What does Dual Diagnosis Mean?
A person who has a Dual Diagnosis is someone who has both a mental illness and a substance abuse disorder. Either illness can come first. In some cases, a person with mental health issues will turn to alcohol or drugs to try and cope. In other instances, alcohol or drug use can lead to mental illness. Dual diagnosis effects almost 9 million people a year. A person with a mental health condition is two times as likely as a mentally healthy person to suffer from substance abuse.
For someone that has a Dual Diagnosis, it is very important that you treat both the mental illness as well as the substance abuse. If you only treat one, it will act as a merry-go-round, making one condition worse and perhaps, relapsing on the other. It will be a continuous cycle. The old way of thinking where doctors would tell you they couldn’t treat your depression because you are also using drugs and/or alcohol is outdated. Both illnesses need to be attended to.
Conditions that May Co-Occur
There are many disorders that can Co-Mingle together, although some are more common than others. The most common Co-Occurring disorders that are seen with substance abuse are:
• Anxiety disorders
• Eating disorders
• Bipolar disorder
• Personality/mood disorders
In another category, certain mental illnesses “attract” certain substance uses. Some examples includes:
• Bipolar and Alcoholism
• PTSD and Opioids
• ADHD and Alcoholism
• Depression and Cocaine
Signs and Symptoms of Dual Diagnosis
Some common signs and symptoms to look for when trying to determine a Dual Diagnosis include:
• You can’t remember the last time you were happy and drugs and/or alcohol were not involved
• You started drinking and/or using drugs to try and help manage stresses of every day life
• You have experienced trauma in your life
• Mental illness runs in your family
Treating Dual Diagnosis
Dual Diagnosis requires special care to make sure both conditions are being addressed. People can receive this type of treatment through Rehabilitation Facilities that offer treatment for both substance abuse and mental illness. Only treating one problem may put the person at risk for relapse.
Challenging circumstances and transitions are often troublesome and can generate painful emotions and a sense of hopelessness. Transformative change simply requires preparation, determination, a plan of action, a commitment to action, and the adoption of a novel approach and desirable behavior. Each year, countless Americans choose the route of professional counseling to help them face and overcome a seemingly enormous problem in their lives. Counselors provide directions and equip patients with the tools needed to pursue the path of personal growth. They offer short-term counseling to individuals overwhelmed by personal, professional, familial, academic, and mental health difficulties.
Substance Abuse and Behavioral Counseling
A substance abuse counselor treats issues involving drug and alcohol abuse and helps individuals identify problems and behaviors emanating from their addiction. These counselors also reach out to family members who are impacted by the addictive behavior of relatives or loved ones. An addiction counselor offers individual or group therapy sessions and conducts addiction-prevention programs (i.e. gambling addiction).
Mental Health Counseling
A mental health counselor is a highly-skilled professional who treats individuals that are experiencing emotional and mental distress. A mental health counselor’s services are available to individuals, groups, families, and couples. A holistic approach is employed, with the counselor keeping tabs on patients’ mental, behavioral, and physical health and examining the environmental and external influences to which they are subjected. A mental health counselor treats several issues involving illness, mental disorders, relationships, and families.
Mental Health Counselors Generally Utilize the Following Principles:
Guide patients towards emotional well-being
Cope with everyday problems and daily life
The Counselor gathers data via tests, observations and interviews and then determines the most effective method to assist clients. To enable patients to avoid, treat and address mental or emotional impairment, a mental health counselor helps them establish goals and create plans. He or she may be a specialist in a specific area such as marital counseling, substance abuse, career counseling or focus on a specific age group.
Mental Health Counseling is Available for a Variety of Issues Including:
Relationship and marital problems
Substance abuse and addiction
Mental health counselors often collaborate with other mental health experts, such as psychologists, psychiatric nurses, psychiatrists, marriage and family therapists, school counselors and social workers.
Marriage and Family Counseling
A marriage and family counselor assists individuals in understanding relationships, improving communication and finding a resolution to emotional crises.
Marriage and Family Counselors Treat Several Issues Including:
Behavioral problems in adolescents
Self-mutilation and suicide ideation
Child abuse and neglect
Vocational and Educational Counseling
School counselors help the elementary school through college-level students attain scholastic achievement, social and personal growth and plan for their career.
