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Dual Diagnosis

What is the Best Treatment for Dual Diagnosis?

Over half of individuals diagnosed with a substance use disorder also reported symptoms of a mental health problem. Conversely, being diagnosed with a condition like anxiety disorder or depression greatly raises the risk of struggling with substance abuse, with a third of people diagnosed with a mental illness also showing signs of addiction, while over half of people diagnosed with severe mental health problems struggled with drug use.

A co-occurring mental health issue with a substance use disorder (and vice-versa) is called a dual diagnosis. But, what is the best treatment for dual diagnosis? And how do you seek help?

What is a Dual Diagnosis?

The link between drug use and mental health issues is very strong because of multiple distinct factors:

  • Addictive substances affect behavior and thinking. This can have a negative effect on self-esteem and exacerbate existing mental health issues. Addictive substances can also negatively impact cognition and problem solving and decrease a patient’s resilience to their mental health symptoms. 
  • Patients with mental health problems are more likely to become dependent on addictive drugs. Using drugs can help distract from certain mental health symptoms, but certain addictive drugs actively combat symptoms of mental illness (such as alcohol and anxiety) if only for a very short time. 
  • Both addiction and conditions like depression, anxiety, and psychosis are hereditary. In some cases, a person who is more likely to be affected by a traumatic event or a family history of depression may also be more susceptible to addictive substances. 
  • There is a strong societal and legal stigma against both mental health problems and addiction. Patients may have a harder time getting the care they need. In times of crisis, access to care is limited and restricted, increasing the risk of relapse. There are different forms of discrimination and stigma against identifying as a mental health patient or an addict. And rather than respond with compassion, outbursts caused by mental health issues or drug use may be treated violently in public. 
  • Both drug use and mental health problems are interdependent and can be causal in either direction. A patient with depression may develop an alcohol problem later, and someone who first begins developing a drinking problem might later show signs of depressive thoughts and suicidal thinking. 

A dual diagnosis or a co-occurring disorder can greatly complicate potential treatments. 

Trying to address a patient’s suicidal thoughts or anxieties without subsequently addressing their drug use and its physical and mental consequences is futile. 

Similarly, putting someone through rehab without a sensible program in place to help them seek therapy for their associated mental health issues will likely result in relapse and further complications, as a patient will have a hard time believing in their ability to get better, deepen their depression, and feel more self-deprecating. 

A holistic approach, a combined treatment that treats a person as a whole and takes all of a patient’s qualities and circumstances into account, is necessary for the successful treatment of a dual diagnosis. 

What is the Best Treatment for Dual Diagnosis?

There are multiple different elements to a dual diagnosis treatment plan. It combines cognitive behavioral therapy with treatment elements from substance use treatment, including residential rehab, long-term outpatient treatment, partial hospitalization, aftercare services, and more. 

Depending on a patient’s diagnosis and the severity of their symptoms, medication may also play a central role in the treatment process, especially for conditions like bipolar disorder and schizophrenia. 

For teens, finding the appropriate treatment environment is critical. A teen rehab facility with a focus on dual diagnosis will primarily have other teen patients, helping teens stay among their peers and emulating a supportive residential or school environment.

In addition to creating a safe space for teens to go through withdrawal symptoms and avoid relapse, these facilities are staffed by professional nurses and other medical personnel, including psychiatrists and therapists. Group sessions and one-on-one sessions help teens discuss their experiences, share breakthroughs, and learn how to cope with addiction and mental health disorders.

Inpatient vs. Outpatient Treatment

In an addiction treatment setting, most substance use treatment programs can be characterized as either inpatient or outpatient treatment programs. Inpatient treatment programs provide a space for patients to live and receive treatment alongside a unique day-to-day experience in a setting conducive to recovery, both physical and mental.

Outpatient programs are less involved but share much of the treatment structure – only that a patient must come to visit a clinic and set regular appointments, rather than living in an adjacent treatment environment. 

There are pros and cons to either approach, and both help patients recover and get better over time. Some patients don’t need inpatient treatment and would benefit more from a routine at home and at school than a fresh start. Others need a period away from their native environments to recalibrate and refresh. 

Long-term Lifestyle Changes and Support Systems

Even after the professional treatment process has ended, recovery continues. The long-term prognosis for a patient with both substance use problems and a mental disorder after initial treatment often relies on the quality of their support network.

Yes, there is an individual responsibility to look after oneself – but some mental health issues are chronic, with symptoms that can last a lifetime. We all need help, and loved ones struggling with bipolar disorder, severe depression, an anxiety disorder, or schizophrenic symptoms may need it more than the average person.

To that end, long-term treatment often entails rallying friends and family to provide support, whether that’s accompanying a patient to a therapy session, helping out around the home when they’re alone, calling an intervention in the case of a relapse, or signs of worsening symptoms.

Education is important as well, both on the part of the patient and their friends and relatives. Learn more about your loved one’s condition and the telltale signs of their disorder, and educate yourself on treatment processes, important caregiving tips, and self-care measures. Help them keep up their coping skills and stress management techniques by encouraging them to go back to the gym with you, cooking healthy meals alongside them, or picking up an old hobby together, like drawing or music.

Household measures, long-term support, and occasional interventions are important for managing a chronic mental health issue. But there are times when specialists are needed. Do not be afraid to talk to your loved one about seeing professional help.

