Dual diagnosis means that an individual has been diagnosed with a substance use disorder and a psychiatric disorder. At Ashley Addiction Treatment in Havre de Grace, Maryland, our compassionate professionals will gather the appropriate information and work with you or a loved one to treat both co-occurring conditions.
Evaluating for Psychiatric Illnesses
All psychiatric illnesses are described in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (known as DSM-5) published by the American Psychiatric Association. This manual specifies diagnostic criteria for the disorders and explains that a diagnosis isn’t solely based on the symptoms an individual is experiencing at the time of the assessment.
Many other factors need to be explored during an evaluation and these include:
- The duration of the symptoms: As opposed to days, minutes, or hours, most disorders have symptoms that persist for weeks, months, even years, usually not days, minutes or hours.
- The severity of the symptoms: Most disorders lead to impairment in functioning in at least one area of a person’s life, sometimes many.
- The family history: Many disorders have a genetic component and are inheritable.
- The presence of a substance use disorder: The symptoms of intoxication and withdrawal mimic common psychiatric disorders. The negative consequences that often accumulate with substance use disorders can be the source of sadness, worry, and demoralization.
- The presence of a medical illness: Some medical disorders and medications have psychiatric symptoms and need to be ruled out as the cause. A physical examination and/or laboratory studies may be necessary.
- The presence of adverse life experiences: Problems with family, money, marriage, children, employment, etc, can be a source of sadness or worry.
- The developmental history: Experiences in childhood can put people at risk for developing psychiatric disorders in adulthood.
In order to be thorough, it’s often helpful to gather information from family members or others who know the individual well. These collaborative sources may be able to clarify history and provide information that the individual didn’t remember or disclose.
Even when thorough, it may not be possible to make a definitive diagnosis because the effects of the substance use can be so profound. In these cases psychiatric care after discharge is important for further monitoring, evaluation and perhaps treatment.
Can Medications Aid in Dual Diagnosis Treatment?
If a psychiatric disorder is diagnosed, medication may be the next point of discussion. Medications can be very helpful and would be prescribed by a psychiatrist or primary care physician who would monitor their effectiveness and side effects. Factors taken into consideration when selecting the appropriate medication include identifying the symptoms being targeted for treatment, the side effects that may be experienced, and interactions with other medications.
When treating those with a substance use disorder, it’s advisable to use medications that can’t be abused, themselves. Most psychiatric medications are ineffective during periods of active substance use. Additionally, there’s no evidence that psychiatric medications should be chosen on the basis of what type of substance use disorder an individual has.
Although medications can be helpful, there is great value in non-pharmacological treatment modalities. The social support of a community reduces isolation. A schedule of activities during the day brings structure and predictability to a previously unstructured life. Groups and counseling address behaviors, thoughts, and situations that promote positive life changes.
How Is Dual Diagnosis Managed at Ashley Addiction Treatment?
The professional staff at Ashley is committed to providing our clients with individualized treatment that addresses individuals’ needs while also preparing them for the challenges of early recovery. Our psychologists and psychiatrists are aware that having a psychiatric disorder is one risk factor for developing a substance use disorder. We also recognize that the toxic effects of drugs and alcohol will negatively affect thinking and feeling while the accumulation of negative consequences becomes a source of intense sadness and worry.
Based on our staffing and physical structure, we’re considered a “Dual Diagnosis Capable” facility. This means that we are able to take care of individuals with stable psychiatric illnesses who have a substance use disorder. Our patients need to be able to participate in the program in a meaningful way, to function in a community setting, and to take care of their personal needs.
Because patient safety is a priority, we can’t assume the care of individuals who are acutely suicidal, homicidal, manic, psychotic or delirious.
It’s common for our patients to experience feelings of sadness, depression, and anxiety, especially at the time of admission. Fortunately, it’s also common for these feelings to resolve after detoxification and while individuals learn that the substance use disorder isn’t a moral failing.
We’ve found that not everyone will need a psychiatric or psychological assessment. Therefore, we arrange them on an as needed basis. Our case managers are trained to screen for symptoms that could indicate that such an assessment is needed. Our clinical professionals prescribe medications for psychiatric disorders for active symptoms. They also monitor patients to ensure their stability.
Our psychologists conduct special groups to help our patients develop coping skills for sadness, depression, worry, anxiety, and the residual effects of trauma. The goal of these groups is to remove some of the barriers that may interfere with maintenance of recovery It can take many weeks to months for symptoms to resolve and our goal is to set patients on a path to recovery. Again, it is of great importance that they continue to seek psychiatric and/or psychological care after discharge for continued assessment and treatment.
The Importance of Psychotherapy During Dual Diagnosis Treatment
There are many forms of psychotherapy including individual, group and family. Most of the time, individuals seek therapy because they’re struggling with life situations such as relationship problems or with intense, uncomfortable emotional states. With few exceptions, the goal of therapy is to bring about changes in behavior and/or thinking so that problems resolve or individuals develop more effective ways of coping.
Our therapy approaches are quite variable and applied in individual, group and family therapies. Common approaches include:
Cognitive therapies: These therapies address distorted assumptions and thoughts that drive negative emotional experiences. Clinical professionals guide individuals to develop more accurate ways of interpreting their experiences so that emotional responses and behaviors are less negative.
Insight-oriented therapy depends on the therapist helping the individual reach an understanding of how or why he or she behaves and thinks.
Psychodynamic therapy encourages individuals to understand themselves through the relationship with the therapist.
When choosing a therapist, it’s important to consider the training and credentials of the therapist. Psychiatrists, psychologists, licensed social workers, mental health nurse practitioners, and licensed clinical professional counselors can be trained therapists. If an individual with a substance use disorder is seeking psychotherapy, it’s important for the therapist to understand these disorders and recovery. The combination of medications for a psychiatric illness and therapy can often lead to better outcomes than either intervention alone.
The therapies conducted at Ashley include:
- Group therapy: This form of treatment can be powerful and is the cornerstone of treatment of substance use disorders. The curative factors in groups as described by Irving Yalom in his book, The Theory and Practice of Group Psychotherapy include the imparting of information (teaching and learning), the instillation of hope, universality (you are not alone), altruism (group members share feedback and offer help and support), development of socializing techniques, imitative behavior (trying new behaviors observed in another), and group cohesiveness.
- Addiction cannot be overcome in a vacuum and connecting with others who share similar struggles has great healing power. In fact, as substance use disorders develop, lives narrow in their focus and people often become isolated. In recovery, lives blossom—and this can’t be achieved without the support and involvement of others.
- Individual therapy: Working on an individual basis can be helpful in addressing some of the problems that may become barriers to recovery. This is a longitudinal process that may be beneficial from months to years. Our staff psychologists see patients while in treatment and referring to an individual therapist may be part of a continuing care plan.
- Family therapy: While participating in the Family Wellness Program family members and the patients meet with a therapist to address issues such as communication patterns and expectations about returning home. After discharge, returning to a supportive environment helps to diminish shame and promotes good recovery. We always encourage and welcome loved ones to participate in the recovery process.