Dual diagnosis occurs when both a mental illness and a behavioral factor, usually substance abuse, are ongoing difficulties for a patient. Both sides of the difficulty must be addressed for the patient to improve. Due to the interaction of the two aspects, recovery is more complicated and difficult to achieve than addressing either of the problems alone.
Considerations
Since the interaction of the mental illness and substance abuse issues affect the whole person, a whole-person approach that reaches into all aspects of the patient's life seems most effective. Regaining a balance of healthy functioning includes help with everyday living challenges and supported work programs as well as the initial phase of treatment to regain physical health. Relationship counseling and even routine social interactions may need oversight and supportive direction in order for the individual to regain normalcy.
History
Integrated treatment of mental illness/chemical abuse (MICA) patients began at a New York psychiatric outpatient center in 1984. Within a year, the integrated approach was being taught in several outpatient facilities in New York. Prior to this, the two difficulties were addressed separately in parallel programs. These early, disjointed treatment programs had little success. Early, confrontational approaches with "clean and sober" patients who had ceased active substance abuse before entering treatment have evolved into programs reaching out to active abusers without a confrontational aspect.
Function
Because of practices learned through the MICA integrated approach therapies, patients may enter a program in any stage of substance abuse and mental illness. Unfortunately, if a patient enters a psychiatric facility, the mental illness aspect is addressed to the exclusion of the substance abuse issue while substance treatment facilities may ignore the mental illness diagnosis, and the patient bounces back and forth between the two. A cycle of gaining confidence while in therapy, going off prescribed medication and self-medicating with illegal or harmful substances can develop, which seems to have no end but the self-destruction of the patient. By addressing both sides of the dual diagnosis, patients have had improved success rates, although exact percentages for long-term recovery are hard to come by.
Time Frame
Kathleen Sciacca, an expert in dual diagnosis treatments, states a typical treatment program can begin with a three- to five-day detoxification stay in a hospital to get the alcohol or other substance cleared from the system. Individual counseling, group work and medications may all be used to help move the patient to a long-term care facility or residential program. The bridge from detox to independent living may include partial hospitalization or intensive outpatient programs; and a social worker, case manager and employment coach may join for a team effort toward recovery.
Significance
The Journal of the American Medical Association reports half of those with severe mental illness diagnoses also suffer substance abuse problems. Those with dual diagnosis, also called co-morbid, are more likely to have violent outbursts, legal difficulties, relapse and a downward spiral of increasing health difficulties, frequent hospitalizations and gravitation toward like-minded patients who are more likely to accept their behaviors. They have more difficulty holding a job, can't pay medical or legal costs and therefore are more of a burden on society in general than either the mentally ill or substance abuse patients with a single diagnosis. Treating the whole dually diagnosed person may help decrease the worst results of the co-morbid diagnoses in their impact on the legal system, the spread of HIV/AIDS virus and the social impact that drains family, friends and co-workers who tend to be frustrated in their attempts to aid the dually diagnosed.