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Dual Diagnosis

5 Common Co Occurring Disorders Among Teens

Common co-occurring disorders affect an estimated 9.2 million adults in the United States and millions of teens. According to government statistics, teens who have experienced a depressive episode were more than twice as likely to begin using illicit drugs or alcohol, and nearly a third of teens who had never tried alcohol before only did so after a major depressive episode.

It doesn’t stop at depression. Mental health disorders and substance use disorders are often intertwined, with one feeding into the other, creating a dangerous and vicious cycle. Teens are especially at risk, given their ongoing mental and physical developments, and the inherent risk of early drug use and its impact on a teen’s emotional and cognitive state.

Understanding how drugs and mental health issues go hand in hand can help families take better care of their loved ones, recognize risk factors and symptoms, and seek help as soon as possible. Stigma and vilification do nothing but make things worse; support, love, and information are key to helping our teens get access to the care they need to thrive and lead fulfilling lives.

What is a Co-Occurring Disorder?

A co-occurring disorder is any diagnosed mental health issue in concurrence with a substance use problem. Excessive drinking alongside depressive thoughts, anxiety attacks and recreational drug use, marijuana and episodes of psychosis – these are just a few examples of common co-occurring disorders, which can prove especially destructive for teens.

It’s estimated that about 60 to 75 percent of teens with substance use disorders also have a concurrent mental health disorder. This can be anything from one of ten different personality disorders to frequent panic attacks, social anxiety problems, depressive or suicidal thoughts, schizophrenic episodes, eating disorders, ADHD, or OCD.

The way drug use interacts with and amplifies these symptoms can make diagnosis and treatment difficult. Specialists can identify and help create individualized treatment plans for teens with a co-occurring disorder by combining different treatment methods to build a holistic plan against both addiction and a teen’s thoughts and behavioral problems.

Let’s look at a few ways different substances and conditions can interact.

1. Alcohol and Depression

Alcohol and depression are closely related, both in terms of risk factors and the effects either have on one another. In terms of co-occurring disorders, most literature references alcoholism and depression or alcoholism and anxiety disorders.

While ubiquitous, alcohol is a dangerous drug. Being intoxicated can lead to feelings of euphoria and loss of inhibition – but the comedown from being drunk and the long-term effects of excessive alcohol consumption are undeniable. On top of being an addictive drug, alcohol is an exceptionally dangerous substance for the body. It can lead to negative long-term effects, such as nerve damage, brain damage, liver damage, heart damage, and cancer.

Alcohol’s availability and status in society mean that many teens grow up learning about its dangers, while also being aware of its effects, both the good and the bad. But teens have trouble recognizing risk and are more susceptible to alcohol’s addictive effects. For teens struggling with depression, the motivation to care about the long-term effects of alcohol is very low. Instead, it becomes an effective way to deal with negative and even suicidal thoughts for a short time.

This type of self-medication is a common feature in co-occurring disorders. In many cases, teens turn to drugs as a means of escaping the symptoms of their mental health issues, or the risk factors that contribute to them.

2. ADHD and Addiction

Attention deficit and hyperactivity disorder is another condition with a high level of co-occurring substance use. However, most of this substance use is not linked to ADHD medication, which can be addictive.

Because of the effects of stimulants like amphetamine and methylphenidate on a person with ADHD, properly dosed ADHD medication when applied at a young age drastically reduces the risk of substance use in patients with ADHD.

It’s cases of unmedicated ADHD that often struggle with excessive drug use, especially when an unintentional form of self-medication becomes recreational. ADHD is more than just a problem with focus – teens and adults with ADHD struggle to concentrate, plan, retain information, or complete tasks.

It can be a debilitating condition that affects every aspect of life and robs a person of independence and agency. Some drugs help alleviate these issues temporarily – but without professional help, self-medication can turn to addiction.

3. OCD and Self-Medication

Like other anxiety disorders, OCD is characterized by overwhelming discomfort surrounding certain obsessive or intrusive thoughts, coupled with compulsive behavior to soothe those thoughts. Addiction often fits into this destructive cycle by providing an alternative, yet still maladaptive coping mechanism for the unwanted thoughts and behaviors associated with OCD.

Trying to quit not only bears the difficulty of overcoming the addiction but having to deal with recurring and powerful OCD symptoms as well. Treating that kind of combination requires addressing both concerns together.

4. Eating Disorders and Substance Abuse

Eating disorders have the highest death rate among any type of mental health issue. They pose an immense physical danger to teens and adults alike and claim thousands of lives per year.

That danger is compounded by drug use, which can often begin as a means of appetite suppression, or to deal with symptoms of anxiety or depression alongside an eating disorder.

5. Personality Disorders and Drug Use

There are ten different personality disorders, each affecting a person’s psyche in a different way. Personality disorders are different from other mental health disorders in that they fully encompass a person’s thought processes and behavior, essentially molding their personality into something dysfunctional.

For many people with personality disorders, drugs can be a way to escape the thoughts and behaviors that they struggle to reconcile with reality. In other cases, the risk of drug use is fueled by their symptoms.

Why Teens Are Susceptible

Studies show that younger people are more likely to struggle with addiction later in life the earlier they start taking drugs. And because mental health issues are a common risk factor for drug use, teens are especially susceptible to the issue of co-occurring disorders and the long-term impact they can have.

The immaturity of the teen brain is also a problem. While both a person’s body and brain complete maturation into adulthood in the late teens, the brain continues to adapt and mature well into a person’s 20s and 30s.

The parts of the brain that are still lagging in progress in one’s teens include those dedicated to managing thoughts and emotions, executive function, decision making, risk assessment, and long-term planning.

