What is Dual Diagnosis?
A dual diagnosis is the term for people who have a drug problem (i.e. a substance use disorder) and a co-occurring mental disorder simultaneously. Which disorder appears first varies from person to person, but often the development of one eventually leads to the development of the other.
Research shows that more than half of teenagers with substance use disorder also have a diagnosable mental illness. It goes the other way as well — for instance, 61% of people with bipolar disorder (a common mental illness) are addicted to drugs. Patients with a dual diagnosis are labeled in the medical community as MICAs (mentally ill chemical abusers), CAMIs (chemically abusing mentally ill) or SAMIs (substance abusing mentally ill).
A dual diagnosis is linked to several negative outcomes:
- Serious infections like HIV
Many parents only learn of their teenager’s underlying mental illness when a destructive addiction comes along beside it. It’s a far bigger problem than most parents realize, and kids with a dual diagnosis will often only receive help for one of their co-existing problems — leaving the second one unaddressed for years or even a lifetime.
Not many rehab facilities are equipped to handle specialized treatment for dually diagnosed patients. Integrated treatment services take longer than typical rehabilitation services because it addresses two issues at once. It can also be difficult for treatment professionals to know where to start because some symptoms can be associated with addiction and another mental disorder.
Teen drug rehab alone is not enough to address a dual diagnosis. Patients require special attention and help from an integrated drug and mental rehabilitation center that targets all co-occurring problems at once.
In particular, teens are often in a fragile state and liable to be misunderstood and mistreated as their co-occurring disorders prevent them from fitting in with the crowd. It’s up to parents to identify the issues as early as possible, so they can get treatment underway before any of the symptoms worsen.
What is Evidence-Based Treatment?
Evidence-based treatment, or evidence-based practices, are dual diagnosis treatment plans that have been studied scientifically or academically, proven to work and replicated more than once.
There are six steps in the EBT process:
- Assess the patient and their needs
- Investigate existing research and studies
- Determine if the treatment matches the patient’s case
- Discuss the research with the patient
- Develop a plan of action specific to the patient’s needs and values
While the process may be adapted to fit the needs of a patient, it’s been proven over time to be effective in the recovery process.
There are several types of EBTs, including the following:
- Cognitive Behavioral Therapy – helps patients understand the link between emotions and behaviors, and therefore helps them change the behaviors
- Family Therapy – can be especially helpful for adolescents
- Exposure Therapy – helps those with phobias and post-traumatic stress disorder
- Integrated Dual Disorder Treatment (IDDT)
What is IDDT?
Integrated Dual Disorder Treatment (also referred to as Integrated Dual Diagnosis Treatment) is an evidence-based practice model that treats dually diagnosed patients for their co-occurring disorders — in the same facility, using the same treatment professionals. This dual diagnosis treatment model is individualized for each patient’s specific needs, and typically involves elements of psychological, educational, social and pharmacological phases of treatment.
IDDT works by making small, incremental changes over a period of time, which eventually lead to significant changes including sobriety and independent living. These organizational changes, clinical changes and service system changes all occur simultaneously.
What is DDCAT?
The Dual Diagnosis Capability in Addiction Treatment index is a tool developed in 2007, used to assess treatment centers that treat dual diagnosis patients. Program administrators can use the index to score their own facility and determine if they are capable of taking on dual diagnosis patients, developing dual diagnosis models, and look identify areas of improvement.
The index uses a five-point scale on seven different criteria to rate a dual diagnosis treatment center:
- Program Structure
- Program Milieu
- Clinical Process: Assessment
- Clinical Process: Treatment
- Continuity of Care
Program assessors will use observation, interviews and facility materials to rate the facility on the DDCAT index.
Once the assessment is complete, a facility is categorized as having one of four types of programs:
- Addiction Only Services
- Mental Health Only Services
- Dual Diagnosis Capable
- Dual Diagnosis Enhanced
What Is the Dual Diagnosis Treatment Process?
