Case Study: Shelby County Mental Health Clinic
I live in Maylene, Alabama which is within Alabaster which is one of the fastest growing cities in Alabama. Alabaster has grown more than 63% in the last ten years. The fast growth has made Alabaster a profitable place to do business and the demand for retail and restaurants is high. Alabaster’s crime rate is one of the lowest in Shelby County which makes it an attractive place to live. With its fast growing economy, Alabaster has much opportunity for employment (City of Alabaster). Though industry is high, opportunities for mental health care are low. Shelby County has a mental health clinic, though it is not located in Alabaster. Alabaster has some psychiatry services, though none are non-profit or work on a sliding scale pay rate. There are opportunities for individuals who have health insurance to obtain services, though the resources for low income individuals or the unemployed are slim. Shelby County Mental Health Clinic would be the nearest resource that would be available to Alabaster citizens, though treatment may be challenging if transportation is an issue. Alabaster has a population of 30,991 with 79% being white, 13.5% black, and 9% Hispanic or
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Latino. Individuals between 25 and 34 make up the highest percentage of this population (US Census Bureau). Alabaster’s limited resources and its high percentage of young adults would make it an ideal place to introduce a substance abuse clinic specializing in dual-diagnosis. Inaba and Cohen (2007) point out that in recent years more attention has been placed on treating people with a dual-diagnosis. The rates of individuals with an SMI and SUD (substance use disorder) vary depending upon the type of mental illness. Individuals suffering from “bipolar disorder have an incidence of co-occurring disorders approaching 75%” (Inaba & Cohen, 2007, p. 32). Inaba and Cohen also note that 47% of individuals with a thought disorder, such as schizophrenia also suffer with an SUD and 81% of incarcerated individuals with an SUD have some type of mental illness (2007, p. 520).
It is difficult for those who are not only mentally ill but suffering from the disease of addiction to be adequately treated for a number of reasons. Leventhal & Zimmerman (2010) assert that often patients who have been given a dual diagnosis “receive partial care-receiving all their treatment in either a psychiatric clinic or a substance abuse clinic-or fragmented care by attending two separate programs” (p. 363). The therapists and facilities responsible for treating these patients may not have the resources to treat them effectively. Leventhal & Zimmerman (2010) point out that individuals who abuse drugs seem to require more treatment and have poorer outcomes than other patients with mental disorders. They further assert that this complication to mental illness by substance abuse compounds both direct and indirect costs of the illness to society. There are several different theories to why those with existing mental disorders may be more susceptible to drug addiction. Among the hypothesis for an increased vulnerability to drug dependence among those with pre-existing psychiatric disorders is an individual’s desire to self-medicate to relieve their symptoms (Dixon, Sweeney, & Frances, 1999). Drugs like heroine or dilaudid which increase the release of neurological transmitters such as dopamine may give individuals with psychiatric disorders temporary relief by reducing psychotic and depressive symptoms (Dixon, Sweeney, & Frances, 1999). Though these individuals may receive temporary relief of their symptoms for a time, prolonged abuse of opiates will inevitable increase the symptoms of their mental illness due to altering brain chemistry as well as producing compounding problems associated with drug addiction. Bradizza et al., (2009) claims “individuals with a severe mental illness (SMI; I.e., schizophrenia, bipolar disorder) and a substance use disorder (SUD) incur significantly more negative consequences compared with SMI individuals with no SUD, including more severe psychiatric symptoms, more frequent psychiatric rehospitalizations, less stable living situations, fewer regular meals and activities, and greater rates of violent behavior” (p.1147). Intervention treatment for individuals suffering from substance abuse addiction is complex in itself, when adding a mental disorder into the diagnosis more drastic measures of treatment must be taken in order to establish a greater probability of recovery for the patient.
