Dual Diagnosis. The Intersection of Substance Abuse and Mental Illness

Transcription

1 Dual Diagnosis The Intersection of Substance Abuse and Mental Illness

2 Table of Contents Chapter 1: What Is Dual Diagnosis?...3 Dual Diagnosis Is Common...4 Mental Illness and Substance Abuse Statistics...4 Vulnerable Populations...5 Symptoms of Dual Diagnosis...5 Common Substance Use Disorders...6 Alcohol Use Disorders...6 Opioid Use Disorders...6 Stimulant Use Disorders...7 Common Dual Diagnosis Mental Health Disorders...8 Anxiety Disorders...8 Depressive Disorders...8 Bipolar Disorder and Related Mood Disorders...8 Trauma Disorders...9 Obsessive-Compulsive Disorder...9 Other Mental Health Disorders...9 Chapter 2: How Is Dual Diagnosis Treated?...10 Different Treatment Components...11 Detoxification...11 Inpatient Rehabilitation...12 Medications...12 Psychotherapy...12 Support Groups...12 Supportive Housing/Sober Living...12 Chapter 3: Hope for People with Dual Diagnosis...13 Retreat s Dual Diagnosis Program...14 Assessment...14 Inpatient Detox...14 Residential Inpatient/Outpatient/Intensive Outpatient/Partial Hospitalization...14 Holistic Therapy...14 Family Education Program (FEP)...14 Specialized Programming

3 Chapter 1 WHAT IS DUAL DIAGNOSIS? 3

4 Dual diagnosis (also referred to as co-occurring disorders ) is a term used to describe someone who has both a substance use disorder and a mental health disorder for example, a person with generalized anxiety disorder plus an addiction to opiates. DUAL DIAGNOSIS IS COMMON There is a known relationship between mental illness and drug abuse. Research shows that abusing drugs and alcohol can bring on or worsen mental illness symptoms and, conversely, that having a mental health disorder can make a person more likely to self-medicate with drugs or alcohol to cope with their symptoms. 1 Both mental illnesses and substance use disorders are believed to be caused by overlapping factors, including genetic vulnerabilities, specific brain characteristics, and in some cases, early exposure to trauma/extreme stress. 1 Mental Illness and Substance Abuse Statistics Individuals who suffer from mental illness have much higher rates of substance abuse and dependence than the general population; this is especially true for those who have mood and anxiety disorders. Consider these statistics from a 2014 survey by the Substance Abuse and Mental Health Services Administration (SAMHSA): Nearly 44 million (18.1%) American adults (ages 18 and up) had some form of mental illness in the past year 20 million adults had a substance use disorder Nearly 8 million adults had a co-occurring mental illness and substance abuse disorder (dual diagnosis) 2 These numbers show that while people with some form of mental illness make up around 18% of the U.S. population, they make up nearly 40% of those who have a substance use disorder. 4

5 Vulnerable Populations Young people (adolescents and young adults), communities of color, lesbian, gay, bisexual, transgender, and questioning (LGBTQ) individuals, and people with disabilities are also at increased risk of mental and substance use disorders. This is often because of lack of access to care, inappropriate care, and environmental, social, and economic disadvantages. 3 Studies have shown that getting sober is often a critical part of mental health recovery for people with a co-occurring addiction and mental illness. 4 Reputable dual diagnosis alcohol and drug rehab programs help people with co-occurring disorders understand the effects of substances on their mental health and quality of life, and these facilities often play an integral role in helping people achieve and maintain sobriety. SYMPTOMS OF DUAL DIAGNOSIS Given the sheer number of possible combinations (there are hundreds of different mental disorders and drugs of abuse), the specific symptoms a person with a co-occurring addiction and mental disorder will experience can vary significantly. While there s no single dual diagnosis profile, there are common physical and behavioral symptoms of drug dependence, which can include: Feeling like you have to use the drug(s) regularly daily, or multiple times a day Needing more of the drug to get the same effect Feeling intense urges for the drug that take over your thoughts and disrupt your life Experiencing withdrawal symptoms when you stop taking the drug Spending all your money on the drug, and/or borrowing/stealing money to get the drug Failing to meet work, school, or home responsibilities because of drug use Spending a significant amount of time getting/using/recovering from the drug Driving, operating machinery, or doing other risky activities while under the influence Doing things you wouldn t normally do in order to get the drug Feeling guilty or ashamed of your drug use but not being able to stop Failing attempts at quitting If you re concerned that a family member or friend may have a substance use disorder, here are some signs to watch out for: Problems at work, home, or school, such as frequent tardiness or absences from school or work, a drop in grades or work performance, or loss of interest in school or work activities Physical health issues, including unexplained weight loss or gain, pale skin, bloodshot eyes, skin problems (such as sores or acne-like bumps), and bad breath or dental problems Neglected appearance, including disheveled hair and clothes, and general poor grooming Money issues, including sudden requests for money with no reasonable explanation, or discovering that money or valuables have been stolen from you; stealing from parents/close family members is common in cases of severe drug addiction Behavioral changes, including being secretive or withdrawn, or refusing to provide an explanation about their whereabouts 5