Dual diagnosis treatment models follow an “integrated” approach, meaning co-occurring mental and drug disorders are diagnosed and treated at the same time, by the same team. Traditional standalone drug treatment options may place patients with a mental illness at risk, particularly with their confrontation techniques and occasional discouragement from helpful prescription medications. This can cause increased stress levels during the process, which can worsen symptoms and lead to relapse (returning to a substance after going clean).
As awareness of this problem continues to spread, and the medical community becomes increasingly confident in the integrated approach, more and more dual diagnosis treatment centers are popping up around the country. The standard treatment process in these specialized facilities involves the following components.
A substance abuse detox is the crucial first step in treating dual disorders. At the time they begin treatment, most teens will still be under the influence. During detox, your teen is supervised and assisted as their body naturally rids itself of the drugs and/or alcohol. This may take a couple days or several weeks, depending on the substance and how much they used.
Detox in a residential treatment setting ensures that they won’t be tempted to use. The staff on-hand will also help reduce the intensity and side effects of withdrawal, the body and mind’s sometimes painful reaction to an unfed addiction. Depending on the withdrawal symptoms, your teen’s doctor may prescribe and offer medication during detox.
While you have the option to oversee your teen’s detox at home (as part of an outpatient treatment program), but success rates are higher on-site at a residential treatment facility with the 24/7 support of a trained staff.
Therapy is at the heart of the best dual diagnosis treatment models and treatment centers. Once your teen is admitted for rehab, their doctors will run a series of tests (also known as a “screening”) to determine both the causes and extent of their disorders. Once they have this information, they can determine which forms of therapy would be most effective. After all, mental health and substance abuse problems begin and end in the brain.
Therapy is the most proven way to reshape and retrain the brain into a healthy, normal state. Cognitive-behavioral therapy (or CBT) is perhaps the most effective and proven form of helping dual diagnosis patients learn to cope with their illnesses, and learn to change unhealthy patterns of thinking.
The difficulty in treating co-occurring disorders lies in addressing both mental illnesses at once, as therapy is mostly designed to target one issue at a time. Your teen’s rehab program will likely be structured to incorporate several types of therapy, and reassess your teen’s mental health (and therapy needs) every step of the way. A patient’s commitment to getting better is an essential piece of the puzzle — therapy will not “take” if a teen is resistant or stubborn in their recovery.
Prescription medications can make or break a successful recovery. Not every teen requires medication during treatment, but if their doctor recommends it, it may help reduce the symptoms of either one or both of their dual disorders. The right medications can also promote recovery and help nudge the brain into good health.
If your son or daughter enters rehab, you’ll be notified of any medications the doctor recommends. You can then research the drugs and discuss it with your family before proceeding with those drugs. Any medications prescribed to your teen will be added to the cost of care.
A proper treatment — including a quality facility, staff and an adequate duration of treatment — can become a costly affair. But compared to the potential costs of an untreated dual diagnosis (i.e. hospital stays, legal issues, etc.) — let alone the stakes related to your teen’s health — the rehab costs tend to become immaterial. Many rehab centers offer financing options to help your family work through the program.
Dual diagnosis programs typically include a few common medications.
Antipsychotic medications may help teens struggling with agitation, hallucinations and delusions — all symptoms of schizophrenia. Antipsychotics are also used to treat bipolar disorder. Common medications are Thorazine, Abilify, Invega and Clozaril.
Antidepressants can help relieve symtoms of anxiety, depression and other mood disorders. Common medications are Prozac, Zoloft, Wellbutrin and Cymbalta.
Anti-anxiety meds are mostly used to combat anxiety disorderslike phobias, post-traumatic stress disorder and obsessive-compulsive disorder. Most anti-anxiety medications are benzodiazepines or beta blockers.
Mood stabilizers can be helpful for teens with bipolar disorder and borderline personality disorder and experience manic episodes. Lithium is the most common mood stabilizer, but anticonvulsant medications like Depakote and Tegretol have also been shown to work as mood stabliizers.
