Rehab for Dual Diagnosis
Why Residential Treatment Program is essential

Rehab for dual diagnosis treats both the substance use disorders and any co-occurring mental health issues, by combining addiction treatment services with mental health services. Dual diagnosis programs employ a collaborative, multidisciplinary approach to integrate each and every aspect of a client’s unique condition into a united, comprehensive treatment plan for recovery.
Like many other phenomena, substance addiction exists on a spectrum. Milder forms of addiction may lead to disruptive social, monetary and/or health effects, while more severe forms of addiction can overturn lives, and even become deadly. Yet amid this variety of outcomes, one key variable can make addiction far more difficult to treat, and therefore more dangerous: A co-occurring mental disorder.
The existence of two inter-related afflictions – substance addiction and mental health issues – means that the treatment of one disorder is necessarily incomplete without the simultaneous treatment of the other. Rehab for dual diagnosis aims to accomplish both objectives at the same time, so that clients can genuinely recover from a combination of issues that had previously seemed intractable.

What is dual diagnosis?

Dual diagnosis (also known as co-occurring disorders) is the term used when a person has a substance use disorder as well as a mental disorder. According to the 2018 National Survey on Drug Use and Health published by SAMHSA, over 9 million Americans had both a mental illness and at least one substance use disorder. Despite the prevalence of co-occurring conditions among people with a substance addiction, many rehabilitation centers are only able to treat the physical and emotional aspects of withdrawal. This means that underlying mental health conditions remain an issue for dual diagnosis patients – often resulting in relapse once they return home from treatment.

The link between mental health & addiction

According to NIDA’s research report series on comorbidity, underlying mental health conditions – such as depression, bi-polar disorder, anxiety and PTSD – can cause or contribute to substance abuse. Heavy use of drugs such as cannabis can increase the risk of developing schizophrenia or psychosis. At the same time, individuals with mental illnesses are more likely to develop a drug dependency.

Substances are used as a way of escaping reality – and once the high wears off, the user finds that the symptoms of their mental illness return. This kind of self-medicating may provide temporary relief, but it does nothing to solve the problem. Moreover, it will almost inevitably lead to a worsening of the mental health condition and, over time, the development of a substance addiction. Self-medicating can also delay the proper diagnosis and treatment of underlying mental health disorders.

People with co-occurring disorders often have multiple combinations of the various mental disorders, such as the following:
Those with co-occurring disorders are at a significantly elevated risk level for suicide. Negative feelings and self-inflicted harm often coincide with substance abuse, which in turn leads many down the path toward suicide. This increase in suicide attempts mostly occurs when a person with a drug dependency tries to stop using drugs, as well as when they experience psychosocial or financial loss.
People with borderline personality disorder, anti-social behavior, or paranoia, often embrace disruptive ways of thinking and feeling – without necessarily realizing how they are changing. When anxiety, mood, or psychotic disorders are involved, the effects can be even worse. People with personality disorders worsen their condition when drugs are also involved – and identifying such conditions also becomes more difficult, as some people use drugs to self-medicate during trying times.
Many of those who suffer from these disorders attempt to self-medicate with a corresponding type of drug – for example, stimulants to deal with depression, or sedatives to cope with anxiety. Yet this tendency can lead to dangerous outcomes; from bipolar disorder and cyclothymia, to panic attacks and phobias, all forms of mood disorders are made more severe if the affected person has a co-occurring drug or alcohol addiction.
Likewise, a drug habit can also worsen the condition of people who suffer from schizophrenia or other psychotic disorders. Certain drugs can induce various psychotic reactions among people living with these conditions, and subsequent withdrawal from substances such as alcohol can create episodes that also resemble psychosis.
Those suffering from AD/HD tend to be somewhat disorganized, have difficulty avoiding distraction, and are more likely to conduct risky activities without thinking of the dangers ahead. A co-occurring drug addiction can add an extra dimension of volatility to this condition – which in turn also makes treatment far more difficult, as AD/HD drug addicts may have a hard time focusing during therapeutic sessions.
To ease their pain and anxiety, people suffering from PTSD are more likely to consume hard-hitting (and therefore dangerous) drugs, such as cocaine or other opioids – although marijuana or alcohol abuse is also very possible. Unfortunately, taking drugs or alcohol actually increases the chances of further or repeated trauma, thereby extending the cycle of hardship.

Pathological gambling drives people to make risky wagers in order to fulfill their inner needs. A certain class of gamblers, called “action” gamblers, are in it for the excitement; another type (so-called “escape” gamblers) seek to escape from stress or negative emotions. As a result, gambling can function for many people as a stimulant similar to cocaine or amphetamines – and for others a tranquilizer or sedative. Some pathological gamblers use drugs as a means of reaching a similar psychological state.

What is dual diagnosis rehab?

