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Abstinence, Motivation, Help People With Dual Diagnosis Recover

Millions of Americans have dual diagnosis, a serious health condition characterized by overlapping symptoms of diagnosable substance abuse/addiction and diagnosable mental illness. Unfortunately, these overlapping problems are substantially harder to treat than isolated cases of abuse/addiction or isolated cases of mental illness. In a study published in October 2014 in the Journal of Dual Diagnosis, researchers from Kaiser Permanente Northwest used interview information from a group of people affected by dual diagnosis to identify the most likely pathways to sustained recovery from combined problems with mental illness and substance use.

Dual Diagnosis

Substance abuse/addiction and mental illness not directly attributable to substance use are deeply intertwined problems in the U.S. and many other countries. The best available estimates from addiction specialists and mental health experts indicate that approximately 30 percent of all Americans with a mental illness diagnosis also have symptoms that would qualify them for a separate alcohol or drug abuse/addiction diagnosis. The rate of diagnosable substance problems is even higher in people affected by the most serious forms of mental illness (e.g., schizophrenia, bipolar disorder and major depression). Among people with alcohol-related substance problems, the rate of separately defined mental illness surpasses 30 percent. Among people with drug- or medication-related substance problems, the mental illness rate rises even higher to 50-plus percent.

Several factors account for the interlinked nature of non-substance-related mental illness and diagnosable substance problems. For example, people already affected by mental illness may turn to substance use/abuse as part of an attempt to keep their most unpleasant symptoms in check. In some cases, drug and alcohol users may undertake a pattern of substance intake that steeply increases their chances of triggering latent problems with mental illness. In addition, abusive or addictive patterns of substance intake may promote the appearance of new mental health issues.

Substance and Mental Illness Treatment

As a rule, a person affected by dual diagnosis has an unusually hard time finding appropriate care, staying in appropriate care and recovering a sustainable amount of health and well-being. In many cases, the critical factor here is substance abuse/addiction. This is true, in part, because the presence of an abusive or addictive pattern of substance use can seriously undermine the effectiveness of the medication-based treatments that usually provide benefits for people dealing with mental illness. In addition to medication aimed at the improvement of substance-related symptoms and mental illness-related symptoms, treatment for dual diagnosis commonly includes a form of behavior-modifying psychotherapy called behavioral therapy, and may also include participation in a 12-step drug or alcohol program.

How Do Affected People Recover?

In the study published in the Journal of Dual Diagnosis, the Kaiser Permanente Northwest researchers used data from 177 people affected by dual diagnosis to help determine the most likely pathways to sustainable dual diagnosis recovery. All of the study participants had substance problems combined with a severe form of mental illness. Eighty-four of the participants had a diagnosis for bipolar I disorder or bipolar II disorder. Another 75 of the participants had a diagnosis for schizophrenia or a related condition called schizoaffective disorder. The remaining 18 study participants had a diagnosis for affective psychosis (psychosis in combination with mania and/or depression). At four separate points over the space of two years, the researchers assessed the recovery of each individual and asked him or her to describe the factors contributing to a return to mental well-being.

The researchers concluded that there were several pathways to recovery among the study participants. Some participants cited enrollment in a well-organized treatment program as the critical factor, while others cited involvement in a 12-step program or similar mutual self-help group. In addition, some participants cited methods of recovery not directly related to involvement in a dual diagnosis program or a mutual self-help program. Whatever the pathway cited by the participants, the researchers concluded that three common threads appear among people who recover successfully from dual diagnosis: a motivation for improvement based on an understanding of the damaging effects of substance use, the attainment of substance abstinence and a sense of self-empowerment generated by the ability to repeatedly avoid falling back into substance use.

The study’s authors note that a fourth factor commonly contributes to recovery from dual diagnosis: consistent, non-demeaning support from the professionals who staff recovery programs. Overall, they emphasize the critical role of controlling substance abuse/addiction in helping people overcome the mental illness-related aspects of dual diagnosis.

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