School Counselors Perform Numerous Tasks Including:
Assessment of students’ interests, personalities, talents, and abilities via aptitude evaluation tests, counseling sessions, and interviews
Implementation of career education programs
The assistance of students with learning disabilities, behavioral problems, or special needs
Developmental and preventive counseling
Coordination of drug and alcohol prevention programs
Domestic abuse screening
Improvement of parent-teacher rapport
Career counselors assist individuals in making productive career choices, achieving higher education, learning new skills, changing careers, relieving stress, and re-entering the workforce. They provide support to individuals coping with the loss of a job, career transition, or employment stress.
Other Tasks Performed by School Counselors Include:
Assessment of clients’ employment history, education, personality, training, talents, skills, and interests
Arrangements for achievement and aptitude tests to help individuals find a career that corresponds to their skills
Assistance with job hunting and with employment applications
Rehabilitation counselors help patients with mental, physical, emotional, or developmental disabilities realize personal and professional objectives and lead more fulfilling lives. The disabilities that rehabilitation counselors treat may be attributed to a number of causes, such as accidents, disease, birth defects or illness. The majority of rehabilitation counselors focus on a specific disability, such as head trauma, deafness, psychiatric disability, blindness, or spinal injury.
Rehabilitation Counselors Assist Patients in Numerous Ways Including:
Assessing their strengths and limitations by meeting with their clients’ employers, psychologists, physicians, and/or occupational therapists
Providing career, post-employment, and personal counseling
Ensuring good working conditions
Arranging for health care and job placement
Evaluating medical and academic reports
Providing job skills training
Helping clients live independently
Many mental health, substance abuse, and marriage and family counselors, especially those who are self-employed, accommodate their patients by accepting weekend and evening appointments.
As hardship related to the public health crisis continues into the second half of 2020, there is a societal mental health crisis looming. The most jarring marker of the virus’s toll on mental health will begin to present itself in the suicide rate. The impact of Covid-19 on these rates give specialists a sense of how extended uncertainty and anxiety affect people’s will to live. “There’s not only an increase in anxiety, but the more important piece is social isolation.” Matthew Nock, a psychology professor at Harvard continues “We’ve never had anything like this — and we know social isolation is related to suicide.” (Carey)
According to the World Health Organization “Close to 800,000 people die by suicide every year. Furthermore, for each suicide, there are more than 20 suicide attempts. Suicides and suicide attempts have a ripple effect that impacts families, friends, colleagues, communities, and societies. Suicides are preventable. Much can be done to prevent suicide at the individual, community, and national levels.” Personally speaking as a mental health professional and wellness advocate, wife, and mother of 3, I come across people daily who are suffering inside. Suicidal ideations do not discriminate so being aware of the warning signs is important along with taking other preventative measures to decrease the risk of death by suicide.
8 holistic approaches to suicide prevention:
Connect with those in your life. Check-in, be present, and let others know you’re there. Hint- Connect creatively if social distancing, utilize video calls and online communities. Strengthen your relationships with loved ones, self, and source.
Service to others. Volunteer work or mentorship is a great way to discover a sense of purpose while giving back in meaningful ways that make a difference.
Structure your days. Use a schedule and create a routine around things you enjoy.
Nature heals. Spend time outside when possible. Plants, animals, and water can also help us feel grounded. Utilize windows for natural light when inside.
Art and Music uplift the spirit. Sounds, colors, and vibrations have been used since the beginning of time to express emotion and communicate feelings we cannot easily put into words. Choose expressive art, uplifting music, or binaural beats.
Nutrition and Vitamins can dramatically affect your state of mind so eat and drink intuitively. Comfort foods are okay but make sure you’re getting the majority of your calories from energy-rich foods high in vitamins and minerals like vegetables, fruits, and whole grains. Iron, magnesium, omega-3 fatty acids, Vitamin B6, Vitamin B12, Vitamin D and zinc are also important for keeping an elevated mood.
Wellness plans should include daily practices and activities that help to attune your mental, emotional, physical, social, and spiritual health.
Safety plans are a good precaution to put in place for family or friends so there is a plan to turn to if and when someone has thoughts of suicide or other self-harming thoughts of behaviors including active addictions or domestic violence.