Rehab for dual diagnosis is specifically designed to address the additional complications that arise when a substance addiction is accompanied by one or more mental health issues. Special familiarity with co-occurring disorders is required to accurately assess and diagnose individual cases, so as to treat them properly. The course of therapy is also markedly different in situations involving dual diagnosis, making inpatient dual diagnosis treatment centers especially valuable to the recovery process.
Not all rehab centers have the experience and resources to adequately treat mental health disorders alongside substance addictions, and are therefore not fully equipped to provide comprehensive treatment to those who may need this extra level of care. By providing integrated dual diagnosis treatment programs to address both of these core issues, rehab for dual diagnosis aim to address these shortcomings, significantly lowering the likelihood of relapse.
Who should attend dual diagnosis residential treatment
Anyone who is dealing with drug or alcohol addiction in combination with mental health issues can benefit from dual diagnosis residential treatment. Unfortunately, due to the interconnectedness of the two conditions, it can be difficult to recognize that you need a dual diagnosis treatment program. You may feel that you’re sad because you’re drinking too much, and therefore you don’t have depression. Or that you only take drugs because you’re feeling anxious, and therefore you don’t have PTSD. It’s for this reason that a comprehensive assessment is vital when determining the best treatment option.
Individuals with the following conditions are recommended to seek treatment at an inpatient dual diagnosis treatment centre:
  • People with active mental health issues, such as unresolved trauma, anxiety, depression or psychotic symptoms 
  • People who use drugs or alcohol to cope with unpleasant feelings
  • People with a history of childhood trauma and/or abuse
  • People who require “as needed” medication and overnight support e.g. those with post-traumatic stress disorder (PTSD) symptoms such as nightmares and sleep problems
  • People with poor management of emotion, memory, and cognitive functions 
  • People with a history of failed attempts at an inpatient or outpatient rehabilitation, for either addiction or mental health disorder
  • People with a family history of substance abuse and/or mental illness
depressed women hand hold medicine with a glass of water, healthcare and medicine recovery concept

Treatment models for dual diagnosis programs

Generally, treatment for a patients’s substance addiction, mental health, and medical problems is provided in separate treatment systems. Since these services are in different locations, people in need of such services often have to pick one or the other and go back and forth between the different systems. They even often have to coordinate their own care, which can be difficult when their issues are active. As a result, they end up falling through the crack or fail to follow up with their treatment.
Nowadays, the majority of programs recognize the downside of the separate system approach for dual diagnosis patients and structure integrative elements into their curricula. Currently, treatment models for patients with co-occurring disorders broadly fall into four categories:
  • Serial treatment: Treatment is given sequentially, in separate modules with no communication between the treatment providers
  • Simultaneous/parallel: The rehab addresses all co-occurring conditions, using complementary but otherwise uncoordinated methods
  • Coordinated/parallel: Using connected and coordinated but nevertheless separate systems, all conditions are treated at the same time with a formal agreement from all parties involved
  • Integrated care: Treatment is given by an assigned team of clinicians within the same program to treat all underlying conditions, for the added benefit of integrated medical services
Whilst research is still developing in this field, a growing body of findings suggest that providing integrated treatment can improve outcomes for patients with co-occurring AOD (alcohol and other drug use) problems and mental health conditions.

What to look for in a dual diagnosis treatment program

Although research supports the need for integrated dual diagnosis treatment programs, high-quality care depends on a number of factors. When selecting between dual diagnosis rehab options, it is important to look for facilities with the following characteristics:
  • Therapists and doctors with experience in co-occurring disorders, to avoid misdiagnosis
  • Qualified health professionals to prescribe, dispense, and monitor medications
  • The ability to design a smoothly integrated treatment plan that takes into consideration the balance between cause and effect 
  • Provision of mental (and medical) health support while you are going through the physical difficulties of detox
  • Complementary treatment systems to address substance use disorders and other mental illnesses together

How long is rehab for dual diagnosis?

The average rehab program lasts for 30 days. Due to the complex and clinically challenging nature of co-occurring disorders, however, people with dual diagnosis are generally advised to undergo a 60-day or 90-day program of residential treatment. A standard schedule of therapy typically involves 15-20 hours per week of focussed treatment, although this total can be modified depending on need.

At most inpatient dual diagnosis treatment centers, you will have the opportunity to extend your stay in order to treat your substance abuse and mental health issues concurrently. Longer rehab stays have been proven to be more effective when it comes to preventing relapse once you return home from treatment.

Most common dual diagnosis treatment programs

As a depressant, alcohol has long been known to slow down certain types of brain activity. However, research by the Anxiety and Depression Association of America has found that nearly 20% of Americans with depression or anxiety disorder also battle with drug dependency. This link between substance use and mental health issues underscores the need to address both situations simultaneously through professional rehab for dual diagnosis.

Several studies have shown consistent prevalence of depression among people with alcohol use disorders. Due to the effects of alcohol on the body, it can be difficult to determine whether depression is a result, or a cause, of alcohol addiction. Alcohol can alter the brain’s neural pathways, changing the balance of dopamine and serotonin. Differing levels of these two chemicals can cause highs and lows, as well as triggering the need to drink, or generating feelings of depression.

