The coexistence of mental illness alongside an addiction or chemical dependency is known as a co-occurring disorder or a dual diagnosis. Co-occurring disorders may require specialized treatment in a mental health rehab.
Are There Rehabs for Mental Health?
Many who struggle with substance use disorders also meet the diagnostic criteria for one or more psychiatric disorders. Those struggling with drug or alcohol addiction, or an eating disorder are also commonly found to face an anxiety disorder, bipolar disorder, depression, personality disorder or schizophrenia.
The Correlation Between Mental Illness and Substance Misuse
The coexistence of mental illness alongside an addiction or chemical dependency is known as a co-occurring disorder or a dual diagnosis. Co-occurring disorders require a specialized approach to therapy and a highly individualized plan that can evaluate and treat both problems. Unless clients receive treatment that target both their mental illness and addiction, they will more than likely leave treatment prematurely or relapse quickly.
Co-occurring disorders are more common than you might think. The Substance Abuse and Mental Health Services Administration (SAMSHA) recently found that just under eight million adults in the United States had co-occurring disorders.
According to the National Alliance on Mental Illness, the problem is extremely common. About 33 percent of individuals with a mental health illness also struggle with substance abuse. Nearly half of those with a severe psychiatric disorder like bipolar disorder or schizophrenia also struggle with addiction. Over 33 percent of alcoholics also exhibit signs of a mental illness.
Depending on the degree and severity of multiple symptoms, clients with co-occurring disorders often suffer for a long period time without an accurate diagnosis. It’s very common for only one disorder to be treated, which decreases the changes of long term, lasting recovery.
Someone suffering from dual diagnosis has two separate co-occurring disorders but they can be related and intertwined. No one person suffers from co-occurring disorders in the same way. A mental or mood disorder can precede an addiction and vice versa.
The most important thing to keep in mind is that for an accurate dual diagnosis, both conditions have to be present at the same time and a plan is formulated to treat both simultaneously.
Dual Diagnosis Treatment
Up until the 1980s, addictions to drugs and alcohol were considered separate problems from mental health disorders. Clients who exhibited both had to first detox at a rehab facility before being treated for their mental health illnesses. For the last 30 years, substance abuse treatment counselors and psychiatric professionals have worked together to better understand and treat co-occurring disorders and integrate treatment plans.
Dual Diagnosis Symptoms
Different combinations of substances and mental health conditions impact the presence of symptoms that can lead to an accurate dual diagnosis. Symptoms of a mental illness are often very similar to the symptoms of addiction and drug withdrawal. Drug or alcohol use can temporarily hide the effects of certain mental health disorders. Substance abuse can trigger a psychiatric relapse in patients with severe conditions like schizophrenia or schizoaffective disorder. An undiagnosed mental health disorder can precipitate an episode of heavy drug abuse.
Most co-occurring disorders emerge when a client self medicates with a substance to escape from the symptoms of a mood disorder. Common symptoms and behaviors of a co-occurring disorder can include:
- Using drugs, alcohol or compulsive behaviors to relieve intense anxiety, depression or mood swings
- Psychiatric symptoms like depressive episodes, flashbacks or panic attacks after drinking heavily or using drugs
- Withdrawing from friends, family and social activities
- Experiencing problems with employment, housing or relationships
- Using emergency services for acute intoxication, self-injury or suicide attempts
- Legal difficulties, homelessness or incarceration as a result of behavioral problems and substance abuse
- Drug or alcohol withdrawal symptoms
- Extreme changes in behavior
- High tolerance to substances being abused
- Perceived inability to function without alcohol or drugs
Self-medicating is the use of a substance, drugs, alcohol or food, for the purpose of cessation or escape from a mood disorder. An example of self-medication who drinks to excess or abuses drugs to escape the pains of anxiety or depression. A dual diagnosis plan treats the underlying cause of the mood disorder while also treating the addiction or dependence that has developed with ongoing substance abuse. As a substance is abused over a long period of time, a resistance to it is built up which requires an increase in frequency of use which leads to addiction. Self medicating can mask root symptoms of a mood disorder which leads to misdiagnosis .
Dual Diagnosis Programs
Dual diagnosis recovery programs integrate mental health treatment with addiction therapy to promote equal healing on both levels. These program can include:
- Medically supervised detox
- Psychological testing
- Individually tailored recovery program
- One-on-one psychotherapy
- Peer support groups
- Behavioral modification courses
- Life skills
- Holistic therapies like acupuncture, yoga, meditation
- Aftercare services
Dual diagnosis treatment should be customized to meet the needs of the individual, giving you the very best chance at success. If you or someone you love is struggling with both mental illness and addiction, you can find the help you need from a rehab facility that specializes in co-occurring disorders.
