Dual Diagnosis

What is dual diagnosis?

 

Dual diagnosis is a term used to describe a condition where someone may suffer from both mental health issues whilst also suffering from alcohol or drug problems.

Dual diagnosis is not a new condition as mental health issues and its relationship with problematic drug use has had a complex history.

Dual diagnosis also known sometimes as COC (co-occurring condition) can be very difficult to diagnose as it is often the case that the use of drugs and alcohol can be the cause of the mental health issue being experienced by the individual.

Being able to differentiate between substance-induced disorders and independent psychiatric disorders is hugely important when deciding which treatment may be the most effective in daily clinical practice.

For people who are experiencing drug problems, which include prescription drugs and alcohol, often experience symptoms which may resemble that of mental illness.

For many of these cases, the psychiatric disorders can disappear with prolonged abstinence.

Although in many cases the substance-induced psychiatric symptoms can be witnessed both when intoxicated and during the withdrawal state. In some cases, these symptoms can last long after a person has refrained from using drugs or alcohol such as prolonged psychosis or depression after cocaine or amphetamine abuse.

The abuse of hallucinogens has been known to trigger psychotic and delusional phenomena long after a person has stopped taking the drug.

Cannabis, when used frequently, may trigger panic attacks and can cause a state similar to dysthymia (persistent mild depression) and in some cases when continued can lead on to recurring depression.

Severe depression and anxiety can be induced by continuous alcohol abuse and even moderate sustained use of alcohol can increase anxiety and depression levels in some people.

 

Those with dual diagnosis face a range of complex challenges. Increased rates of relapse, hospitalisation and homelessness are more prevalent than in substance and mental health disorders alone.

For people who have a dual diagnosis and therefore complex needs may have experienced great adversity in their lives.

This may include childhood abuse, deprivation. Poverty or loss of close family.

As an adult having these multiple complex needs may affect issues such as employment and exploitation as well as poor physical health, suicide, self-harm and of perpetrating violence.

People with a dual diagnosis may experience a lack of empathy from individuals as part of our society’s entrenched attitude towards people with drug and alcohol problems are perceived as lifestyle choices rather than a condition that is deserving of treatment, care and support.

 

 

Woman with anxiety

Treatment

 

Only a small percentage of people with dual diagnosis receive treatment for both substance and mental health issues.

An integrated treatment would require both drug and alcohol services blending with mental health services creating a philosophy of a single treatment package that can offer specialised support.

Staff from both services being trained with transferable skills and knowledge would be needed to achieve this philosophy.

A parallel approach would involve treatment from a mental health service whilst receiving support from an alcohol or drug service.

In most cases at present partial treatments are offered to treat the primary issue first and then treating the secondary problem once the first has been stabilised, however this can all be done in a Residential Rehab. It is vitally important you call us to find out which rehab can provide the correct care and support.

 

There is evidence to indicate that with help and support, people with a dual diagnosis can recover and stabilise.

A large percentage of the treatment for dual diagnosis is based upon behavioural interventions.

 

Individual psychotherapy

Can be successful in treating behaviours related to drug and alcohol abuse and/or mental health or behavioural problems.

 

Cognitive behavioural therapy

C.B.T works to minimize problematic behaviours and beliefs to develop a healthier pattern of thinking helping to sustain sobriety.

 

Dialectic behavioural therapy

D.B.T is often used to reduce self-harming behaviours that can often be witnessed with mental health conditions and substance misuse disorders.

 

Integrated group therapy

Which aims to treat the symptoms of both mental health illness and substance misuse disorders together.

 

Medication

There are multiple medicines to help both mental health issues as well as substance and alcohol misuse issues if therapies are unable to help.

 

There are many different theories that can explain the relationship between mental illness and substance misuse.

 

Causality

The causality theory indicates that that certain types of casual drug abuse may lead to mental ill health.

There is evidence that suggests using cannabis may sometimes produce temporary and mild psychosis.

More frequent users may show symptoms of psychosis.

Although the effective outcome is less strong there is no real evidence that the connection between people using cannabis is more lightly to experience psychotic disorders.

The causality theory is often challenged due to the fact that all though cannabis use has greatly increased over the last forty years, cases of psychosis has remained relatively stable.

 

Attention deficit hyperactivity disorder.

 

It is suggested that people with ADHD will try drugs and alcohol much younger than their peers.

They are more likely to have a poorer outcome, as in a longer time to remission. They may experience more psychiatric complications from substance misuse.

Past exposure to psychiatric medications theory.

 

This theory suggests that exposure to psychiatric medications may alter neural synapses introducing an imbalance that may not have been present before.

 

Self-medication theory

 

This theory suggests that people with mental health conditions might misuse substances in order to create a set of symptoms to counter the negative side effects of anti-psychotic medication.

