozen-odd years. Acknowledgement must be given to researchers in all areas, whom have helped to not only diagnose the disorder with more accuracy, but to prescribe medications that better suit the condition.

Dual Diagnosis is co-occurring disorders (COD), and is described as having some variety of mental illness along with substance abuse. There are varying degrees of the disorder; the mental illness side can be represented by severe forms such as schizophrenia or psychosis, to milder conditions such as panic or anxiety disorder. In addition to this, symptoms of substance abuse can often mirror those of mental disorders, making it difficult to distinguish between substance abuse-induced psychiatric states and pre-existing psychological health issues. It is common knowledge though, that many disorders among substance abusers fade away with extended abstinence. However, certain stages of detoxification trigger, for instance, prolonged depression or psychosis; this is quite common with amphetamine and cocaine addiction. As you can see, this is terribly complex beast to combat…

Medication is critical in treating dual diagnosis. Through certain medications in treatment (for brief periods), doctors can lower anxiety, cravings and paranoia in dual diagnosis patients. With opiate use, replacements in the detox portion of treatment including methadone or buprenorphine can lower relapse rates and fatalities. Baclofen is being used more often across the board to help reduce cravings. These drugs, along with anti-psychotics and other psych meds specifically prescribed for mental disorders, aid treatment dramatically.

As far as treatment programs for dual diagnosis disorder, there are multiple modalities. Partial treatment treats just the disorder that is considered primary. When the primary disorder is treated first, followed by the secondary is called sequential treatment. Parallel treatment involves a patient receiving mental health assistance from one provider, and addiction services from another. While many patients receive successful treatment from the practices mentioned, the most successful treatment for dual diagnosis disorder is integrated treatment.

Integrated treatment involves an amalgamation of care into a single, articulate treatment package.  With this method, both issues are considered principal. Integrated treatment offers a greater ease of understanding, improved treatment engagement, commitment and compliance… and drastically improved overall outcomes. Many higher-end treatment centers, especially the Malibu-based rehabs that treat dual diagnosis, focus solely on integrated treatment. In addition to this, alternative forms of treatment such as art/music therapy, neurofeedback programs and outdoor activities such as swimming/surfing and equine therapy often help round-out the integrated treatment package with excellent results.

Another important factor in dual diagnosis treatment is the length of the program. Due to the complexities of the disorder and its treatment, it clearly should not be rushed through in a short 30-60 day ‘spin-dry’. It’s been described as “a marathon, not a sprint”, and this couldn’t be more accurate. A dedication to longer-term treatment as well as selecting a quality program are two of the best decisions one can make in selecting a successful dual diagnosis treatment program.

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