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
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.