Residential Rehab
Treating patients with a Dual Diagnosis, a mental health condition combined with an addictive disorder requires a highly individualized, integrated approach to therapy. Residential rehab facilities provide a structured environment for clients who face special challenges in their journey to recovery. At a residential treatment center, where the stressors and distractions are removed, clients can devote all their time and attention to learning new coping skills and building a stronger sense of self-worth.
When a dual diagnosis is involved, it can be hard to distinguish between the symptoms of a psychiatric illness and the signs of drug or alcohol addiction. Recognizing the need for treatment is the first step in getting the help you need to restore balance and health to your life. If you see signs that indicate that it’s time for you or a loved one to reach out for help, it’s always best to be on the safe side. If you have any reason to believe that someone you care about needs treatment, contact a mental health specialist near you for an evaluation. Your decision to help someone in your life get into residential rehab may help prevent the serious consequences of substance abuse, such as incarceration, loss of key relationships or incarceration.
Entering a residential rehab facility can be a scary prospect, especially for those with a co-occurring disorder. Depression, anxiety and emotional instability can create an intense fear of the unknown. Patients with social phobias may be terrified of group meetings, while those with obsessive-compulsive disorder may have difficulty living in an unfamiliar environment. At a residential facility that specializes in dual diagnosis treatment, they train staff members to expect these responses and to provide the most comfortable atmosphere possible.
What to Expect at Mental Health Rehab
Assessment and evaluation are the first stages of the rehab process. When you enter a facility, you’ll be evaluated by an addiction specialist (a psychiatrist, psychologist, counselor or social worker) who will gather information about your recent substance use, your current and past medical history, and your psychiatric symptoms. The assessment phase is crucial for developing an individualized treatment plan that addresses both your mental health condition and your substance use disorder
Residential vs. Outpatient
What makes residential treatment so effective for patients with a dual diagnosis? At a residential facility, fully integrated care may be easier to provide. Integrated care refers to combined treatment for an addiction and a psychiatric disorder. When both conditions are treated at the same time, the patient has a greater chance of making a full recovery, according to the National Alliance on Mental Illness (NAMI).
Here are a few ways that integrated care lends itself to a residential environment:
- Patients who need intensive monitoring for heavy substance abuse or acute psychiatric symptoms can receive clinical care 24 hours a day.
- Clinical professionals and recovery resources are gathered in a single setting, where patients can focus exclusively on their rehabilitation.
- In a residential setting, there’s more time to foster trust between caregivers and dual diagnosis patients.
- Patients who have trouble with denial or low motivation can receive specialized attention and encouragement without the distractions of daily life.
- Patients can go through rehabilitation at their own pace in a secure, supportive environment.
- Peer group support is stronger in residential facilities, where dual diagnosis patients can share advice and hope with other clients who have similar concerns.
Outpatient treatment programs are useful and effective for patients who require a lower level of supervision. Outpatient counseling and group meetings take place at rehab facilities, mental health centers and clinics in many communities. Services are generally provided during daytime or evening hours, and patients go home at night.
While the cost of outpatient care is usually lower than the cost of residential services, the lack of structure and supervision places patients at a greater risk of relapse.
In a study published in Drug and Alcohol Review, researchers at Dartmouth Psychiatric Research Center compared the effectiveness of residential treatment programs with outpatient programs for dual diagnosis patients. Their study showed that outpatient care was less effective than residential treatment in up to 50 percent of cases. Participating in outpatient rehab requires a higher level of motivation and compliance, which may not be present in a patient who has a severe mental illness. The structured setting of a residential community provides a sense of security and safety that isn’t available in an outpatient clinic or treatment center.
Medication Management
Pharmacological therapy is a vital component of residential dual diagnosis treatment. In a residential treatment program, patients undergo thorough evaluation to assess their recent history of substance abuse (if any), their psychiatric history and their current symptoms. Medications may be prescribed to relieve the symptoms of anxiety or depression, to control flashbacks, or to reduce cravings for drugs or alcohol. Prescription drugs used to support recovery from a dual diagnosis include:
- SSRIs: Selective serotonin reuptake inhibitors, or SSRIs, are a class of antidepressants that help to restore healthy levels of serotonin, a neurotransmitter that influences mood, appetite and energy levels. SSRIs like fluoxetine (Prozac), citalopram (Celexa) and sertraline (Zoloft) are prescribed for the treatment of depression, obsessive-compulsive disorders, eating disorders and many other psychiatric conditions.
- Anti-anxiety medications: Medications used to treat anxiety disorders include beta-blockers, which help to manage the physical symptoms of panic attacks, and buspirone, a medication used to treat generalized anxiety disorder. Benzodiazepines like lorazepam (Ativan) and alprazolam (Xanax) are sometimes prescribed for the short-term control of severe anxiety, but because these drugs can be addictive, they must be used with care in Dual Diagnosis individuals.