Treating an individual with a dual diagnosis of substance abuse disorder and mental illness can be problematic in several different areas. Because the individual not only suffers from SMI but SUD as well, several factors must be considered before an accurate diagnosis can even be made. It is unlikely that a therapist specializing in addiction counseling or a therapist specializing in clinical mental health counseling would be equip in and of themselves to treat these patients, consultation and combined efforts would be
needed. Many patients with SMI and SUD often are treated either in a psychiatric hospital where their addiction may not be treated or in a substance abuse treatment facility where they will not receive competent care for their mental illness. It seems to be especially detrimental when a patient with a dual diagnosis is first placed in a psychiatric hospital to be treated. If the patient becomes agitated or anxious they are often drugged further in order to stabilize the patient or facilitate compliance, though this would only further trigger the patient’s addiction. It is also detrimental to recovery if the patient is suffering from a mental illness due to prolonged alcohol or opiate abuse. Inaba and Cohen (2007) assert, “as a result of substance abuse and/or withdrawal, the user develops psychiatric problems because the toxic effects of the drug disrupt the brain chemistry” (p. 521). Salloum, Williams, and Douaihy (2008) assert “integrated care is the recommended treatment approach to fully addressing the treatment needs for these complex conditions” (p.21). For sustained recovery is necessary for those diagnosed with both SMI and SUD to be treated for both diseases. As Salloum, Williams, and Douaihy (2008) suggest, the optimal outcome for treatment would include “integration at the system level to ensure adequate planning of services, financing, and access to care; integration at the provider level to ensure that a multidisciplinary team with appropriate training, competencies, and commitment is available to address the multiple psychosocial, general physical health, psychiatric, and substance use treatment needs; and integration at the intervention level to ensure that effective, empirically-based, psychosocial and pharmacotherapeutic interventions are being developed and used” (p.21). This type of care and pharmacotherapeutic intervention would be ideal for those with SMI and SUD.
Thus an approach that could be substantially beneficial to many would be an integration of care at a substance abuse treatment facility that could consist of at least two psychiatrists trained and equipped to diagnose, treat, and care for the mentally- ill working in conjunction with the counselors and medical doctors treating the patients for substance abuse.
Often in treatment facilities patients are prescribed antidepressants, mood stabilizers, and sleeping pills after only a short consultation with a physician that they are likely to meet with only a couple of times during the course of their treatment. Inaba and Cohen (2007) declare that “the prudent clinician addresses all symptoms but avoids making a specific psychiatric diagnosis until the drug abuser has had time to get sober and beyond drug withdrawal” (p.522).
Patients in a drug treatment facility also may be required to meet weekly with a counselor in order to develop a personalized treatment plan and future treatment suggestions in which the patient themselves may participate little in the actual development of personalized treatment goals. In order for appropriate treatment plans and medication to be prescribed a more equipped team of professionals would be needed to work in conjunction with one another in order to ensure more quality care as well as a better success rate for the patients. Increasing the staff in order to enhance the likelihood of recovery and produce more integrated-care may not solve the complexities of treating individuals with a dual-diagnosis, but it would improve the odds of recovery for many.
References
Bizzarri, J., Rucci, P., Vallotta, A., Girelli, M., Scandolari, A., et al. (2005). Dual Diagnosis and Quality of Life in Patients in Treatment for Opiod Dependence. Substance Use & Misuse, 40, 1765-1776.
Bradizza, C., Maisto, S., Vincent, P., Stasiewicz, P., Connors, G., et al. (2009). Predicting Post-Treatment-Initiation Alcohol Use Among Patients with Severe Mental Illness and Alcohol Use Disorders. Journal of Consulting and Clinical Psychology, 77(6), 1147-1158.
City of Alabaster. (2013). Retrieved from: http://www.cityofalabaster.com/
Dixon, L., Haas, G., Weiden, P., Sweeney, J., & Frances, A. (1990). Acute Effects of Drug Abuse in Schizophrenic Patients: Clinical Observations and Patients’ Self-Reports. Schizophrenia Bulletin, 16(1), 69-79.
Leventhal, A. M. & Zimmerman, M. (2010). The Relative Roles of Bipolar Disorder and Psychomotor Agitation in Substance Dependence. Psychology of Addictive Behaviors, 24(2), 360-365.
Lyvers, M. (1998). Drug Addiction as a Physical Disease: The Role of Physical Dependence. Experimental and Clinical Psychophaimacology, 6(1), 107-125.
Mueser, K. T., Bellack, A. S., & Blanchard, J. J. (1992). Comorbidity of Schizophrenia and Substance Abuse: Implications for Treatment. Journal of Consulting and Clinical Psychology, 60(6), 845-846.
Mueser, K. T., Drake, R. E., Ackerson, T. H., Alterman, A. I., Miles, K. M., et al. (1997). Antisocial Personality Disorder, Conduct Disorder, and Substance Abuse in Schizophrenia. Journal of Abnormal Psychology, 106(3), 473-477.
