Mental health treatment

Leaving rehabThe National Institute on Mental Health (NIMH) periodically sponsors a nationwide survey to compile data on the prevalence of mental health disorders among adults and children. The survey is particularly insightful and useful in that it differentiates between illnesses and reliably indicates which are the most common. NIMH recently made the following findings:

  • In 2012, an estimated 43.7 million adults in the 18-and-older age group had a mental illness (18.6 percent of all US adults).
  • About 18.1 percent of Americans suffer from anxiety disorder, and 22.8 percent of those have severe cases.
  • Approximately 3.5 percent of Americans have post-traumatic stress disorder (PTSD), and 36.6 percent of the cases are categorized as severe.
  • About 2.6 percent of Americans have bipolar disorder, and 82.9 percent are considered severe (equivalent to 2.2 percent of the US adult population).
  • Over their lifespan, 0.6 percent of Americans have experienced bulimia nervosa.
  • Approximately 1.1 percent of the US population suffers from schizophrenia.

Overall, nearly one in five adult Americans has a mental health disorder. That statistic can mean that one of your colleagues, one of your neighbors, one of the people standing in line with you at the supermarket, or even you have a mental health issue. The benefit of bringing this important information to light is that the rise in awareness has helped to de-stigmatize mental health disorders and encourage afflicted persons to seek treatment.

Dual diagnosis

Doctor talking to her male patient at officeIn addiction treatment, the term “dual diagnosis” is used clinically to designate a person as having a substance abuse disorder simultaneously with a mental health disorder. Dual diagnosis, also known as a co-occurring disorder, may involve more than one mental health disorder and more than one drug of abuse. “Dual” refers categorically to substance abuse and mental health, not the number and type of conditions involved.

As the National Alliance on Mental Illness (NAMI) discusses, there is a positive association between substance abuse and mental health disorders. NAMI provides the following statistical information about co-occurring disorders:

  • Socio-markers, such as having a lower socioeconomic status or being a military veteran, influence the level of risk of abusing alcohol, marijuana, opiates, cocaine, and other stimulants.
  • Recent research findings suggest that nearly 33 percent of all persons with mental illness abuse illicit substances.
  • Approximately 50 percent of persons with severe mental illness, such as schizophrenia, abuse illicit substances.
  • More than 33 percent of all persons who abuse alcohol and more than 50 percent of those who abuse other drugs also suffer from mental illness.
The co-occurrence of a substance abuse disorder and mental health illness has a “chicken-and-egg” relationship. It is often not possible to determine which came first or how the two disorders are connected.

As NAMI discusses, the following theories describe the possible relationship between substance abuse and mental health disorders:

  • Self-medication: In an effort to manage painful feelings or cope with stress, individuals may self-medicate with drugs. This short-term strategy can have long-term consequences on one’s physical, mental, and social status.
  • Drugs exacerbate mental illness: Where there is an underlying mental health condition, abusing alcohol or other drugs can trigger side effects. For instance, a person with clinical depression who drinks excessively may become suicidal. In addition, withdrawal from drugs can worsen the symptoms of the existing mental illness.
  • Drugs can trigger an otherwise latent mental illness: For example, a person who smokes marijuana may experience paranoia for the first time as part of a substance-induced psychosis.

PsychCentral, addressing the topic of substance abuse and bipolar disorder, notes that substance abuse is more common in people with this diagnosis than any other Axis I psychiatric disorder. Further, having bipolar disorder may influence the type of drugs abused. Up to 30 percent of persons who abuse cocaine, and a considerable portion of alcohol and amphetamine users, meet the criteria for bipolar disorder. The linkage of a disorder with a preference for a specific drug or drug type (such as stimulants, tranquilizers, and pain relievers) needs further exploration. As research and clinical feedback develops in the area of dual diagnosis, prevention and treatment efforts can expand.

Although the relationship between substance abuse and a mental health condition may be unknown, one thing is clear – both conditions must be treated simultaneously. Caring for one condition and not the other would be akin to taking the leg off a table and expecting it to still stand. It is well accepted in the dual diagnosis treatment community that continuing substance abuse worsens the underlying mental illness.