 

Multiple risk factor theory

 

This theory suggests that there may be shared risks that can lead to both substance misuse and mental health issues.

These may include social isolation, poverty, a lack of adult role responsibilities or a lack of structured daily activities.

Other evidence suggests that traumatic life events such as abuse can lead to both mental health and substance misuse issues.

 

For many people a dual diagnosis can be very lonely and frightening.

Having to deal with mental health issues or substance misuse alone is normally a long and painful experience that often leads to heartache, relapses and many tries before reaching abstinence.

For people who have to take on both issues at the same time may face a constant struggle working out which issue is the most prominent and which is working against the other at any given time.

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Detoxification (detox) is the medical intervention required for someone who is physically dependent to drugs or alcohol. If required, medical detoxification would be the first step taken in residential rehab. Detox is used to prevent uncomfortable and dangerous (even fatal) withdrawals symptoms resulting in suddenly becoming abstinent from alcohol/certain drugs.

The goal of a medical detox is to aid in the physical healing required following long term addiction and rid the body of all together of substance whilst providing a cushion for unpleasant symptoms of withdrawals. Detox is not considered the whole treatment for drug/alcohol addiction and it is always recommended that a comprehensive rehabilitation program is used along side to help maintain long term abstinence.

Medication is often required for alcohol detox. If you are dependent on alcohol and experiencing withdrawal symptoms it is vitally important to seek medical advice prior to stopping. There is a long list of medications used when treating alcohol addiction and the exact medication given to an individual will depend on their needs/medical history. Some of these include;

  • Chlordiazepoxide (Librium)
  • Lorazepam (Ativan)
  • Diazapam (vailium)


Librium and Valium are the most commonly used detox medication in the UK. All medication used to help with alcohol detox have been proven to help reduce the effects of withdrawal symptoms.

There are also a number of drugs recombined by the NHS to help treat alcohol misuse. Some of these include:

  • Naltrexone
  • Disulfiram (Antabuse)
  • Nalmefene
  • Acamprosate (campral)

Medication is always required for heroin detox. For someone suffering from heroin addiction, the thought of detoxification (detox) can be exceptionally daunting. Withdrawal symptoms from opiates, such as heroin, can be severe and include pain, vomiting, nausea and shaking.

There are different ways that heroin detox can be carried out, most usually either ‘maintenance therapy’ or ‘full medical detox’.

Attempting to switch from heroin to a heroin substitute, usually on a controlled prescription, is known as Maintenance therapy. Subsites used are most often methadone or buprenorphine.

A full medical detox from heroin will always be carried out in a residential rehab setting and will allow the individual to switch form heroin to a substitute and slowly withdraw completing treatment free of all substances. Someone using a heroin substitute can choose to have a full medical detox at any time, however detoxing substances such a methadone can often add to the length of detox required. Drugs most commonly used to fully detox from heroin are, Subutex, Suboxone and Methadone. Much like alcohol, the exact drugs used will be dependent on the individuals needs/medical history.

Once detoxed from heroin the risk of overdose is much higher following relapse due to tolerance following withdrawal.

The length of treatment in a residential rehab depends on a number of elements. Some substances require longer periods of detox than others.

Private paying patients will also often choose a length of stay that suites their therapeutic and financial needs. As a rule, a full treatment program in a rehab is considered to be 28 days (often referred to as a month), however, treatment is offered in several different ways and lengths starting at 7 days.

Treating alcohol addiction will always require a minimum of 7-10 days, this would be considered the detoxification (detox) faze. The length required for treating drug addiction can vary drastically depending on the substance being used. Detox for Heroin addiction is generally around 14 days minimum, with more time required if substances such a methadone are being used. Treating prescription drug addiction can often take the longest. The time required for treating gambling addiction, eating disorders and sex addiction will be based on the individuals needs.

Rehab programs can be as long as an individual requires but primary treatment is normally caped at 12 weeks, with the offering for further secondary and tertiary treatment thereafter.

*based on average rehab stays, everyone will vary dependant on needs and medical requirement/history.

There is no need for your employer to know that you are seeking help for trauma and addiction unless you choose to involve them with the process. All employers should have a policy that explains what you do if you cannot come to work due to illness – illness to include treating alcohol addiction/treating drug addiction.

If your work absence extends over 7 days your employer is likely to require an official statement of fitness to work which would be obtained from your GP. This would need to supply evidence of your illness as well as any adjustments required for returning to work, fazed return or reduced hours, but does not need to specify in detail the reason why you have been absent.

If you are absent from work for 7 days of less, for example entering rehab for a detoxification (detox) on a Saturday for 7-10 days taking a full week away from work, you can self-certify your illness by letting your employer work you will not be attending work for that period of time. Exactly how an individual would do this would be dependent on a specific companies’ policies on taking sick leave.

