According to the World Health Organization (WHO), "One in four people in the world will be affected by mental or neurological disorders at some point in their lives." Therefore an estimated 450 million people have a mental illness. Mental illness is defined as mental health conditions that affect thinking, mood, and behavior. Millions of Americans are living with mental illness or have a loved one living with mental illness. Examples of mental health conditions are Attention Deficit Hyperactive Disorder (ADHD), Depression, Anxiety Disorders, Autism, Bipolar Disorder, Post-traumatic Stress Disorder (PTSD), and Schizophrenia. There are many other mental health conditions that are associated with a variety of symptoms that unique to each person living with the illness. Many individuals who have mental illness face challenges by social stigma and discrimination, finding helpful resources and acquiring adequate treatment for their symptoms. However, there has been an increase in awareness and organizations providing support for those affected by mental illness. The first week in October is acknowledged nationwide as Mental Health Awareness Week. During this week organizations such as NAMI (National Alliance on Mental Illness) and the American Mental Wellness Association work diligently to spread awareness and provide resources for those living with a diagnosis or condition. These organizations provide valuable online resources that educate individuals on symptoms and treatments available for various mental illnesses. In addition, the above organizations are great resources for finding local resources that can provide mental health services for those living with mental illness and their families. They also advocate for those living with mental health condition by actively participating in legal processes that affect the rights, research, and treatment available for those affected by mental illness.
Mental health and addiction continue to be a complex subject for many individuals. Mental health professionals and people living with mental illness and addiction are challenged by symptoms that are more persistent, severe, and resistant to treatment compared with individuals who only has a mental health diagnosis or addiction (National Institute of Drug Abuse). The occurrence of mental illness and addiction at once is often referred to as comorbidity. The National Institute on Drug Abuse further stated that since 1980 multiple national population surveys have reported data indicating that individuals diagnosed with mood or anxiety disorders are twice as likely to suffer additionally from a drug use disorder or dependence.
Many treatment centers say they offer dual diagnosis treatment when in reality they do not. The first issue with this is that often for clients who enter a substance abuse treatment center, this is not their first rodeo. In other words, it is likely this is not their first treatment facility or attempt to get help. Unfortunately, many individuals who abuse alcohol or substances carry with them at least one mental health diagnosis. Some common ones include depression, anxiety, and very often bipolar disorder. Does that mean these diagnoses are accurate? Again, unfortunately, NO! When someone has been abusing drugs or alcohol, he or she may appear to meet criteria for any one of many mental illnesses. It is not until they are off these drugs for a significant amount of time that we can begin to tease out the symptoms and understand their history, to truly know what, if any, diagnosis is accurate. Honestly, this takes time, expertise, and an understanding of mental illness. In the treatment industry, all of these can present a challenge. Let's start with time. Insurance companies often don't give facilities sufficient time to diagnose accurately. This starts with having to diagnose someone in their first visit/session and ends with not giving them enough days to truly come off the drugs and alcohol and present with who they are and what they are and have experienced. Next, expertise or an understanding of mental illness. Many substance abuse treatment centers do not utilize licensed mental health professionals regularly. Certified Addiction Professionals (CAPs), interns, techs, or other office staff, do not have the background or expertise to be able to diagnose mental illness. These factors and more present significant challenges to effectively treating individuals with dual diagnosis. We need to know if they truly are dual diagnosis and if so, what other mental health diagnosis is indeed correct.
Don't get me wrong; some facilities do a great job at this. Unfortunately, there are more that don't than do. It starts with not trusting a diagnosis someone comes in with. Do not simply diagnose an individual based on their past diagnosis. Instead, start from the beginning and understand the person, their history, behaviors, and symptoms and diagnose them based on those factors as well as what you see in your office over time. Don't forget to account for the unusual symptoms one experiences when stopping the use of drugs or alcohol after a significant period.
Dr. Rachel Needlehas specialized training in the area of substance abuse. She is a professional consultant to substance abuse facilities and assists them in expanding and enhancing clinical programming. Dr. Needle also does expert training for staff members at residential and outpatient facilities that specialize in alcohol and substance abuse.
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