- Antipsychotic medications: Antipsychotic medications like aripiprazole (Abilify), clozapine (Clozaril) and risperidone (Risperdal) are used to treat severe, persistent mental health disorders like bipolar disorder and schizophrenia.
- Anti-addiction medications: For dual diagnosis patients who are addicted to alcohol or opiates, drugs like naltrexone (ReVia, Vivitrol) and buprenorphine (Suboxone) are prescribed to help reduce cravings and maintain long-term abstinence. Methadone may be prescribed to minimize withdrawal symptoms in patients who are addicted to heroin or other opiates.
Therapy
At a residential mental health rehab, individual therapy may be modeled on one or more of these therapeutic schools:
- Cognitive Behavioral Therapy (CBT): The goal of CBT is to change destructive thought patterns and behaviors that interfere with the patient’s desire to lead a more productive, fulfilling life. CBT can be used in the treatment of mental disorders like depression or anxiety, as well as in the treatment of addictive behavior. The coping skills that patients learn in CBT can empower them to manage their moods, fears or flashbacks without the help of drugs or alcohol.
- Motivational Interviewing (MI): Motivational interviewing arose from the need to provide a more supportive, compassionate form of therapy to dual diagnosis patients. According to Professional Counselor, MI is designed to help patients with low levels of motivation and compliance find a reason to recover. MI is a nonjudgmental school of therapy that accepts the client’s level of readiness to change instead of attempting to force recovery.
- Dialectical behavior therapy (DBT): Originally developed for the treatment of chronically suicidal patients, the principles of DBT have been applied successfully to addiction treatment and rehabilitation. Dual Diagnosis patients can benefit from this innovative approach to therapy, which focuses on mindfulness, self-acceptance and the regulation of emotional responses.
What to Bring to a Rehab Facility
When you’re admitted to a rehabilitation facility, you’ll need to bring certain personal items and you may also be presented with a list of prohibited items.
Below are some of the basics you’ll need:
- Personal identification, such as a driver’s license or passport
- A contact list of family members, friends and physicians
- Comfortable clothing, footwear and workout gear
- Personal toiletries, such as soap, shampoo. Products containing alcohol are prohibited.
- Electronic devices, such as clocks, hair dryers and CD players
- Reading material (pornography may be prohibited)
Cameras, clothing that advertises drugs or alcohol, incense, candles and cigarette lighters are not allowed at some facilities. The use of cell phones and laptop computers may be limited, but most facilities will allow you to bring these items with you. Your admissions team will advise you on what to bring to the facility before you enroll.
Mental Health Aftercare
According to the U.S. Department of Health and Human Services, peer support is crucial to long-term recovery. Aftercare services can fulfill a number of functions: offering emotional strength, providing education or information about addiction, helping you connect with community resources (transportation, healthcare, affordable housing, etc.), or introducing you to social groups that can give you a sense of belonging.
Aftercare services help you maintain the coping skills you learned in rehab, so you can continue to build the healthy, fulfilling life you want after you graduate from a recovery program. Even as you go through detox and rehab, your treatment team will work on identifying the tools and skills that you’ll need to be successful after you finish the program.
Aftercare can continue for as long as you’re committed to a healthy, meaningful life. People who stay stable despite a mental illness diagnosis often attribute their success to participation in aftercare services like self-help groups, 12-step meetings, alumni organizations, or volunteer activities that support recovery. These activities can help you stay connected to other people who share your goals and values — people who can motivate and inspire you as you create the future you really want.
The following services fulfill one or more of these functions:
- Counseling and therapy
- Family education and counseling
- Case management
- Relapse prevention therapy
- Outpatient recovery services
- Sober living homes
Covering the Cost of Mental Health Rehab
In 2014 the passage of the Affordable Care Act required both individual and group insurance policies to cover care for mental health issues or substance use disorders. However, the extent of what’s covered varies significantly depending on what type of plan you have. Some luxury-level rehab facilities don’t accept insurance but most psychiatric hospitals do since they obviously have a heavy medical component. In general, facilities that advertise as addiction rehabs that offer dual diagnosis support or detox also accept insurance since prescription medication, whether for drug withdrawal or treating mental illness, necessitates physicians on staff. Again though, this isn’t always the case to be sure to call each facility to confirm what their policy is.
The good news is, there are so many different ways to get help now. If treatment isn’t available near you, changes are help isn’t very far. Sometimes it’s best to completely remove yourself from the environment you associate with active addiction or untreated mental health issues in order to begin the healing process.