It’s important to seek help for teens struggling with addiction or a mental health issue, or both. The long-term physical and mental effects of a co-occurring disorder can be prevented through early treatment and a focus on long-term recovery.

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Dual Diagnosis

What is Dual Diagnosis Among Teens?

For a few years now, drug use among adolescents has been trending heavily down, apart from marijuana. Kids were drinking at a later age, using “hard drugs” less frequently, and had all but given up on smoking.

Teenage mental health issues have been climbing as we enter the 2020s, however, and it’s more important than ever to be vigilant about the signs and symptoms of teen drug use, and the factors that contribute to it.

It’s not quite Woodstock or the 1990s painkiller crisis, but between the natural growing pains of being a teen and the ongoing social climate, helping our teens avoid drug overuse and learn to cope with stress in healthier ways is crucial.

This is especially important for teens diagnosed with mental health conditions, whether it’s ADHD or an anxiety problem. Co-occurring disorders, or a dual diagnosis, are a toxic relationship between psychiatric hardship and drug addiction, where one can feed the other, and complicate both treatment and long-term recovery. And teens are especially susceptible.

What is a Dual Diagnosis? 

To recap, a dual diagnosis is a diagnosis of substance use disorder and a concurrent mental health condition. These can range from the most common ones, such as anxiety disorders and mood disorders, to rarer conditions such as schizophrenia, OCD, and personality disorders.

Because this is such a broad category, treatment and prognosis will depend on a patient’s history. A teen with a history of depression who has recently developed a drinking habit will receive a different kind of treatment from someone who has PTSD and no consistent home address, with a polysubstance use problem. The treatment plan is always adjusted to the needs and circumstances of the patient.

Boys are more likely than girls to develop a dual diagnosis. Among patients with mental health issues, more than half suffer from one or more forms of addiction. The same goes vice versa – among people diagnosed with substance use disorder or a drug problem, the majority also had signs and symptoms of a different mental health issue.

The challenge with a dual diagnosis is that you cannot treat the addiction and the concurrent mental health problem as two separate beasts. It is one interconnected and amalgamated issue, both linked together, intertwined and in need of targeted help. Addressing a dual diagnosis requires understanding the link between addiction and other mental health issues, and why specialized treatment is so important.

The Link Between Mental Health and Drug Use

There are three prevailing theories about why mental health conditions and addiction are heavily intertwined.

The first is a theory of shared factors. Conditions like anxiety and depression are heavily hereditary. What this means is that someone is more likely to experience depression in their lifetime if they have a close family member with a diagnosis of depression. It’s never a guarantee, but the odds are significantly higher. Other risk factors include environmental factors such as childhood trauma, victimization at school, and a poor parental relationship.

Substance use problems share many of the same internal and external risk factors with depression, anxiety, PTSD, and other mental health problems. These shared factors indicate that when people become depressed, they’re also statistically more likely to turn to drugs.

Which brings us to another theory – self-medication. In this case, mental health issues are more likely to drive someone to use drugs over and over again, rather than simply try them once, or stay away entirely. Teens with mental health issues may be less hesitant to try a risk, or more susceptible to outside influence, whether from their peers or someone else.

Addictive drugs trigger their addictive mechanism through the supraphysiological release of neurochemicals like dopamine, altering the reward system while creating a euphoric high. As a long-term consequence, most addictive drugs make the symptoms of conditions like depression and anxiety much worse.

Meanwhile, depressants like alcohol help temporarily alleviate the symptoms of anxiety and panic disorders and help teens “relax”. These short-term benefits are fleeting, inviting recurring drug use, creating a vicious and dangerous cycle.

Finally, there’s the theory that the long-term consequences of drug use create other mental health problems. Illegal and addictive drugs invite stress, risk, and danger into a teen’s life in the form of suspensions, legal troubles, and even jail time. Addiction can end relationships and alienate loved ones and alter personalities. It can create and fuel negative thoughts and self-deprecating feelings, triggering latent psychiatric health problems, or creating new ones.

In many cases, there’s a bit of all three theories involved. A dual diagnosis puts a teen at greater risk for long-term mental and physical health troubles and can give them a much tougher start in life. But aside from that, teens are uniquely susceptible to addiction and a dual diagnosis.

Teens and Dual Diagnosis

An older teen’s body is usually through with puberty, and entering the final stages of maturation. By the late teens, most people’s growth plates have fused, and they stop growing.

But the brain takes longer to mature. Even in girls, who develop faster than boys, the human brain doesn’t stop developing for years and years after the teen years are over. Critically, the portion of the brain dedicated to cognitive control and executive function – the ability to plan, think ahead, assess risks, make important choices – isn’t done cooking until about age 25. Some portions of the brain continue to mature until the 30s.  

What does this mean for teens? It means that even though they might feel big and grown, they’re far from done growing, especially mentally, and drug use can have a dramatic effect on a teen’s cognitive and decision-making abilities. On the other hand, an immature risk assessment center means teens are more likely to struggle with the addictive effects of long-term drug use and are less likely to realize it.

More directly, studies have shown that the earlier one’s first experience with drugs is, the more likely they are to get addicted later in life. On the other hand, the longer you wait before trying a drug, the less likely it’ll become a habit (there’s never a zero chance, of course).

Getting Help for a Dual Diagnosis

A dual diagnosis requires professional treatment. Psychiatric mediation, group therapy, family therapy, and long-term one-on-one counseling are some of the core features of a dual diagnosis treatment plan.