6 COMMON SUBSTANCE USE DISORDERS Substance use disorders can range from mild to severe. Drug and alcohol addiction can impact a person physically, mentally, financially, and socially. In the most severe cases, a person s very life could be at stake. Three of the most common substance use disorders include: Alcohol Use Disorders An estimated 17 million Americans meet the criteria for having an alcohol use disorder, and nearly 90,000 people die a year from excessive alcohol use. 5 Signs of an alcohol use disorder include difficulty or inability to control alcohol consumption, developing a tolerance, continuing to drink even when it s causing problems at home or work, experiencing alcohol withdrawal symptoms (such as shaky hands, headache, nausea), and engaging in risky behavior when drinking. Opioid Use Disorders Opioid addiction has reached epidemic levels in the United States in recent years. Consider these statistics: The number of opioid deaths has increased fivefold since An estimated 1.9 million people had an opioid use disorder involving prescription pain pills in In 2016, the majority (66%) of overdose deaths involved opioids. 6 An average of 115 Americans die each day from opioid overdoses. 6 Signs of opioid addiction include not being able to control or reduce use, using larger amounts over time, developing a tolerance, social withdrawal, problems at work or school, and spending an excessive amount of time or money to obtain the drug(s). Physical symptoms can include nausea and vomiting, muscle aches, fever, insomnia, and diarrhea. Many people who become addicted to prescription pain pills eventually turn to snorting or injecting the drug for a stronger high. 6

7 Stimulant Use Disorders Stimulants are a wide class of drugs that increase alertness, attention, and energy. Prescription stimulants have historically been used to treat attention hyperactivity disorder, obesity, and even depression. Plant-derived versions, such as cocaine, have been used for centuries, while synthetic versions, such as amphetamines, emerged more recently. Stimulant use disorders are common, and methamphetamine (meth), amphetamines (such as Ritalin and Adderall), and cocaine are some of the most commonly abused stimulants. In 2014, more than 900,000 people ages 12+ had a stimulant use disorder related to cocaine, and 476,000 had a stimulant use disorder related to use of other types of stimulants (excluding methamphetamine). 5 Symptoms of stimulant use disorders can increase not being able to control use, using more and more over time, developing a tolerance, and continuing to use the drugs even when they re interfering with your life and ability to meet obligations. Withdrawal symptoms after quitting or reducing use can include nightmares, sleep issues, increased appetite, and problems controlling physical movement. These are just a few classes of drugs that are commonly abused. Others include hallucinogens like ecstasy (MDMA) and LSD, cannabis (e.g. marijuana, hashish), and tobacco. The Study Drug Phenomenon Abuse of prescription stimulants like Adderall and Ritalin as study drugs has skyrocketed in recent years among high school and college students, who use the drugs to cram for exams or simply to have more energy. More and more young people are being diagnosed with ADHD today, which has in part led to the sharp increase in stimulant prescriptions. Consider these stats: In the last decade, manufacturing of stimulants has increased by a stunning 9 million percent. A study of 10,000 college students found that around 7% of students had abused stimulant drugs; the percentage at some colleges is much higher. Side effects of abusing these drugs can include increased heart rate, increased blood pressure, reduced circulation, gastrointestinal problems, blurred vision, irritability, and others. For students with a heart condition, these side effects could be deadly. Source: 7