Salloum, I., Williams, L., & Douaihy, A. (2008). Diagnostic and Treatment Considerations: Bipolar Patients with Comorbid Substance Use Disorders. Psychiatric Annals, 38(11), 718-723.
Siris, S. G. (1990). Pharmacological Treatment of Substance-Abusing Schizophrenic Patients. Schizophrenia Bulletin, 16(1), 111-122.
United States Census Bureau. (2012). Retrieved from: http://quickfacts.census.gov/qfd/states/01/0100820.html
Latino. Individuals between 25 and 34 make up the highest percentage of this population (US Census Bureau). Alabaster’s limited resources and its high percentage of young adults would make it an ideal place to introduce a substance abuse clinic specializing in dual-diagnosis. Inaba and Cohen (2007) point out that in recent years more attention has been placed on treating people with a dual-diagnosis. The rates of individuals with an SMI and SUD (substance use disorder) vary depending upon the type of mental illness. Individuals suffering from “bipolar disorder have an incidence of co-occurring disorders approaching 75%” (Inaba & Cohen, 2007, p. 32). Inaba and Cohen also note that 47% of individuals with a thought disorder, such as schizophrenia also suffer with an SUD and 81% of incarcerated individuals with an SUD have some type of mental illness (2007, p. 520).
It is difficult for those who are not only mentally ill but suffering from the disease of addiction to be adequately treated for a number of reasons. Leventhal & Zimmerman (2010) assert that often patients who have been given a dual diagnosis “receive partial care-receiving all their treatment in either a psychiatric clinic or a substance abuse clinic-or fragmented care by attending two separate programs” (p. 363). The therapists and facilities responsible for treating these patients may not have the resources to treat them effectively. Leventhal & Zimmerman (2010) point out that individuals who abuse drugs seem to require more treatment and have poorer outcomes than other patients with mental disorders. They further assert that this complication to mental illness by substance abuse compounds both direct and indirect costs of the illness to society. There are several different theories to why those with existing mental disorders may be more susceptible to drug addiction. Among the hypothesis for an increased vulnerability to drug dependence among those with pre-existing psychiatric disorders is an individual’s desire to self-medicate to relieve their symptoms (Dixon, Sweeney, & Frances, 1999). Drugs like heroine or dilaudid which increase the release of neurological transmitters such as dopamine may give individuals with psychiatric disorders temporary relief by reducing psychotic and depressive symptoms (Dixon, Sweeney, & Frances, 1999). Though these individuals may receive temporary relief of their symptoms for a time, prolonged abuse of opiates will inevitable increase the symptoms of their mental illness due to altering brain chemistry as well as producing compounding problems associated with drug addiction. Bradizza et al., (2009) claims “individuals with a severe mental illness (SMI; I.e., schizophrenia, bipolar disorder) and a substance use disorder (SUD) incur significantly more negative consequences compared with SMI individuals with no SUD, including more severe psychiatric symptoms, more frequent psychiatric rehospitalizations, less stable living situations, fewer regular meals and activities, and greater rates of violent behavior” (p.1147). Intervention treatment for individuals suffering from substance abuse addiction is complex in itself, when adding a mental disorder into the diagnosis more drastic measures of treatment must be taken in order to establish a greater probability of recovery for the patient.
Treating an individual with a dual diagnosis of substance abuse disorder and mental illness can be problematic in several different areas. Because the individual not only suffers from SMI but SUD as well, several factors must be considered before an accurate diagnosis can even be made. It is unlikely that a therapist specializing in addiction counseling or a therapist specializing in clinical mental health counseling would be equip in and of themselves to treat these patients, consultation and combined efforts would be
needed. Many patients with SMI and SUD often are treated either in a psychiatric hospital where their addiction may not be treated or in a substance abuse treatment facility where they will not receive competent care for their mental illness. It seems to be especially detrimental when a patient with a dual diagnosis is first placed in a psychiatric hospital to be treated. If the patient becomes agitated or anxious they are often drugged further in order to stabilize the patient or facilitate compliance, though this would only further trigger the patient’s addiction. It is also detrimental to recovery if the patient is suffering from a mental illness due to prolonged alcohol or opiate abuse. Inaba and Cohen (2007) assert, “as a result of substance abuse and/or withdrawal, the user develops psychiatric problems because the toxic effects of the drug disrupt the brain chemistry” (p. 521). Salloum, Williams, and Douaihy (2008) assert “integrated care is the recommended treatment approach to fully addressing the treatment needs for these complex conditions” (p.21). For sustained recovery is necessary for those diagnosed with both SMI and SUD to be treated for both diseases. As Salloum, Williams, and Douaihy (2008) suggest, the optimal outcome for treatment would include “integration at the system level to ensure adequate planning of services, financing, and access to care; integration at the provider level to ensure that a multidisciplinary team with appropriate training, competencies, and commitment is available to address the multiple psychosocial, general physical health, psychiatric, and substance use treatment needs; and integration at the intervention level to ensure that effective, empirically-based, psychosocial and pharmacotherapeutic interventions are being developed and used” (p.21). This type of care and pharmacotherapeutic intervention would be ideal for those with SMI and SUD.