Many clinics suggest an inpatient or residential treatment program to help teens recover in a clinical, yet welcoming environment, surrounded by nurses and professional medical staff, as well as peers. But these programs are always just the start.

Long-term recovery means continued therapy and use of medication to combat mental health symptoms and reinforce sobriety.

It’s a tough road, so support is important. Family and friends play a big role in long-term success, especially with a dual diagnosis. 

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Dual Diagnosis Mental Health

7 Mental Health Conditions to Learn for Every Day of MIAW

Started in 1990, Mental Illness Awareness Week (October 4th to 10th, 2020) is an annual event encompassing National Depression Screening Day (on October 8th) and World Mental Health Day (on October 10th). This year’s Mental Illness Awareness Week (MIAW) plays a particularly important role in helping spread more information and encouraging more understanding regarding the illnesses and conditions that have been on a rise since the pandemic started.

Learning More About Mental Health Conditions, One Day at a Time

This year, MIAW will focus on seven of the most common mental health issues in the world, from how they might be recognized, to what treatment and symptom management looks like. MIAW 2020 aims to dispel myths and emphasize the role of support and community treating mental illness as the societal issue that it is. The seven major mental health conditions addressed this year will be:

    • Anxiety Disorders
    • Bipolar Disorder
    • Psychosis
    • Eating Disorders
    • Depression
    • PTSD
    • Substance Use Disorders

Mental health conditions take on many shapes and forms, and while we will talk about some of the most common mental illnesses, this list is by no means comprehensive. Mental health is often complex, and we don’t always need a diagnosis to seek help and support from one another. The goal this upcoming Mental Illness Awareness Week is to help encourage those of us with various symptoms to seek support, and to encourage everyone to learn more about these conditions and how they can be managed.

1.  Anxiety Disorders

Anxiety disorders are some of the most commonly diagnosed mental health conditions in the US and encompass a variety of diagnoses related to very specific fears (phobias), generalized anxiety, social anxiety, and conditions such as obsessive-compulsive disorder (OCD). While the overarching symptom of an anxiety disorder is irrational fear, anxiety disorders can include many different symptoms, including:

    • Irritability
    • Strict or very rigid thinking
    • Negative thoughts
    • Hyperventilation
    • Panic attacks

Not every fit of fear or anxiousness is an anxiety disorder. An important hallmark is whether the anxiety interferes with a person’s regular day-to-day life, and whether it could be considered irrational. Mocking or hazing someone for their fears or anxieties can serve to further alienate them from seeking support, and force them to turn to dangerous or ineffective coping mechanisms, from ineffective or illegal medication, to outlets of nervous energy or fear, including self-harm.

When someone exhibits anxiety, it’s important to recognize that their fears feel real to them and help them calm down and return to reality through breathing techniques, reassuring language, and a calm voice. Long-term management of anxiety can involve medication but is often centered around therapy that aims to target, isolate, and replace negative or anxious thoughts.

2.  Bipolar Disorder

Bipolar disorder is a mood disorder (like depression) that involves some form of mania, and often a form of depression, usually cycling between one state or the other in infrequent intervals – once every few months, usually. While mania could be summed up as the opposite of depression that does not always make it a positive emotion. Mania can lead to outbursts of creative energy and motivation, but it can also lead to risky or unstable behavior, delusions of grandeur, restlessness, and lack of appetite. Some people describe their manic behavior as frightening and unsustainable.

Depressive thoughts and behavior, on the other hand, are marked by inescapable sadness. It’s a dark vacuum that makes it difficult to comprehend or embrace any positive thoughts, and depression can lead to a self-consuming lethargy and a total absence of motivation, even for life’s most basic tasks, such as personal hygiene and food preparation. Bipolar disorders usually feature both manic and depressive symptoms, with varying degrees of severity, and varying cycles. Therapy can help deal with both irrationally depressive and manic thoughts, but medication also plays a vital role in providing a balanced mental state.

3.  Psychosis

Psychosis is an all-encompassing term for symptoms that indicate a person is struggling with a disconnect from reality, including types of dissociation, hallucination, and various delusions. Symptoms of psychosis can range from mild to very severe and are a common hallmark in illnesses such as schizophrenia and psychotic disorder. A psychotic episode can be very scary, particularly if it is a severe one. Staying safe and keeping one’s loved one safe is important. But not all episodes of psychosis are severe, and symptoms can be mild and fly under the radar.

Simple dissociation or delusional thinking can be a form of psychosis, and hint at a neurological or psychiatric illness. Treatment for psychosis varies because it’s a symptom in many different conditions, but certain medications can help reduce or eliminate psychotic episodes. Discovering the underlying cause is an important part of the treatment process. Alongside medication, some forms of talk therapy may help people begin to differentiate between reality and the thoughts in their head, allowing them to isolate and ignore their psychosis.

4.  Eating Disorders

While many readers may be familiar with anorexia and bulimia, eating disorders encompass a variety of unhealthy relationships with food and body image, and many of these conditions are driven by a high level of anxiety and discomfort with one’s appearance. The hallmark of an eating disorder is that no amount of change in diet will ultimately satisfy the person’s desire for physical change, whether it’s thinness, muscle size/tone, or some other physical attribute.

The urge to become bigger or smaller is often impossible to satisfy, which is why these conditions can be life-threatening – and in many cases, life ending. Eating disorders have some of the highest mortality out of all mental illnesses, and they remain some of the most common and undiagnosed conditions in our society. External pressures – such as beauty standards, fitness advertisements, and image editing – further fuel these conditions.

