properly treating dual diagnosis

by john carcerano




the importance of recognizing dual diagnosis in treating your addiction


A dual diagnosis is found in at least 40-45% of those with a history of alcohol or drug addiction. Dual diagnosis is the presence of at least one psychological disorder besides the addiction. An addiction itself is a diagnosable disorder according to the Diagnostic Manual of Mental disorders (DSM 4). It is extremely important that when you are addressing your need to quit your alcohol or drug addiction that you be checked for a psychological disorder. If there is an over looked disorder then you will most certainly not succeed in quitting your addiction until you properly treat that disorder. When you are free from all mind altering substances then you will be able to look for any and all psychological issues. The reason being, because one will mask the other. Anxiety,depression, anger and irritability are the most common symptoms to look for. A psychiatrist will be unable to look for a 2nd disorder besides the addiction, if the addiction has not been arrested because the addiction itself will bring on many of the symptoms associated with a psychological disorder. In fact, in most cases the psychological disorder will be the main trigger for the substance addiction. Drugs and alcohol are a way to self medicate from the symptoms of a mental illness. A mental illness will also make the body more physiologically susceptible to drugs or alcohol. There often is great controversy in the medical community as to what disorder should be treated first. There are psychiatrists who will not treat a patient until they are free from all drugs and alcohol, and then there are addiction counselors who will not treat an addict until their psychological disorder is being treated. For a psychiatrist or addiction counselor to take one of these attitudes really is a form of malpractice. Both disorders need to treated at the same time. If the treating counselor is not both an addiction counselor and a psychiatrist, then the patient with the dual diagnosis needs to see an addiction counselor who will work in conjunction with the treating psychiatrist. The medications used for treating the psychological disorder often take several weeks to several months before they begin working. And often times the first prescribed medications are not found to be the right ones for the patient. There are several different medications for each diagnosis, and the right ones for a specific persons physiology can only be found through trial and error. So the addiction counselor needs to have patience while this trial and error process of finding the right medicine to stabilize their patient plays out.




Diagnosis For Substance Abuse According to DSM IV CRITERIA



Figure 2-1DSM-IV Diagnostic Criteria for Substance Abuse
The DSM-IV defines the diagnostic criteria for substance abuse as a maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one or more of the following, occurring within a 12-month period:
(1)Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; neglect of children or household).
(2)Recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use).
(3)Recurrent substance-related legal problems (e.g., arrests for substance-related disorderly conduct).
(4)Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of intoxication, physical fights).
Source: Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Copyright 1994, American Psychiatric Association.



Simple Criteria For Alcohol Dependence

What is alcoholism?Alcoholism, also known as alcohol dependence, is a disease that includes the following four symptoms:
Craving--A strong need, or urge, to drink.
Loss of control--Not being able to stop drinking once drinking has begun.
Physical dependence--Withdrawal symptoms, such as nausea, sweating, shakiness, and anxiety after stopping drinking.
Tolerance--The need to drink greater amounts of alcohol to get "high."

The problem in treating the addict with the dual diagnosis can often be the denial by the addict of accepting a diagnosis for a psychological disorder. Psychological disorders often carry a social stigma with them, and because of this no one wants to be labeled as “crazy”. And this stigma is one that really should not exist given the facts that 1 in 5 people have a diagnosable psychological disorder and more than 1 in 3 people have a diagnosable addiction. Why society is so stigmatized by having one of these is really beyond the pale when you truly look at how common disorders and addiction really are. Actually, there are so many addictions in our society, from alcohol and drugs, to gambling, sex, spending, dieting, anorexia, bulimia, cosmetic surgeries and constant prepping with makeup for our looks, etc. Our social pressures have brought on such anxieties and depression that we often turn to self medication as a form of refuge just to try to find calming and comfort. Addiction is our modern day society’s number one health problem without a doubt. The top 6 causes of death in the U.S. are as follows;1.heart disease, 2.cancer, 3.strokes, 4.resperatory illnesses, 5.accidents, 6.diabetes. Most if not all of these are themselves caused by addiction to food, cigarettes, tensions, drugs or alcohol. So as a society we do need to look at why there is a stigma to something that most everyone themselves have to some degree or another. This is why it is important for an addict to be checked for a psychological disorder as well so that the addiction can be treated with success. Remember that all addictions are rooted in a chemical imbalance, and the chemical imbalances are brought on by psychological disorders, stress, emotional strain, traumatizing situations or even a lower inability to cope with many situations. So properly treat the reasons for the chemical imbalances and you will greatly diminish the compulsion to engage in the addiction.

Please see an expert psychiatrist for a proper diagnosis
You will need to see an expert psychiatrist to get the exact diagnosis for your psychlogical disorder. Do not be surprised if you get diagnosed with more than one disorder. The truth is that most people who are diagnosed have several disorders. There usually is the main disorder and 1 or 2 secondary disorders with lessor degrees of severity. Again, address the issues with the proper maintainance of medication, and you will be correcting to a high degree the chemical imbalance. By correcting the imbalances you are reducing the strength of the triggers and this will allow much greater success in treating a co-occuring addiction to drugs or alcohol.

this blog is written in conjunction with the upcoming book “A NEW JOURNEY” RECOVERY FROM ALCOHOL AND DRUG ADDICTION by john carcerano . visit my self help website at http://www.newjourneyrecovery.com/