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Dual Diagnosis and Co-Occurring Disorders

Through scientific research, we have made many great advances in understanding the nature of alcohol and drug addiction, which has led to greatly improved treatment for these problems. For many years, the mental health profession debated whether addiction was a unique problem, or merely a symptom of underlying psychological problems. The belief was that if the underlying problems were treated, the symptoms would disappear. We now know that such a model is false, and that addiction is a real, brain disease, with a unique etiology, course, prognosis, treatment, and recovery. But, having recognized that, we know that it is a complex illness, and it does not exist in a vacuum. There is a fragile interaction between biological, psychological, social, and spiritual factors which all must be assessed, and treated when problems are evident.

The terms co-occurring disorder, or dual diagnosis, indicate that for many people with a drug or alcohol problem, there is a psychological or emotional diagnosable problem existing alongside it. It is believed that as many as half of people with substance use disorders have mental disorders as well.

Conversely, suffering from a psychological disorder increases the probability that one will develop an addictive disorder.

Trying to find out which came first, the proverbial "chicken or egg" is almost impossible, and not necessary, as both disorders need to be properly diagnosed and treated simultaneously. The problems we see in treatment include depression, anxiety, ADD, post traumatic stress disorder, bipolar illness, and panic disorder. People with such problems will often turn to drugs or alcohol as a way of "self-medicating".

Unfortunately, the relief is only temporary, does not address the real problems, and ultimately creates a co-existing problem of it's own. What we do recognize is that treating only one part of the problem will most likely lead to relapse.

What we also find in our work is that working on sobriety and recovery is, for some, removing the self-medicating buffer or bandaid that they have on their emotional problems. When that is eliminated, patients often experience a flood of emotions, memories, reliving of past traumas, and anxieties. If these are not addressed, and treatment and coping skills instituted, the return to drugs or alcohol as a coping mechanism and means of escape is very likely to return. The co-existence of substance abuse problems with psychological and emotional ones exist in adolescents as well as adults.

Dr. Michael Dennis of the Lighthouse Institute states that "co-occurring disorders are the norm among adolescents entering substance abuse treatment…..if you really want to break the pattern you have to identify all of the co-occurring disorders and address them at the same time".

As with any problem, the key to a successful treatment plan begins with a comprehensive assessment and diagnosis of the problem. At the Thelma McMillen Center, this begins with our initial free consultation, where both the substance and alcohol use history is explored in detail, as are the psychological history and past traumas.

Previous attempts at treatment, both for substance abuse and addiction as well as for mental health are examined, and help assess the full scope of the problem. Present treatments and prescribed medications are reviewed, and consultation with existing providers is often established with the client's written permission. The specific stressors which lead to choosing to seek help now often provide valuable information.

Once admitted, one's history is further explored on Intake, and one's emotional issues are examined.

As a community based outpatient treatment center, connected to a premier and highly respected and recognized acute care hospital – Torrance Memorial Medical Center – we have the advantage of having tremendous community resources available to us.

When we identify a co-occurring psychological problem, we collaborate with local psychiatrists, psychologists, and therapists, and make appropriate referrals.

This community, team approach allows us to collaborate to insure that the full needs of the patient, both in regards to substance and alcohol abuse as well as emotional and psychological, are being attended to simultaneously. Treatment can include individual, couple, or family therapy, encompassing Cognitive Behavior Therapy, (CBT), Dialectic Behavior Therapy (DBT), and other modalities, as well as utilization of appropriate and non-addicting medications for the treatment of anxiety, depression, and bipolar disorders.

We have utilized this collaborative, community based approach to assess and treat alcohol and substance abuse problems when they co-occur with emotional disorders for the twenty two years we have been helping people in the South Bay, and our results have been excellent.

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