But they do start in the brain, and can be exacerbated by physical ailments that affect weight gain/loss, appearance, and appetite. Treating an eating disorder requires not only a recognition of the problem itself, but professional guidance, both physical and psychological. Many teens and adults affected by eating disorders need medical attention and the continued assistance of both a therapist and dietician, to help establish a healthier and less rigid relationship with food and promote good health.

5.  Depression

Depressive disorders can be considered the second most common kind of mental health problem behind anxiety disorders, and they too share a variety of potential causes and symptoms. The difference between a form of depression and typical sadness is the severity and length of the mood, as well as its context. It’s normal to grieve, however, but certain kinds of behavior may suggest an adjustment issue, one that might require more support to overcome.

On the other hand, depression doesn’t always need an external trigger, and can start and persist without any real reason or event. Depression treatment varies with severity and disorder type, as it can occur due to neurological differences, stress and trauma, endocrine triggers, or a combination of all three. Antidepressants are a common first-line treatment because of their effectiveness, but it’s important not to assume that the problem goes away with pills. Long-term support, especially from friends and family, is crucial to depression treatment.

6.  Post-Traumatic Stress Disorder (PTSD)

Post-traumatic stress disorder, or PTSD, is an issue that affects an estimated 7.5 million Americans every year. Child abuse and domestic violence are some of the most common causes of PTSD, alongside sexual assault, and exposure to violence (including combat). PTSD symptoms vast in variety, but can be understood as a maladapted response to a horrifying event. As a result, of stores a lasting impression that changes the way the brain perceives and responds to threats.

PTSD has an effect on our fight-or-flight response, and is directly tied into how we react to the world around us. Individuals who suffer from PTSD can seem permanently agitated or on-edge, but it’s a state of mind they can’t always control. PTSD treatment aims to address this hyperactive state through a variety of specialized therapeutic methods, each of which aim to work through the trauma in a, sustainable constructive way.

7.  Substance Use Disorders

Also known as addiction, a substance use disorder is a complex mental illness because it affects the brain and body directly. Substance use disorders are characterized by continued drug use despite repeated negative consequences, and lack of ability to quit. Internal and external factors both play a leading role in exactly how and why substance use and abuse disorders occur and the potential for uncontrollable spiral.

Thus, both physical and psychological factors affect how quickly drug use can become an addiction. Substance use disorders often co-occurring with mental health conditions, such as depression and anxiety. It is often a gradual process – and treatment is equally gradual, requiring a long-term approach to address both physical and mental symptoms, achieve successful cessation, manage cravings and thoughts of relapse, and much more.

Education Matters More to Mental Health Conditions Than Ever Before

Mental Illness Awareness Week 2020 aims to take a week to help those whose lives have been touched by mental illness better understand the conditions their loved ones are living with. It’s important to recognize that these symptoms last far longer than a day or a week, and that we may all know one or more people who have been living with the symptoms of some of these conditions for months, years, or decades.

Sometimes, they’re just burdensome enough that no one suspects anything, but life becomes a whole lot harder than it might be for the average person. In other cases, these conditions can be so pervasive and intrusive that they completely change one’s day-to-day circumstances and dominate nearly every waking minute. People in our midst affected by mental illness deserve more recognition and support, not just from friends and family, but from communities and society at large.

Every year, we and other organizations aim to spread awareness during MIAW 2020 to encourage everyone to band together and learn more about the different illnesses that affect the people we interact with, from family members to distant acquaintances. Knowledge and awareness can do a lot to dispel myths and misconceptions, avoid and defeat stigma, and encourage those who fear to speak out about their illnesses seek the help and support they need to live better and more fulfilling lives.

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Dual Diagnosis

Understanding Teen Co-Occurring Disorders

A co-occurring disorder refers to cases where a person has some form of anxiety disorder, mood disorder, personality disorder, or other mental conditions, coupled with a drinking problem or drug addiction. Also known as a dual diagnosis, teen co-occurring disorders does not refer to examples of polysubstance addiction (being addicted to more than one substance) or a string of mental health issues without signs of drug use or addiction (such as anxiety coupled with depression).

Teen co-occurring disorders represent a special issue because they are quite widespread and yet not effectively treated most of the time. Dealing with a dual diagnosis requires a very individualized approach as the symptoms of a mental disorder and compulsive drug use often complicate both diagnosis and treatment.

To understand why teen co-occurring disorders are so common, it’s important to discuss how drug use can affect a teen’s mental health, and how existing mental health issues affect a teen’s likelihood to rely on drugs.

Why Is Drug Use More Common Among Teens With Mental Disorders?

The numbers speak for themselves – as many as six in ten teens who have participated in substance use disorder treatment programs meet the criteria for at least one other mental health issue. Other data also supports the fact that substance use disorders (addiction) often co-occur with other mental disorders, including (but is not limited to):

    • Anxiety disorders
    • Major depression
    • Bipolar disorder
    • Attention-deficit hyperactivity disorder (ADHD)
    • Psychotic disorders
    • Schizophrenia
    • Personality disorders

It’s often a chicken or the egg situation, wherein it’s not always clear which came first – the drug use, or the mental health problems. They feed into each other. A teen struggling with symptoms of consistent low mood may find they care less when they’re drunk, or that drinking helps them take the edge off their anxiety.

However, alcohol hits back with stronger symptoms of depression and anxiety afterwards. This can feed a cycle that eventually leads to withdrawal issues and signs of addiction or problem drinking. The same goes for many other co-occurring disorders, where drug use at least partially starts as a coping mechanism and creates a vicious cycle. This can complicate treatment.