Drug abuse is not conducive to a person staying on his psychiatric medication regimen or going to his doctor appointments. In addition, a mentally ill person who abuses drugs is at an increased risk of self-harm and violence towards others. From a treatment standpoint, the person becomes more difficult to treat and may end up on a downward spiral – one that can be fatal.

For persons with a mood disorder, stabilization is usually a prerequisite to providing treatment and having the person maintain attendance in a rehab program. Although there is a host of treatment complications that a dual diagnosis can present, rehab is effective but should proceed along a two-pronged path designed to concurrently treat the substance abuse and all mental health issues.

Effective treatment

Help Someone with AddictionThe Depression and Bipolar Support Alliance, a resource site for persons afflicted with these disorders, discusses the hallmarks of dual diagnosis treatment. Treatment of co-occurring disorders combines traditional substance abuse treatment methodologies with psychiatric care for the specific diagnosed mental health disorders. In addition, skilled and experienced treatment professionals will address the particular needs that arise from the combination of the specific drugs of abuse and the diagnosed mental illnesses. The Alliance provides insight into what a person with a mood disorder can expect from dual diagnosis treatment and is referenced here for purposes of elucidation of dual diagnosis in general.

For those individuals who enter dual diagnosis rehab having recently abused illicit substances, detox will be necessary. An inpatient treatment program may offer detox services on site, while an outpatient program may work in conjunction with a local hospital or detox facility. A rehab program can organize the detox program, or, in some cases, a new client will enter rehab ready for abstinence maintenance treatment after having detoxed elsewhere.

Prevailing wisdom in the addiction treatment community is that a person with a co-occurring disorder should be treated at a specialized dual diagnosis rehab center. The dual diagnosis rehab experience is different from a program that only treats substance abuse. Firstly, a dual diagnosis facility will necessarily include a staff psychiatrist or work in close connection with a local psychiatrist. The psychiatrist may also be a board-certified addiction specialist. If not, the client may work separately with another doctor to treat the substance abuse, as necessary. For instance, an individual recovering from opioid abuse, such as abuse of heroin or prescription pain relievers, may receive medication-assisted treatment like methadone or Suboxone. An addiction treatment specialist will be involved in that process, to both prescribe the medication and manage the treatment program.

 
 

Psychotherapy is a cornerstone of both substance abuse treatment and mental health care services. A person in a dual diagnosis program may address these issues with the same therapist, although treatment should always be tailored to the individual and may, for warranted reasons, involve separate therapists (although the two therapists would confer professionally about the client’s progress). It is most advisable for psychotherapy to continue after completion of an inpatient or outpatient program. Psychotherapy is a critical part of an aftercare program.

Group recovery is another form of therapy, and it has proven effective in the treatment of both substance abuse and mental health disorders. These support groups may be self-directed (for example, a 12-step program) or led by a psychotherapist. The benefit of group recovery is that similarly situated persons can empathize with one another and provide reciprocal support. The group may have a dual diagnosis focus during primary rehab treatment, but if such a group is not available for aftercare, the recovering person may join separate groups for each disorder.

Attendance at group recovery meetings is a critical part of aftercare. Such participation can last a lifetime in some cases. Many individuals in long-term recovery credit group support with their ongoing success.

After graduation from a rehab program, the recovering person may opt for residence in a sober living home. These living facilities do not provide treatment. The unifying goal of a sober living home is for all the residents to be drug-free, which is beneficial for a person with a mental illness. It is important to note that some sober living homes may have a zero-tolerance policy for drugs. This presents a complication for recovering persons in a medication-assisted treatment plan where opiate medications, such as methadone, are prescribed. Oftentimes, the zero-tolerance policy, if in effect, usually applies only to addiction-forming drugs. Persons on psychiatric medications, such as antidepressants or anti-anxiety medications, will usually not be excluded from a sober living home on this basis.

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Mental Health Treatment was last modified: November 22nd, 2016 by The Recovery Village