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Dual Diagnosis: The Solution

Increased Awareness Is a Key

When patients with major mental health disorders and co-existing alcohol or substance addictions have been diagnosed correctly, proper treatment is not always available.

As was reported last week in Dual Diagnosis: The Problem, it is difficult for mental health care professionals to accurately identify patients with mental health disorders and substance abuse problems, but the profession seems even further divided about how to treat these patients.

Many in the profession have come to realize that chemical dependency is not simply a symptom but a full blown problem in its own right. But treatment still lags. Some counselors admit to "winging it" due to the complex problems unique to those who are dual-diagnosed.

Addiction professionals may believe that mental illness is a symptom of substance abuse; mental health professionals may believe that substance abuse is a symptom of mental illness. Therefore neither can provide effective treatment for dually diagnosed patients.

Frequent Relapses

Treatment of the dual-diagnosis patient is still difficult even when properly diagnosed. Many who need medication for mental disorders choose to "self-medicate" with street drugs instead. In addiction, they would to be told by their recovery support group that they were not truly "clean and sober" if they were taking medically prescribed medications.

Individuals with a dual-diagnosis can feel discriminated against by the treatment professionals as well as other recovering addicts and alcoholics by this attitude that all drugs are bad. They may have difficulty being accommodated at home and may not be tolerated in community residences of rehabilitation programs. They lose their support systems and suffer frequent relapses and hospitalizations.

Mental health care patients with a substance abuse problem are almost twice as likely to drop out of outpatient mental health treatment as patients who did not have substance abuse problems.

Kathleen Sciacca, M.A., the founding executive director of Sciacca Comprehensive Service Development for Mental Illness, Drug Addiction, and Alcoholism (MIDAA) in New York City, believes the answer lies in integrating mental health and addiction treatment in a single program design.

Increased Awareness

Sciacca has developed Motivational Interviewing Training Seminars to help professionals recognize and properly treat dually diagnosed patients.

Alan I. Leshner, Ph.D., director of the National Institute on Drug Abuse (NIDA) agrees with the combined approach. "Logic says 'go to that which came first' but data suggests that's not true, particularly in the short term," he said. "In the short-term, we need to address both simultaneously, or be blowing in the wind. So for acute treatment and stabilization, focus on both disorders at once. For maintenance and rehabilitation, attend to the primacy of one disorder."

"In designing a dual-diagnosis system of care, each system must include program elements that meet patient needs in each phase of recovery from each illness, address various levels of severity and disability in each recovery phase, and be suitable for clients variously motivated to assume responsibility for their recovery," Leshner said.

Many in the field agree that awareness of the situation is the key to providing proper care. "There is a need for education that demonstrates that addictive disorders are illnesses," Sciacca writes. "Understanding mental illness as a disease that is not caused by families was necessary to successful advocacy for the mentally ill. The same advocacy must happen for those who are dually diagnosed, through a clear understanding of the addictive disorders."

"Families of the dually diagnosed continue to experience frustration resulting from a service delivery system that does not meet their needs, or the needs of their relatives," she said.

"There is a unique disconnect between the scientific facts and the public's perception about mental and addictive disorders -- a big difference between reality and perception," said Leshner. "We now have the scientific knowledge to mount a major campaign on public opinion."

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