It may or may not come as a surprise that you or someone you know and love is suffering. In the United States alone, 132 Americans die by suicide each day according to the 2020 United States Suicide Facts and Figures. In today’s uncertain world, more and more people are experiencing symptoms of depression and other related mental health imbalances. Symptoms are heightened at this time after months of “social distancing” and the majority of people are feeling uncertain about what is to come. This can cause anxiety in addition to feelings of helplessness, hopelessness, extreme sadness, detachment from loved ones, loss of interests, or thoughts of self-harm, including suicidal ideation.
Suicidal Ideations are when someone suffering is thinking about, considering, or planning suicide. Ideations can range from fleeting thoughts to extensive thoughts, to creating a detailed plan to commit suicide. Once any of these thoughts are identified in oneself or others, it is important to seek support from loved ones and a qualified mental health specialist to put a safety plan and a wellness plan or treatment plan in place. At a time when social distancing is mandated, we get to approach connection more creatively. The connection can save lives so now more than ever, lean in, and be present with each other when times are hard.
The National Suicide Prevention Lifeline is 1-800-273-8255.
Carey, Benedict. “Is the Pandemic Sparking Suicide?” The New York Times, The New York Times, 19 May 2020, www.nytimes.com/2020/05/19/health/pandemic-coronavirus-suicide-health.html.
“Suicide Data.” World Health Organization, World Health Organization, 27 Sept. 2019, www.who.int/mental_health/prevention/suicide/suicideprevent/en/.
CDC, 2018 Fatal Injury Reports (accessed from www.cdc.gov/injury/wisqars/fatal.html on 3/1/20). Find additional citation information at afsp.org/statistics.
By Lea Hummel, Divinity Recovery
There are a number of different schools of therapy and two major modes of therapy. Space limitations prevent mentioning every specific type of therapy, but there are several different major paradigms or schools of therapy that can be used in the treatment of substance use disorders. These schools include:
The psychodynamic paradigm of therapy: This paradigm was originated by the famous psychologist Sigmund Freud. Typically, the approach of this school of thought is to try and ascertain how the results of interactions during childhood relationships lead to problems in later life. Most often, this school looks at unconscious mental processes that are played out in everyday behavior. At one time, this paradigm was the most common school of therapy; however, over the years, it has generally lost a significant portion of its popularity. Part of the reason is that traditional psychoanalysis in the Freudian sense is very lengthy and expensive. Today, briefer forms of psychodynamic therapy are more popular, and there is evidence that they can be useful in the treatment of substance use disorders. Individuals who are interested in exploring how the early relationships may have affected their substance use and other issues, and who are interested in understanding their motivations, may find this type of therapy appealing.
The behavioral school of therapy: This school of therapy attempts to directly treat behaviors without trying to develop much insight into motivation as is done in the psychodynamic paradigm. For instance, the development of medications like Antabuse that result in a person becoming violently ill if they take the medication and drink alcohol is based on the principle of aversion therapy that comes directly from the behavioral school of psychology. Behavioral techniques are often combined with other forms of therapy to enhance their effectiveness. It is rare for anyone to engage in strictly behavioral therapy.
Cognitive therapy: This paradigm explores the individual’s thinking patterns, attitudes, and expectations as they relate to behavior. The cognitive paradigm of psychology has risen in popularity as a direct reaction to both the psychodynamic and behavioral schools of psychology. In addition, the style of therapy that is most commonly used in the treatment of substance use disorders and probably can claim the most research support for its use is known as cognitive Behavioral Therapy (CBT). CBT applies the principles of cognitive psychology and behavioral psychology.
The humanistic school of therapy: The humanistic school of psychology was originated by the famous psychologist Carl Rogers who believed that the principles of psychodynamic psychology and behavioral psychology lacked a sense of real understanding of people. Humanistic psychology and humanistic therapy strive to help individuals “be all they can be.” The paradigm views many issues, such as substance use disorders, as situations that occur because people have a false impression of what is important in their lives, what types of things are worthy of striving for, and they place too much emphasis on what other people think. Even though Carl Rogers was the first famous psychologist to actually allow formal research to be done on therapy, and certain humanistic principles have been demonstrated to be very important in the success of therapy, therapists rarely adhere to a formal humanistic approach in the treatment of substance use disorders. Instead, most therapists apply Rogers’s notions of being empathetic, being genuine with clients in therapy, and having unconditional positive regard for clients in therapy in their treatment of individuals with substance use disorders. These three qualities emphasized by Rogers have been demonstrated to be important in the success of any type of therapy.