There are many ways that drug abuse can affect or contribute to depression. Drugs such as cannabis, cocaine, and prescriptions stimulants are commonly linked to depressive episodes. When used for long periods of time, many drugs – both illicit and over-the-counter – can cause depressive symptoms to appear during intoxication or withdrawal. Since withdrawal symptoms that are similar to mood disturbances may result from substance addiction and not necessarily an underlying depression, a period of time should elapse before depression is diagnosed.

How dual diagnosis rehab works

Symptoms of addiction and withdrawal can be similar to mental health problems, making it sometimes difficult to determine whether a person has a co-occurring or independent mental health issue while they are an active drug or alcohol user. For this reason, it is important that the affected individual undergo a detox process first, before a final diagnosis is made.
Depending on the type of drugs, substitute medications for central nervous depressant drugs (such as opioid and alcohol) may be used to alleviate withdrawal symptoms. Adjunct medications may also be used to treat co-occurring mental health symptoms, such as depression and anxiety.
After a period of abstinence, it’s important that rehab professionals observe and distinguish between the effects of substance withdrawal and the symptoms of co-occurring mental disorders. It is recommended that treatment professionals wait 2-4 weeks after acute withdrawal before diagnosing a mental illness, in order to create an accurate dual diagnosis treatment program.
People with co-occurring disorders can benefit from a variety of behavioral treatment programs. There are several types of behavioral therapies which tend to be effective for people with different underlying conditions:

Cognitive behavioural therapy is a form of psychotherapy that is effective for those suffering from mood disorders and anxiety, and is aimed at changing their negative thoughts and habits with more positive ones.​

Dialectical behaviour therapy was initially used to treat people with borderline personality disorder (BPD), as it seeks to redirect their thoughts away from the ideas of self-harm, suicide, and drug use. The technique has since been adapted to treat people suffering from addiction, however, as many people with BPD are also involved in patterns of substance abuse. The therapy is now also used to promote abstinence, and to reduce the length and adverse impact of relapses.​

Exposure therapy is designed to help those with certain anxiety disorders such as PTSD or phobias. It works by gently exposing the individual to a simulated situation, similar to the kind of stimulus which would potentially trigger an emotional response – but doing so in a controlled and safe environment, as a way of reducing their sensitivity and strengthening their coping mechanisms.​

An additional layer of Eastern-influenced holistic care is often added to the luxury rehab experience in Thailand – so that treatment addresses not only the addiction itself, but also your mind, body and spirit. The effect of this east-meets-west approach is far more than merely stylistic; it presents a healthy and satisfying model for living that you can follow after you complete your stay as an inpatient.​

Contingency management (or motivational incentives) can be used in addition to other treatment programs, as it introduces a reward system for good behaviour. Each psychological achievement is treated as a step toward recovery, and can be rewarded with vouchers or cash as an incentive for progress.​

Inpatient dual diagnosis treatment centers
While both inpatient and outpatient care are available, patients with co-occurring severe mental illness and substance use disorders are best suited to dual diagnosis residential treatment for a number of reasons:
  • Inpatient rehab provides close supervision for substance abuse and acute psychiatric symptoms, offering medical and clinical support 24/7
  • Multidisciplinary teams of medical, mental health, and addiction professionals work within one setting, where they can coordinate to provide integrated disorder treatment
  • Rapport can be built between rehab staff and clients as they get to know each other
  • Clients can receive individualized care, focusing on recovery without distractions or temptations from their usual environment
  • Clients can go through their recovery journey at their own pace in a safe and secure environment
  • Group work ethos and peer support is stronger in inpatient treatment centers, as clients share their stories, seek advice, and support each other
  • Clients can receive tailored detoxification treatment, including medication, to manage withdrawal symptoms and prevent relapse
  • Clients can receive a relapse prevention plan along with ongoing support, to ensure a long-lasting recovery

Dual diagnosis treatment programs in Thailand

As a world-renowned rehab destination, Thailand offers a range of treatment options at far better prices than can be found in Western countries such as the US, UK, and Australia – even while offering comparable levels of care. With its well-trained therapists, Thailand has the most advanced rehab industry on the continent.
Counsellors in Thai rehabs typically come from Western countries, receiving excellent education as they develop high-level skills and experience. Facilities across the country usually offer a resort-style and tranquil setting, with additional comforts depending on the type of rehab you select.
Undergoing dual diagnosis residential treatment in Thailand can also give you a chance to experience the country’s natural and cultural charms, far away from the stresses of life back home. The new and welcoming environment often leaves a lasting impression on visitors, and can help to re-calibrate your mindset with fresh perspectives as you recover.

Are you ready to get help for your dual diagnosis? Call us for a free consultation with one of our clinical coordinators.

Author
Cameron Brown
Psychologist
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