People who go into treatment for drug use may not benefit from the kind of therapy being offered at most drug rehab facilities in the absence of a trained and experienced psychiatrist. Any attempts to help them get sober and stay sober fail when they eventually begin to struggle with symptoms that their drinking or drug use was masking, in the short-term.

Furthermore, addiction can complicate treatments for many mental health issues. Withdrawal symptoms can make mental health symptoms worse. Certain drugs amplify and exacerbate symptoms of psychosis, anxiety, and low mood. And a treatment program that tries to focus on one but not the other may only serve to waste a teen’s time.

How Mental Disorders Interact With Common Drugs

Common drugs among teens include marijuana, alcohol, and subscription drugs, and drug use is often matched with ADHD, anxiety disorders, and depression. Substance use is especially high among teens with untreated ADHD, while teens who received medication for their ADHD were less likely than their peers to use drugs (even though ADHD medication can be addictive).

This may suggest that teens who lack access to treatment for their mental health issues are more likely to turn to drugs as an ineffective coping mechanism. Teens who experienced abuse or trauma are also far more likely to not only struggle with feelings of depression or trauma-related mental health issues, but also turn to substance abuse in their youth at a greater rate than their peers.

Among teens with depressive symptoms, many drugs may induce short-term feelings of euphoria and general content. However, when the high ends, they may be left feeling even more empty as a result. Some of the signs of a comorbidity between depression and substance use include feelings of helplessness, irritability, appetite changes, unexplained pains and aches, and frequent thoughts or mention of suicide.

In cases of anxiety, drugs like alcohol or marijuana can help soothe and reduce feelings of fear, worry, and paranoia. However, their effects in the long-term are disastrous to both the body and the mind. Marijuana with high levels of THC, which is the psychoactive compound in the drug, is tied to higher levels of anxiety, even though marijuana’s other compounds (like CBD) show potential benefits in treating mental health issues.

In teenagers with symptoms of psychosis, which include hallucinations or aberrant thoughts and false sensory experiences, drugs like marijuana can exacerbate or trigger symptoms. Other drugs may also affect their condition, as with as stimulants as well as depressives like alcohol can interact heavily with psychosis and related symptoms, such as paranoia, delirium, and angry outbursts.

The Challenges of Treating Teen Co-Occurring Disorders

One of the reasons why drug rehab facilities are not always well-equipped to deal with co-occurring disorders are because they require a holistic treatment approach. Holistic treatment simply means approaching a case from a perspective of treating the patient rather than the disorder.

Since co-occurring disorders are a combination of issues complicated by a variety of factors – such as a teen’s home life, school life, early experiences, family history, and more – they require a treatment approach wherein a team of professionals rather than a single professional work together to treat a teen’s physical and mental symptoms, addressing their condition behaviorally, socially, emotionally, and physically.

This can mean combining treatments or modalities to deal with a series of symptoms from different angles. Every case requires an individualized approach, and treatment takes time.

Seeking Help for a Dual Diagnosis

Some treatment facilities specialize in dual diagnosis/co-occurring disorders, providing inpatient and outpatient services to deal with both addiction and mental health issues, with a staff experienced in handling both.

If you or a loved one is struggling with a complicated mental health situation coupled with non-medical or recreational drug use, including heavy smoking or frequent drinking, then it may be important to find a healthcare provider specifically targeting teen co-occurring disorders.

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Dual Diagnosis

Considerations for Teen Dual Diagnosis Treatment Amid COVID-19

The world has been changing around us. Many of our socialization and recreational activities have been halted, and our freedom to move about our cities as we please has been reduced. Along with reducing freedom and autonomy stemming from social distancing measures to control the virus, there is a potential increase in mental health problems. Those impacted by COVID-19 disruptions are at risk of experiencing more depression, anxiety, and substance abuse problems.

What Is Teen Dual Diagnosis?

When mental health disorders are accompanied by substance abuse, it is known as a dual diagnosis situation. It is often the case that a teen who struggles with mental health issues, such as depression or anxiety, will begin to use substances as a means of escaping negative feelings.

It is also the case that the use of drugs and alcohol – while possibly providing a short relief – actually contributes to an increase in mental health symptoms. Symptoms and substances work together in making the situation worse. Teen dual diagnosis treatment for such co-occurring disorders requires a unique approach.

Teen Substance Abuse Risks Related to COVID-19

Substance abuse is always a risky business. During the pandemic, it is even more so. The coronavirus is highly contagious, and it tends to attack a person’s ability to breathe. Many types of drugs also decrease the ability to take in a good, healthy breath. When the effects of the virus are added to the drugs’ effects, chances of survival can be decreased. Substances that are well known to decrease lung function and capacity include:

    • Opioids
    • Cocaine
    • Tobacco
    • Marijuana
    • Phencyclidine (PCP)
    • Methamphetamines

Teen Dual Diagnosis Treatment Is Essential

When the importance of social distancing to control the spread of the virus came to light, governments quickly decided what our country absolutely could not do without. Physical healthcare, food resources, and transportation were obvious choices. Mental health and substance abuse treatment support was placed at the top of the list of essential services.

Not only have mental health concerns been increasing over the past several years, but the impact of the virus on our society has directly contributed to increased reports of depression, anxiety, and substance abuse. Mental health problems are difficult enough to deal with on their own.

