Understanding Dual Diagnosis: How to Deal with Resistance in Clients

Motivational Interviewing (MI) is a brief treatment approach designed to help patients develop an intrinsic motivation to change addictive behaviors. Many people turn to alcohol or drugs to cope with difficult emotions, such as loneliness, depression, or anxiety. However, HelpGuide's free Emotional Intelligence Toolkit can teach you how to manage these feelings without relying on substance use. Substance use disorders (SUDs) include both substance abuse and dependence.

A person struggling with a substance use disorder and mental health condition is said to have co-occurring disorders, also known as dual diagnosis. This is defined as alcohol dependence with one or more psychiatric comorbidities. Studies have found that dual diagnosis is common among those with spinal cord injury (SCI), with incidence rates ranging from 15-70%. When imaging is used to determine the co-occurrence of brain injury with SCI, rates range from 16-24%.

When post-traumatic amnesia is added as a diagnostic factor, rates increase from 42-50%. Despite the frequency of brain and SCI occurring simultaneously, this dual diagnosis tends to be undiagnosed or undocumented and therefore often not adequately addressed during rehabilitation of SCI. Dual diagnosis (DD) has been defined as comorbidity of at least one disorder from the use of substances (SUD) and severe mental illness (SMI), especially those included in the psychotic and affective clinical categories. Alcoholics often abuse other substances, such as crack, nicotine and even opiates.

Estimates of comorbidity among alcoholics, gender preferences for addictive substances, and patterns of progression vary widely. Patients with psychotic disorder and alcohol dependence should be encouraged to address their alcohol consumption and may benefit from motivational, cognitive behavioral therapy (CBT), family and non-confrontational approaches. Structured environments may offer some advantage for patients with psychotic comorbidities. Another challenge in treating alcoholics with comorbid conditions is impulse control disorders (ICD). Also known as “behavioral addictions”, ICDs include pathological gambling (PG) and many other conditions.

Of interest in the treatment of alcoholics is evidence that patients with PG may benefit from treatment with naltrexone. Studies have found that attendance at dual recovery therapy (DTR) can contribute to abstinence among this dual-diagnosed population by providing social support, a forum to learn from the shared experiences of others, and the opportunity to help yourself by helping others. A person diagnosed with substance abuse and another mental disorder may be particularly challenged by the social difficulties of a dual diagnosis. Adequate treatment should address the social struggles of a dual diagnosis, as well as the disorders themselves. This approach has provided significant improvements in the treatment of patients with a dual diagnosis. A dual diagnosis carries a whole set of unique problems, and understanding these issues is key to treatment and recovery.

Traditional substance abuse treatment programs are often conflicting, emotionally charged, and require total abstinence and a large amount of reading and writing. An interaction between both conditions can complicate a person's recovery, resulting in a less favorable treatment outlook and a combined risk of negative health consequences without adequate treatment. The NICE Guidelines suggest specifically designed psychotherapeutic treatments, individual and group, for antisocial personality disorder (ASPD) and borderline personality disorder (BPD). Unless a significant cognitive deficit or change in medical status indicates the need for further diagnostic testing, the patient progresses through ongoing care without a formal diagnosis of brain injury. Because a person with a dual diagnosis may experience more extreme and chronic symptoms, they are more likely to neglect self-care.

It can be hard to resist temptation but it's important to remember that you'll be thankful you don't end the holiday with the feeling of guilt that follows a binge episode. The evaluation of long-term outcomes highlights the impact of comorbidities on the level of functioning, educational performance, occupation and social relations. A systematic review looked at current treatment options for concurrent TDU and BPD, including six studies examining the use of three psychosocial therapies (dialectical behavioral therapy, dual-approach scheme therapy, and dynamic deconstructive psychotherapy). The health consequences of a dual diagnosis depend both on the substance being used and on the mental disorder present.

The presence of a dual diagnosis can complicate the course of treatment a little but with better understanding and education this complex condition can be successfully recovered from.

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