8 COMMON DUAL DIAGNOSIS MENTAL HEALTH DISORDERS There are hundreds of different mental health disorders, and symptoms can vary significantly, depending on the condition. Common signs of a mental disorder can range from extreme mood changes, to problems concentrating, to extreme anxiousness, to feelings of hopelessness, to social isolation. Below are some of the most common types of mental disorders that can co-occur with substance abuse. Anxiety Disorders Anxiety disorders are common and affect nearly 40 million people in the U.S. 7 These conditions cause excessive fear, anxiety, or worry that interferes with a person s daily life and activities. Examples of anxiety disorders include obsessive-compulsive disorder (OCD), panic disorder, phobias, and social anxiety disorder. Depressive Disorders Depressive disorders are also very common and include several conditions, including major depressive disorder (MDD) and persistent depressive disorder (PDD). MDD affects an estimated 16 million adults in the U.S., while PDD affects an estimated 3.3 million adults. 8 Depressive disorders can cause feelings of sadness, hopelessness, or emptiness ; difficulty concentrating and making decisions; fatigue; feelings of guilt, worthlessness, or helplessness; loss of interest in activities once enjoyed; aches and pains, including headaches that won t go away; digestive problems; and suicidal thoughts. Bipolar Disorder and Related Mood Disorders Bipolar and related disorders cause dramatic mood swings (highs and lows) that vary from periods of feeling intensely happy to periods of feeling intensely depressed, sad, or hopeless. 8

9 There are several types of bipolar disorder, classified as bipolar I disorder, bipolar II disorder, and cyclothymia, which together are estimated to affect 2.6% of the U.S. adult population and a striking 11.2% of those aged Trauma Disorders Experiencing or witnessing a traumatic event(s), such as rape, child abuse, verbal or physical abuse, natural disasters, or violence in combat can lead to trauma disorders. Post-traumatic stress disorder (PTSD) is the most common such disorder, and is estimated to affect more than 7.7 million people in the U.S. 7 Symptoms of PTSD can include psychological symptoms like flashbacks, severe anxiety, and mistrust of others; mood symptoms like guilt, shame, or loss of interest; sleep problems like insomnia or nightmares; behavioral symptoms like agitation, irritability, hostility, hypervigilance, and startling easily; and self-destructive behaviors like drug or alcohol abuse, or self-injury. Obsessive-Compulsive Disorder (OCD) OCD is characterized by intrusive or unwanted thoughts, urges, or images. People with OCD often engage in ritualistic behaviors (such as compulsive hand washing) that help ease the anxiety of their obsessive thoughts. More than 2 million people in the U.S. have OCD, and most people are diagnosed before age OCD may run in families, and traumatic childhood events are thought to increase a person s risk of developing the condition. Other Mental Health Disorders These are just some of the many mental health disorders that often co-occur with substance use disorders. Others include schizophrenia, personality disorders (including borderline personality disorder, narcissistic personality disorder, and others), attention deficit hyperactivity disorder (ADHD), and impulse control and conduct disorders. 9

10 Chapter 2 HOW IS DUAL DIAGNOSIS TREATED? 10

11 Integrated, coordinated care is the ideal approach for individuals with co-occurring mental health and substance use disorders. Dual diagnosis treatment should address both the substance abuse and the underlying psychiatric disorder. Certain substance abuse disorders, such as alcohol addiction, can cause severe or even lifethreatening withdrawal symptoms during detox. Therefore, it s critical for heavy drinkers/drug users to have an experienced, credentialed medical team overseeing the detox process. DIFFERENT TREATMENT COMPONENTS While different treatment facilities vary somewhat in their program options and their philosophy about treatment (for example, some treatment facilities encourage/require involvement in Alcoholics/Narcotics Anonymous, while others utilize a purely science-based approach), reputable dual diagnosis treatment facilities should offer the following: Detoxification. This important first step in the treatment process involves allowing the body to metabolize or process any drugs or alcohol in the system. Inpatient detox is the safest and most effective method, since trained medical staff oversee the patient 24/7. Reputable rehab facilities will also ensure that a trained psychologist or psychiatrist is available to provide psychological care during the detoxification process. Complete detox can take up to 7 days, depending on the drug and the person s level of dependency. 11