Any time longer than 7 days it is likely an employer will require a note from the individuals GP certifying their sickness and a fit note on return. Most companies have a clearly outlined policy on sickness and receiving sick pay so the exact requirement can vary. A rehab will always be willing to advise on time off work.

How much does rehab cost is a very frequently asked question. The cost of treatment can range from £1,000 per week upwards depending on the place, with luxury rehab being the most expensive.

There are free options available on the NHS but the waitlist of those looking for free treatment is longer than that for privately paying patients. Some private health insurance policies will cover treatment in some rehabs around the country.

Choosing the right rehab centre will often be based on priced but it is important to follow guidance on the most suitable treatment centre for an individual’s needs which our expert team of advisers are on hand to offer.

There are certainly pro’s for both treatment near by and traveling for treatment with one of the most asked question being should I get rehab near me? There are rehabs all over the UK and around the world that all offer expert programs, let’s look at how to choose a rehab.

Local treatment

Being close to home gives certainly has benefits. Visitors are normally permitted in rehab following the first 7 days stay, therefore if an individual is in treatment for a length of time longer than that being local will make it easier for loved ones to visit.

Most rehab centres will also provide a full aftercare plan for someone following treatment, this will include ongoing aftercare in the specific treatment centre. Living close by can make it easy to take full advantage of ongoing aftercare. There can also often be the option for ongoing care with an individual therapist, again being close by will allow that treatment to be carried out face to face.

Some individuals wish to be local but are willing to look broader, for instance the greater city of residence (London, Manchester, Liverpool, etc)

Treatment Away

Getting treatment away from home can be very appealing to some. Being out of the local area makes it a lot harder to just walk out of treatment as resources locally are unknown. Some also take comfort in knowing that they are not near home and focus more on treatment.

As the price for treatment can vary so much from one residential treatment centre to another, private paying patients often would rather travel to keep the cost down. Those using private health insurance may also have to travel to find a treatment centre covered in their policy.

When opting for treatment away from home this can be anywhere in the UK and also abroad. Aftercare can still be carried out and very successful using tools such as The Online Rehab.

There is no right or wrong when choosing where to go to residential rehab, but our expert advisors are always on hand to help provide information on all possible options.

Whilst millions of people in the UK have taken recreational drugs (amphetamine, cannabis, cocaine, crack, crystal meth, GHB, heron, ketamine, methadone, and prescription drugs) and drank alcohol not all become ‘addicted’. Most recent reports show that 279,793 individuals were in contact with drug and alcohol misuse services in the last year with over half of that being from opiate addiction and a quarter for alcohol.

There are several risk factors invoiced in addiction and those using drugs and alcohol socially, simply take the risk. These risks are as follows;

Tolerance – basically, if a substance is used repeatedly an individual’s tolerance to it will build. This will result in more of the same substance being required to get the same effect. In the long run this can easily lead to addiction and physical dependencies.

Environmental risks – these can include influences such a peer pressure and stress as well as physical or mental abuse of an individual (particularly as a child). Overall, those who live with frequent pressures and stress are more likely to reach for a substance to cope and are therefore at higher risk of becoming addicted.

Drug type – it is very well known that certain drugs are simply more addictive than others. Using substances such as heroin increases the risk of becoming addicted for need to ‘chase’ a high as well as physical dependency.

Drug administration – how a drug is administered can affect its addictive qualities. A drug injected rather than smoked or snorted will release a quicker and more intense high thus making it psychologically (and in many cases physically) more addictive.

Biological factors – it is now widely reported that being an addict is not only psychological but also biological. This includes your genetic makeup, mental health, sex and age. It is also reported to be 8 times more likely for the child of an addict to become an addict themselves.

Its believed that addiction is approximately half genetics and therefore some are 50% more likely to become addicted than others.

How do you help a loved one trapped in addiction?

The first step is to help and encourage the individual to become willing to accept help. They do not need to be shouting this off the rooftops, but they do need to be willing to go into treatment. There are ways to help someone become willing to get treatment for alcohol or treatment for drugs.

Set boundaries – set boundaries and stick to them. Once you have laid them out follow through with whatever consequences you have set however hard it is.

Stop finances – if you are financially supporting someone stopping these finances can be the quickest way for the addict needing to ask for help. With no money to acquire a substance an addict’s options become very limited.

Intervention – getting together with other family members/friends/colleagues and staging an intervention is often very successful in the fist stage of acceptance and gaining an admission to residential rehab.

You can’t make them quit, this can lead to dangerous withdrawal. Boundaries are very important in helping someone become willing to get help. Unfortunately you cannot do someone’s recovery for them and without self-motivation it is very hard to make it work.

The next step is to call our highly trained advisers 0330 088 9518.

There is a huge range of rehab options available and where to start can be completely over whelming so let us help.