When substance abuse is also present, treating the underlying mental health problems can become even more difficult. In the past, treatment providers would attempt to address the substance abuse problem before moving on to the addiction’s psychological sources. Currently, providers recognize that simultaneous treatment for both disorders produces the best outcome.

Treatment Procedures Have Changed

The model of treating both mental health and substance abuse disorder simultaneously persists through this pandemic. Due to the contagious nature of the virus, however, the way that such services are delivered has been adjusted. When choosing a teen dual diagnosis treatment center, be sure to ask about the procedures that have been adopted toward keeping your teen safe.

Telemental Health and Teletherapy

As soon as social distancing measures were hinted at by government officials, providers began actively preparing to deliver mental health treatment services through telemental health. Also known as teletherapy and telehealth, telemental health refers to remote appointments conducted by healthcare providers. This can include phone calls, video conferencing, and text messaging. Ensure that your selected provider employs the telehealth service mediums designed to keep your teen’s personal information safe and secure.

Social Distancing

Many teens enjoy participating in large group activities. The presence of COVID-19 in our country has put a damper on that pastime. Schools are busy placing desks six feet apart, concerts and ceremonies have been canceled, and parties have been postponed. Teens entering treatment are likely to notice a difference in how their support groups are run, as well. There are likely to be fewer participants in each group, and the gratification of giving peers a physical hug will need to be replaced with gestures of distanced appreciation.

Sanitation

Even with safety measures of keeping a distance from others, additional sanitation practices are being implemented within facilities. The coronavirus is thought to exist on a surface for some time after an exposed person has interacted with it. Treatment facility rooms will be kept tidier, frequent hand washing is required, and patients may be asked to help maintain clean rooms. On the plus side, these stringent hygiene procedures can provide a teen with great training toward keeping a more tidy dwelling in the future.

Regular Testing

Teen dual diagnosis treatment programs often include regular drug testing as part of the recovery process. During these times, most are also offering support for the testing of COVID-19. Any time space is shared, such as in a treatment center, there is a risk of spreading the virus from person to person.

Fortunately, as our knowledge of the virus has increased, the availability of screening tests has also increased. If a facility detects coronavirus, or if a patient exhibits symptoms associated with the virus, programs need to have a plan in place. Treatment programs may have access to these virus tests on campus or have a system for transporting clients to a nearby testing facility.

Visitations

One of the most difficult aspects of entering a teen dual diagnosis treatment facility during COVID-19 has to do with the ability to visit with loved ones. Each time that a new person is introduced into the facility, the risk of potential cross-contamination is increased. By this time, many of the social distancing regulations which prohibited all visitations have been relaxed across the nation.

Rather than barring all outside contact, treatment facilities move ahead with allowing limited and safely distanced interactions. To whatever extent possible, parents, siblings, and other family members in a teen’s treatment program are an important aspect of a successful outcome.

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Adolescence Dual Diagnosis Education Mental Health Recovery Treatment

The Benefits of Blending School and Treatment

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There is tremendous value in combining school and treatment. Many clients come to us having fallen off-track in their education as a result of substance abuse and mental health issues. There may also be undiagnosed learning disabilities that need to be addressed. Falling grades and school pressure can create another layer of stress and panic for a teen. When an adolescent comes to treatment, it is our responsibility to provide them with both treatment and educational support that fosters an environment of safety and encouragement around learning and healing. At the same time, providing school and treatment simultaneously allows us to notice where an adolescent needs extra support so we can provide that client with adequate educational and clinical support.

 

I looked to Daniel Dewey, our Residential Director of Education, and Joseph Rogers, our Educational Coordinator at our Outpatient Day School for some insight and perspective, particularly since they each see both sides of the education/treatment pendulum. Daniel sees our clients from their initial point of treatment, while Joseph spends time with our clients during their aftercare process. Both of them promote and create foundational pieces to add to the bedrock of an adolescent’s recovery; they invite curiosity about learning, provide support during times of difficulty, and provide individualized methods of teaching to facilitate and nurture a healthy outlook on education.

 

Daniel gave me some wonderful insight when he said, “School is important for treatment success; when a resident can stay on track (or in many cases gets back on track) they will have a stronger foundation for their aftercare. School can be a big stressor, so if school can work with treatment, we feel residents will be better equipped to leave Visions and follow their academic path. Additionally, doing well in school tends to be a source of self-esteem for adolescents.  We want our clients to feel good about learning. Many of our clients come into treatment hopeless. It is our goal to help them see the intrinsic value in education and to guide them toward a meaningful life.”

 

Joseph gave us similar insights, which also help identify the continuum that occurs with school and treatment. He said,  “The practical piece of joining treatment and education is having the benefit of rolling enrollment – clients can enroll at any time, increasing their opportunities of getting back on track. Additionally, students may not be emotionally able or prepared to go back into a normalized educational setting. Having them in a setting that is therapeutically structured for their safety gives them the chance to practice their new behaviors before they go back to their regular school, and because we have clinicians on staff, we can react to and notice a change in behavior quickly and effectively.”

 

We understand the importance of creating a therapeutically alive and nourishing environment for our clients and their families. Placing school in the treatment arena allows us to support our clients at optimum levels, and it provides a multi-level aspect to the healing process. School and Treatment from the residential and outpatient perspective is a necessary stone in the path to wellness. It is beneficial to the adolescent, building confidence and self-esteem, and it is advantageous for parents to see their children simultaneously succeed in their education and in their substance abuse and mental health treatment.