Thus an approach that could be substantially beneficial to many would be an integration of care at a substance abuse treatment facility that could consist of at least two psychiatrists trained and equipped to diagnose, treat, and care for the mentally- ill working in conjunction with the counselors and medical doctors treating the patients for substance abuse.
Often in treatment facilities patients are prescribed antidepressants, mood stabilizers, and sleeping pills after only a short consultation with a physician that they are likely to meet with only a couple of times during the course of their treatment. Inaba and Cohen (2007) declare that “the prudent clinician addresses all symptoms but avoids making a specific psychiatric diagnosis until the drug abuser has had time to get sober and beyond drug withdrawal” (p.522).
Patients in a drug treatment facility also may be required to meet weekly with a counselor in order to develop a personalized treatment plan and future treatment suggestions in which the patient themselves may participate little in the actual development of personalized treatment goals. In order for appropriate treatment plans and medication to be prescribed a more equipped team of professionals would be needed to work in conjunction with one another in order to ensure more quality care as well as a better success rate for the patients. Increasing the staff in order to enhance the likelihood of recovery and produce more integrated-care may not solve the complexities of treating individuals with a dual-diagnosis, but it would improve the odds of recovery for many.
References
Bizzarri, J., Rucci, P., Vallotta, A., Girelli, M., Scandolari, A., et al. (2005). Dual Diagnosis and Quality of Life in Patients in Treatment for Opiod Dependence. Substance Use & Misuse, 40, 1765-1776.
Bradizza, C., Maisto, S., Vincent, P., Stasiewicz, P., Connors, G., et al. (2009). Predicting Post-Treatment-Initiation Alcohol Use Among Patients with Severe Mental Illness and Alcohol Use Disorders. Journal of Consulting and Clinical Psychology, 77(6), 1147-1158.
City of Alabaster. (2013). Retrieved from: http://www.cityofalabaster.com/
Dixon, L., Haas, G., Weiden, P., Sweeney, J., & Frances, A. (1990). Acute Effects of Drug Abuse in Schizophrenic Patients: Clinical Observations and Patients’ Self-Reports. Schizophrenia Bulletin, 16(1), 69-79.
Leventhal, A. M. & Zimmerman, M. (2010). The Relative Roles of Bipolar Disorder and Psychomotor Agitation in Substance Dependence. Psychology of Addictive Behaviors, 24(2), 360-365.
Lyvers, M. (1998). Drug Addiction as a Physical Disease: The Role of Physical Dependence. Experimental and Clinical Psychophaimacology, 6(1), 107-125.
Mueser, K. T., Bellack, A. S., & Blanchard, J. J. (1992). Comorbidity of Schizophrenia and Substance Abuse: Implications for Treatment. Journal of Consulting and Clinical Psychology, 60(6), 845-846.
Mueser, K. T., Drake, R. E., Ackerson, T. H., Alterman, A. I., Miles, K. M., et al. (1997). Antisocial Personality Disorder, Conduct Disorder, and Substance Abuse in Schizophrenia. Journal of Abnormal Psychology, 106(3), 473-477.
Salloum, I., Williams, L., & Douaihy, A. (2008). Diagnostic and Treatment Considerations: Bipolar Patients with Comorbid Substance Use Disorders. Psychiatric Annals, 38(11), 718-723.
Siris, S. G. (1990). Pharmacological Treatment of Substance-Abusing Schizophrenic Patients. Schizophrenia Bulletin, 16(1), 111-122.
United States Census Bureau. (2012). Retrieved from: http://quickfacts.census.gov/qfd/states/01/0100820.html