Dual Diagnosis

Dual Diagnosis
Thomas Hollyday
Liberty University

Introduction
Duel Diagnosis has become more frequent, with the advancement into the signs and symptoms of each disorder progresses. I great amount of the time when a person has an addictive personality they tend to have other personality disorders also. Just three generations ago if a person had substance use disorder (SUDs) they would stop after that diagnosis. At that time they didn’t know that the majority of psychiatric patients also had a co-occurring SUD (Doweiko 2015 p. 339). The book goes on to say that the health care professionals do not understand why they would have more than one problem at a time. Earlier in the text it did mention that drugs and alcohol abuse does change the person with the disorders brain, and sometimes the brain never goes back to the way it was before the addiction. Today the norm for people with SUDs is to be diagnosed with multiple disorders. From going to AA and NA meetings I learned that some people stop drinking or drugs but they are still miserable because they have not changed anything except taking the drink or drug out of the hands. Dual-diagnosis patients are people that suffer with co-existing disorders of mental illness and SUDs. All of these mental illnesses do not have to be related to each other, the book used hypertension and obesity. The book also mentioned that the SUDs did not cause the psychiatric disorder (Doweiko 2015 p. 340). There is always a chance that SUDs can increase the person secondary disorder like cirrhosis or the liver, heart failure, alcohol or drug overdose and other medical disorders that could put the person in the hospital. Having a dual-diagnosis can be very tricky for both the licenses professional counselor and the patient to identify and to treat properly.
Theoretical Models
There are four different theoretical models for dual-diagnosis; the first is that the SUDs and mental illness both reflect a common undiscovered factor. The second is that substance use by a person with a mental illness is considered a form of self-medication. The third model is that substance abuse is secondary to psychopathology and when the psychopathology problem is dealt with the substance problem will be resolved. The fourth and final theoretical model is people with mental illness might be exceptionally sensitive to the effects of the drugs of abuse. With all these being listed none of them explain drug abuse and mental illness (Doweiko 2015 p. 340).
Dual Diagnosis Dual diagnoses can me a challenge understanding which of this diagnosis should be treated first, and how the first treatment might affect the secondary problem. Sometimes the mental disorder is the reason the person has become SUD. The patient possibly did not understand how to deal with the mental problem and turned to drugs or alcohol to not feel the pain inside. In some cases this is the way of running away from dealing with the problem (Doweiko 2015 p. 342). Patient with dual-diagnosis for the most part have the worse treatment outcomes, higher healthcare utilization , increased risk of violence, trauma, and suicide, child abuse and neglect, and involvement in criminal justice system; more medical comorbidity, particularly of infectious diseases; and higher health care than people with a single disorder (Doweiko 2015 p. 341-342). Unfortunately with the 1950’s deinstitutionalization of patients formerly hospitalized by the state and federal psychiatric wards this is what put a large demand for outpatient treatment in the community. I stated this in an earlier paper, 1st case study, and it stated this was my opinion (Doweiko 2015 p. 342). When a person that has a gambling problem losses there money because they continue to play until they are broke this opens the door for them to use alcohol to numb the losing feeling, this is why in Las Vegas if your gambling you receive drinks for free, and the casinos pump pure oxygen into the air handlers to help people stay awake longer and gamble longer. I know because I worked in this field and learned all about it while I was at a company trip/meeting in Vegas. The amount of financial loss encourages the addicted gambler to use chemicals to help them get numb (Doweiko 2015 p. 350).
Personality-Disorder Clients The interesting part of this disorder is that it’s estimated that 50-60% of clients with a suds also have a concurrent personality-disorder; the author also states that 40% of AUDs have a concurrent personality-disorder. These are much higher than I would have guested.
Borderline Personality Disorder (BPD) BPD is often an enigma both to the mental health professional and the layperson. These alternate between people over-idealization of significant of others and total rejection and distrust of the same person after a perceived slight or rejection. They do, however, share the characteristic of impulsiveness and overemphasis on their own perceived “rights,” as does antisocial personality-disorder client, and are often misdiagnosed as having ASPD. Perhaps 30-50% of persons with a SUD will also have BPD (Doweiko 2015 p. 351).
Posttraumatic Stress Disorder (PTSD) Women appear to develop PTSD about twice as much as men. PTSD patients often turn to drugs and alcohol to self-medicate and numb the feelings. The loss of hope in PTSD is one of the more damaging aspects of this disorder, thus establishing one therapeutic goal for the client at the onset of therapy (Doweiko 2015 p. 351).
Problems with working with dual-diagnosis The motivation for getting off drugs or alcohol is normally just a step to just get them out of trouble with personal/legal/legal problems. Many dual-diagnoses demonstrate a special form of denial called free floating or interchangeable denial. To complicate matters, many health care professionals view dual-diagnoses clients as being primarily substance abuse patients who require substance abuse treatment (Doweiko 2015 p. 353-354).
Traumatic Brain Injuries (TBI) and SUDs Currently TBI is used to describe any damage to the brain. Physicians use Glasgow Coma Scale (GCS) this measures the individuals level of consciousness on a scale of 3-15. The individual’s ability to respond to verbal commands, voluntary movement, and to provide information lower scores reflects more TBI. The effects of TBI vary from one individual to the next depending on the (a) cause of brain injury, (b) location of injury, (c) extent of injury, and the (d) individual’s level of function before the injury. (Doweiko 2015 p. 354).
Postconcussion Syndrome (PCS) This is a subcategory of the TBI, which involves a person having a concussion. It used to be the school of thought that a patient who suffered from a concussion healed within hours. Recently it was discovered that the aftereffects of a concussion may linger much longer. (Doweiko 2015 p. 355).
Dual-Diagnosis Clients and Medication Compliance There are problems with all medical patients and medication compliance. Clients with dual diagnoses are 8.1 times more likely to not comply with their medication. Complications could arise with both the psychiatric and the SUD’s (a) refusing to take medication, (b) continuous use of alcohol and non-prescribed drugs, (c) choosing the medications that give them the effects they desire (Doweiko 2015 p. 355).
Treatment Approaches with Dual-Diagnosis Clients People who have dual diagnosis have suffered and been shunned from both the psychiatric and SUD treatment facilities. The approaches to treat dual diagnosis patients are being to improve. Even today they have not perfected a method to diagnose SUD patients that have a dual diagnosis. The clients are continuing to suffer with this problem since there doesn’t seem to be enough money to research this issue and the rehabilitation departments have poor funding as well. (Doweiko 2015 p. 356).

Stages of Treatment A therapist must establish a good relationship with the clients who are dual-diagnosed. Second, they must engage the client to understand their condition in all of its aspects. Third and final, the staff will teach the client coping skills and direct them to their community resources. (Doweiko 2015 p. 357).
The Outcome of Treatment The home environment that the client returns to is a variable that affects the outcome of treatment. If they return to the place where they once used drugs it can trigger the response of drug usage once again. It is important for them to be as close as possible to the meetings that can help them continue their sobriety. A more realistic outcome for these dual-diagnosis patients may be a reduction in using, rather than complete abstinence. (Doweiko 2015 p. 358).

Reference
Doweiko, H. E. (2015). Concepts of chemical dependency (9th ed.). Stamford, CT: Cengage Learning. P. 339-358