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Adolescence Dual Diagnosis Family Parenting Recovery

An Intensive Family Program Promotes Healing the Family System

Visions knows that a family in crisis needs requires an intensive family program. It doesn’t benefit a family to be viewed as having individual branches that need to be removed, trimmed or repaired. We are thrilled to be building out our 3-day intensive family program with the help of Jeff and Terra Holbrook. They have been doing family work for almost two decades and are deeply committed to healing the family system. Their insight and experience are invaluable and in line with the  culture of Visions. Visions wants the family to heal from the inside out; We require all families to go to:

  • Weekly parent support groups;
  • Weekly multi-family groups; and
  • Individual family sessions.

Families are also encouraged to go to outside support groups (Al-Anon, AA, ACA, Refuge Recovery, et cetera).  When we meet with families, we address issues of attachment, enmeshment, codependency, and we assist families in creating healthy boundaries. The recovery process requires a level of willingness and curiosity on everyone’s part and it is particularly important to do family work because addiction and mental health are rooted in the family system. It is not uncommon for parents and loved ones affected by their child’s addiction or mental illness to become angry, place blame, distance themselves from their child, or try to fix the problem themselves; often times, the focus remains on the addict. Here’s where an intensive family program comes in.

 

Think of the family system as a garden. Imagine the roots of everything in the garden weaving their way through nutrient rich soil containing love, respect, healthy boundaries, positive attention, and connection to healthy resources. Now imagine what happens when that same soil becomes fallow: The roots begin to suffer from neglect, abuse, abandonment, deprivation, and entanglement; the garden begins to whither away, grasping onto whatever is closest to try to survive. Family systems need to be nurtured from their root systems all the way up. Removing one unhealthy part won’t allow the entire system to heal. In fact, the entire root system will malfunction as a result.

 

Our intensive family program provides salient educational tools for parents to learn to face addiction and mental health in a healthier way. Families must begin to unpeel their own layers, and begin looking deeply within themselves and at the origins of their own root systems. Parents must also understand what they are asking their kids to do to recover, and more importantly, it’s invaluable for parents to show their kids they are willing to do the same hard work.  For example, if a family is asking their kids to look at how they are powerless, that same family needs to ask themselves the same question.  Addiction and mental health are a family disease; they are not isolated incidents wherein one family member goes rogue. As David Sheff, author of Clean says, “The addicted are not morally bereft, they are ill.”

 

An intensive family program will also help parents move away from the stigma of mental health and addiction and move toward acceptance and healing.  Families are often surprised to find out that their feelings are in line with their child’s: Both may feel angry, betrayed, ashamed, scared, resentful, frustrated, tired, and so on. When parents are able to shed a light on these similarities, the willingness to look at the hows and whys of addiction and mental illness becomes more palpable. Recognizing this similarity also elicits compassion and empathy for their child and for themselves. When a family can recognize that everything is connected, recovery can truly bloom.

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Addiction Dual Diagnosis Guest Blogs Mental Health

Dual Diagnosis and Teens: What to Know

Guest blog by Recovery Rob from the Pat Moore Foundation

The combination of substance abuse and forms of mental illness are common. In fact, it’s what most clinicians, therapist, and counselors often expect to find when one diagnosis is confirmed. According to the NAMI (National Association on Mental Illness) more than

half of all adolescents with substance abuse issues also have a diagnosable mental illness. These diagnosable mental illnesses consist of ADHD (Attention Deficit Hyperactivity Disorder), Depression, and Bipolar Disorder. Unfortunately, history has not shown treatment for both at the same time. Typically a teenager who is in treatment for substance abuse is not referred out to a qualified mental health professional to discover a source of their drug and alcohol abuse. Self-medicating with alcohol and illegal drugs is prevalent when there is a mental health issue.

Over the years, the psychiatric and drug counseling communities have begun working together, agreeing that both of these disorders must be treated at the same time. Often with one diagnosis you have the other. With a dual diagnosis it’s been found that suicide attempts and psychotic episodes decrease rather quickly. Treatments consist primarily, but not exclusively to 12-Step programs. However, special peer groups that focus on treating both the illness and substance abuse are found to strengthen social networks.

Adolescents often seek acceptance, and support each other as they learn the role alcohol and drugs have taken in their lives so far. Learning, and in some cases re-learning, social skills will help replace self-medication with patterns of healthful and helpful behaviors.

In order to discover the presence of a confirmable dual diagnosis, one must seek a professional assessment from a psychologist or psychiatrist. Once the dual diagnosis has been established confirmed, then family members and mental health professionals are urged to work together to seek a strategy that works best for the adolescent.

Here are five tips on what to do if your adolescent has a substance abuse disorder.

  • Your teen is NOT a disgrace to the family.
  • Establish consequences for behaviors, and don’t be afraid to call upon law enforcement if your child is drinking on your property.
  • Don’t threaten unless you plan to follow through. Typically a parent surrenders and their addicted child learns their parent doesn’t mean what they say.
  • Try not to nag or lecture.
  • And, if your teenager is seeking and working at his or her recovery you should offer support, love and encouragement.

BIO:

Recovery Rob is a 47-year-old man who has more than nineteen years of sobriety, whose drugs of choice at one time were alcohol and drugs, and he has worked in and around the field of addiction for more than 20 years. Recovery Rob is a professional writer who has published two novels and is currently working on his third. He has been writing and working as Pat Moore Foundation’s premiere blogger and content writer, which helps keeps Pat Moore Foundation’s addiction and recovery blog top-rated.

You can also follow Recovery Rob on Twitter!

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