12 Inpatient Rehabilitation. Inpatient rehab provides 24/7 medical and mental health care. The patient resides on-site for the duration of their care, which usually lasts a minimum of 28 days and up to 90 days. Inpatient rehab programs provide health services, medication, and therapies to help uncover the underlying causes of the substance use disorder. Inpatient rehab (versus outpatient rehab, in which the patient lives off-site) is generally preferable for patients with dual diagnoses. Medications. Some people may need medication to control their mental health symptoms. For example, a person with bipolar depression may need mood stabilizing medications, while a person with generalized anxiety disorder may need antidepressants or medications to relieve anxiety or tension. Certain medications may also help ease withdrawal symptoms during detox and help people in the recovery process. Medications should only be administered by trained medical professionals. Psychotherapy. Individual, group, and family therapy are often a vital part of the rehabilitation process. Cognitive behavioral therapy appears to be particularly helpful. 9 Dialectical behavioral therapy (designed to reduce self-harm) and eye movement desensitization and reprocessing therapy (EMDR) are additional forms of therapy that may be helpful, based on individual needs. Support Groups. Self-help and support groups are a critical component of the ongoing recovery process for many individuals. They provide a space for sharing feelings and frustrations, forming new healthy relationships, and being of service to others. 12-Step groups, including Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), are among the most popular support groups, but there are others, including the non-faith-based group Smart Recovery, and Double Trouble in Recovery, a 12-step fellowship for people with dual diagnosis. Supportive Housing/Sober Living. Sober living facilities are shared homes for people in recovery. They provide a safe, supportive environment to help ease the transition between inpatient/outpatient rehab to independent living. Sober living environments are completely drug and alcohol free, and residents are usually required to follow house rules, contribute to the house by doing chores, and participate in individual (and possibly group) counseling. Many sober living facilities have a therapist on-site or on-call. 12

13 Chapter 3 HOPE FOR PEOPLE WITH DUAL DIAGNOSIS 13

14 Research has shown that the best way to address co-occurring substance abuse and mental health disorders is to treat the two conditions together. It s critical for those with dual diagnosis to seek care from a reputable treatment facility like Retreat Premier Addiction Treatment Centers. INPATIENT & OUTPATIENT TREATMENT Retreat offers world-class inpatient and outpatient rehab services for those with co-occurring substance use and mental health disorders at our Lancaster County, Pennsylvania and Palm Beach County, Florida, alcohol and drug rehab centers. Our treatment options include: Assessment: Our intake counselors conduct a thorough assessment of each patient s circumstances and needs to create a custom treatment plan. Inpatient Detox: Under the close supervision of our skilled medical team, patients detox from drugs or alcohol the first step toward recovery. Residential Inpatient/Outpatient/Intensive Outpatient/Partial Hospitalization: Our robust rehabilitation programs include individual, group, and family counseling, medication management, and other services, based on each patient s needs. Holistic Therapy: Retreat offers additional holistic modalities to compliment our main addiction treatment services such as music, art, equine, recreation, culinary, gardening, yoga, chanting, drumming and more. These anciliary programs allow individuals to safely address and express their feelings in a secure environment. It also introduces patients to new forms of expression. Family Education Program (FEP): Our Family Education Program is designed to provide patients and their loved ones with vital information, tools and resources to help them understand the disease of addiction and the family dynamic role. Specialized Programming: We offer a diverse range of programs to meet the needs of all patients; our special programming includes gender-specific groups, LGBTQ services, cooccurring (dual diagnosis) treatment, and programs to meet the needs of veterans with PTSD. 14

15 Our dynamic team includes skilled substance abuse counselors, including primary and team therapists, treatment technicians, credentialed nurses, and outreach specialists. Retreat takes an individualized approach to care, tailoring treatment plans to meet each patient s physical, mental, emotional, and spiritual needs. Our substance abuse treatment programs are highly integrative, experiential, and personalized. We recognize that each patient has his or her own needs and personal history, and we focus on empowering patients and their families with the tools and information they need to forge a new path forward. Healing and wellness are at the heart of our mission. If you or a loved one needs dual diagnosis treatment, please contact us at Retreat to learn more or call our 24/7 helpline at (800) Walk-in visits are welcome and encouraged. Healing begins at Retreat Premier Addiction Treatment Centers. 15

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17 ABOUT RETREAT PREMIER ADDICTION TREATMENT CENTERS Retreat was established in 2011 in Ephrata, Pennsylvania, with the mission of providing a compassionate and spiritual environment where those suffering from the disease of addiction can begin the journey to recovery by providing enlightenment and education to the individual and their families. Since Retreat s founding, it has grown into a network of leading alcohol and drug treatment centers, helping people from all walks of life throughout the US. RETREAT S COMPASSIONATE TEAM We strive to create a warm, welcoming, supportive environment where patients can focus on healing. Retreat works with an expert clinical team that includes primary and team therapists, treatment technicians, team nurses, and outreach specialists. We embrace a holistic approach to substance abuse treatment, considering each patient s physical, emotional, and spiritual needs. OUR TREATMENT SERVICES Retreat offers inpatient drug and alcohol detox, partial hospitalization, intensive outpatient, family education programs, and more, as well as a range of holistic therapies to promote healing and wellness. Our holistic therapies include culinary, recreational, yoga, art, music, drama, gardening, & massage. Learn more about Retreat at retreataddictioncenters.com.