During the detox process, your teen may experience symptoms of withdrawal, which are often physically painful. Medical detox, using drugs like Suboxone and Subutex, can reduce this discomfort and aid your teen in ridding toxins from their body.
How Long Does Treatment Take?
Treatment for dual disorders is not over until the doctor says it is. Typically, rehab for a substance use disorder takes anywhere from 1–6 months. Add in a co-occurring psychological disorder, and it’s hard to know just how long recovery will take — or if your teen will respond well to treatment at all.
If your teen begins a rehab program for their co-occurring disorders, it’s important not to pull them out prematurely. This can undo some (if not all) of their progress, and potentially leave them in even worse shape, as the weight of this perceived failure can aggravate their mental illness and lead them to abuse substances harder than ever.
Rather than rush them through treatment, support your teen and encourage them no matter how long it takes. Follow up with their doctor regularly to stay mindful of their progress or any difficulties. Along the way, remind your teen, your family and yourself that a successful recovery is the number one priority, and you’ll stand by their side no matter what happens.
Even after a successful rehab, your teen needs to remain vigilant. Their brains are simply wired differently, and any mental health problems or substance habits can spring back up at any time. With that in mind, there are a number of ways to continue with treatment even after rehab.
Aftercare options include the following:
- Group Houses, Sober Houses or “Halfway Homes” – transitional living situations that monitor a teen’s progress as they ease back into life outside of rehab
- Support Groups – community meeting places and 12-step groups, where teens can meet others in recovery and reinforce their new sober lifestyle
- Counseling – personal counselors are often recovered individuals themselves, and one-on-one sessions offer insight and accountability to teens still adjusting to life after a dual diagnosis
- Medication – certain prescription drugs help teens with mental health problems continue to manage and minimize their disorder — some teens remain on antidepressants or anti-anxiety pills into adulthood
Dual Diagnosis Residential Treatment
Inpatient, or residential treatment, rehab is highly recommended in the case of a dual diagnosis, although outpatient treatment is also an option. Most doctors recommend dual diagnosis patients participate in inpatient treatment because they have round-the-clock care, supervision and support.
Although addiction can be tough for any person to deal with, handling addiction and a mental health disorder at the same time can be overwhelming. Surrounding your child with medical professionals and a sober environment may be the most effective dual diagnosis treatment model available.
Additionally, treating dual diagnosis can take much longer than substance abuse treatment because the patient has two disorders to overcome, not just one. Outpatient rehab typically takes longer than inpatient rehab because it doesn’t involve a completely immersive environment. During outpatient treatment, your teen will live at home and go to school or work while attending rehab in the evenings or on the weekends. Because dual diagnosis treatment already takes longer than other programs, outpatient dual diagnosis treatment may take even longer and slow down your teen’s recovery.
Is Dual Diagnosis Rehab Covered by Insurance?
Thanks to the Affordable Care Act (colloquially referred to as Obamacare), insurance companies must cover substance abuse and mental health programs if they cover traditional medical services. For addicts and families of addicts, this means treatment is now more accessible than ever.
In general, this means there are insurance options for rehab — even for a dual diagnosis. However, each person’s health benefits plan is different. To truly understand what your health insurance covers, read through your benefits package, or contact a representative from your health insurance provider. If you are involved in a public insurance plan, such as Medicare or Medicaid, there may be restrictions on which rehab facilities you can use.
If you don’t have insurance, many rehab centers also offer payment plans that help make their services more affordable.
Common Co-Occurring Disorders in Teens
So what mental health problems are common in teens? Our minds may paint a certain picture when we hear the phrase “mental illness.” But the truth is, the most common mental illnesses may not be too obvious from the outside. Tens of millions of people — young and old alike — struggle with these disorders every day. And some of these serious disabilities develop in children as early on as preschool.
