Pubdate: Tue, 13 Sep 2011 Source: Missoulian (MT) Copyright: 2011 Missoulian Contact: http://www.missoulian.com/ Details: http://www.mapinc.org/media/720 Author: Katherine Kosma, The Missoulian Note: Katherine Kosma is a social worker at St. Patrick Hospital Mental Health. NURSE’S NOTES: TREATMENT COMBINED FOR ‘DUAL DIAGNOSIS’ When a person suffers from a mental illness and has problems with mood-altering substances - drugs such as prescription medications, cocaine, ecstasy, heroin, marijuana, etc. and alcohol - we call this "dual diagnosis." Professionals often call this substance abuse or substance dependency, depending on specific criteria. Mental illnesses that often occur with substance abuse are mood disorders such as depression and bipolar disorder, anxiety disorders such as panic disorder and post-traumatic stress disorder, schizophrenia and personality disorders. The American Medical Association notes that "roughly 50 percent of individuals with severe mental disorders are affected by substance abuse" and "37 percent of alcohol abusers and 53 percent of drug abusers also have at least one serious mental illness." Another study conducted by the Epidemiologic Catchment Area found that 47 percent of people with schizophrenia had a substance abuse disorder and 61 percent of those with bipolar disorder had a substance abuse disorder. Dual diagnosis is also widely seen in our veteran population, homeless population, and jail and prison inmates. It is uncertain which comes first - the mental illness or the substance use. Many believe the mental illness is first, leading the person to self-medicate with mood-altering substances. For example, people with anxiety disorders will find themselves relying on substances to cope, which often makes the axiety disorder worse. Other times, especially in adolescents and young adults, people find themselves using increasing amounts of substances, resulting in emotional and mental problems. While active in substance abuse, they will often have unexplained anxiety and depressive symptoms, such as beginning to isolate themselves and losing interest in activities they once loved. However, regardless of which comes first, both mental illness and substance abuse must be treated. Most often, the conditions affect the person simultaneously and feed off of each other. If only one problem is treated, the other often becomes worse, hindering recovery and preventing the person from addressing core issues. When one abstains from substances, symptoms of the mental illness will often become more noticeable and difficult to cope with, which can result in the person using substances again. Those with dual disorders are at much greater risk for relapse. Due to the complexity of the disorders, integrated services need to address substance use and mental health symptoms together. This is critical for recovery. Patients can use a long-term community-based process to aid in recovery. When approached in stages and tailored to the individual, services include peer and family support groups, consistent motivational interventions and counseling. Furthermore, many who struggle with dual disorders may have difficulty with medication compliance, relationships, social activities and basic coping skills. It is critical to address stress management, social networks, jobs, housing and other activities. There is hope for those struggling with dual disorders. Through education and appropriate treatment, patients can learn the skills necessary to live a healthy and fulfilling life. - --- MAP posted-by: Richard R Smith Jr.