There’s no exact science to “what causes what” in a dual diagnosis. Mental health problems may lead to substance addictions, but it can also be the other way around. When a teen is diagnosed with dual disorders, each of the co-occurring issues demands an appropriate attention.
There’s a difference between teenage doldrums and full-blown teenage clinical depression. Major depressive disorder — the term doctors give for clinical depression — causes hopelessness, constant guilt and some cognitive impairments that range from mild to severe. This disorder affects 15 million people in the U.S. and 3% of kids aged 13–18.
Because the symptoms may appear in more subtle ways than most illnesses, the problem is often overlooked in adolescence. Around 80% of those with depression never receive professional help. When a teen battling depression fails to get treated, they may take it upon themselves to self-medicate — this often means experimenting with and getting hooked on drugs or alcohol.
Teen anxiety disorder is even more common than clinical depression. In fact, it’s the most common mental health issue in the age group. Like depression, anxiety symptoms tend to blend in with the normal ebbs and flows of adolescent behaviors. In general, young people get anxious — about good grades, first dates and making friends. But for those with anxiety disorder, these feelings are persistent and uncontrollable, and can make their day-to-day functions an uphill battle.
More than a quarter of high schoolers in the U.S. have a diagnosable anxiety disorder in their lifetimes, and 6% of these cases are severe. Research also shows that these kids are 2–3 times more likely to develop alcohol dependence, and significantly more likely to abuse marijuana or other hard drugs, which can easily snowball into a substance use disorder.
ADHD symptoms are also prevalent in adolescence. Attention-deficit hyperactivity disorder is an illness that impacts more than 6 million youths in the United States, at an average age of 7 years old. Marked by hyperactivity and difficulty learning, ADHD is a problem that has trended upwards every year since 1997, and tends to afflict young people more than anyone else. It’s commonly associated with trouble in school along with other problems, not the least of which is substance addiction.
Approximately 35% of teens with ADHD also use at least one harmful substance. On top of that, ADHD medications (e.g. Adderall and Ritalin) are some of the most common abused prescription drugs — for both medical and nonmedical use.
Teens with a dual diagnosis can suffer from several other mental disorders, and all of them are rife with serious side effects and hurdles to be overcome.
Dual diagnosis treatment modalities and programs take on teen patients with all of the following illnesses, which are all psychologically-based and can be made worse by substance use:
- Personality disorders
- Bipolar disorder
- Eating disorders
- Post-traumatic stress disorder
- Obsessive-compulsive disorder
Take the time to research these individual problems if you feel your teen may struggle with one. Keep in mind that the longer these issues go unaddressed, the harder they can be to resolve — especially if a co-occurring substance problem exists as well.
Does My Teen Need Dual Diagnosis Treatment?
As a parent, your teen’s road to recovery starts with you. If you notice unusual behavior or symptoms of addiction in your teen, make an appointment with their doctor or guidance counselor to figure out what’s going on. The earlier you catch addiction or mental health disorders, the better chance your teen has to recover.
If it turns out that your teen is struggling with addiction and a comorbid condition, you absolutely must consider treatment. Addiction alone is difficult enough, but when combined with mental illness, the situation almost always requires professional intervention. Once you and your child’s doctor identify the issue, be sure to keep pushing until your child has the tools to achieve complete recovery. This means finding the right treatment center.
We at TeenRehabCenter.org have spoken with thousands of parents who have been in your shoes. Our addiction professionals are able to help guide you towards recovery, so give us a call to discuss your family’s problem and begin the healing process. Your conversation with us is free and confidential. Isn’t it time for a change? Take the first step today.
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- “Dual Diagnosis Capability In Addiction Treatment (DDCAT).” Tarzana Treatment Centers. Tarzana Treatment Centers, Inc, n.d. Web. 28 Mar. 2016.
- “Medications for Mental Health Treatment.” Dual Diagnosis. DualDiagnosis.org, n.d. Web. 28 Mar. 2016.
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