Why dual-diagnosis requires IMMEDIATE Attention 2018-07-03T10:56:06+00:00

Why dual-diagnosis requires IMMEDIATE Attention


Before the existence of Dual Diagnosis Treatment methods, the pathway to sobriety was a long and twisty one. This is because once a person is dual-diagnosed, he will be denied rehab service until they can get rid of their mental health problem. Sadly, mental health problems will persist as long as they don’t get free of addiction. Likewise, substance abuse will likely continue as a result of mental health challenges such as depression. Thus, many substance abusers back then are trapped in a maze with no exit.


Thankfully, the advent of Dual Diagnosis Treatment in the 1990s served as a milestone to change the previous counterproductive approach to treating dual-diagnosed people.


A brief history of Dual-diagnosis


The Old Way


Sequential treatment will address addiction independently to whatever mental health problems plague the patient. Such rehabilitation will try to treat addiction without doing anything about the mental health problem. Worse, patients will never be treated for their mental health problem as long as they are not sober. This is because professionals used to believe that the mental health challenge will return in the presence of substance abuse disorder, which is, of course, true and undeniable. Unfortunately, it is also true that the substance abuse disorder will likely return as long as the mental health problem persists. This gap is what parallel treatment models attempt to bridge.


Parallel treatment methods attempt to treat both addiction and the mental health challenge. Whether it is the addiction that caused the mental health problem or it is the mental health problem that caused the addiction, treating them at the same time addresses the inadequateness of sequential treatments. If both will be treated at the same time, the chicken-and-egg puzzle will finally be solved. Sadly, even this treatment model failed. The reason for this failure is because parallel treatment specialists fail to coordinate with each other. That is, an addiction specialist will do his best in treating the substance abuse disorder without addressing the mental health problem while the mental health specialist attempt to treat the mental health challenge. The lack of coordination between specialists and treatment facilities compromised each other’s treatment methods sometimes even causing unnecessary drug interactions which hamper the entire treatment process. Addiction and mental health disorders were treated as separate entities that needed to be treated at the same time but independent of each other.


The Modern Way


The modern way of treating dual-diagnosed disorders patches up the hole in the models sequential and parallel treatment models. Bearing the name “Integrated Treatment,” this modern approach addresses both addiction and mental health problem at the same time while treating them as a single entity. That is, a cocaine abuser who has ADHD will require different treatment from an opiate abuser who has ADHD. Every case will be unique and tailor-made for an individual but will always involve the integration of the treatment methods. Such approach will avoid unnecessary delay, drug interactions, and even death.


Integrated treatments are usually done in a single facility, unlike parallel treatments. In addition, it requires detailed planning thus requiring more inputs from the client, the client’s family, and even the client’s peers to lay out a plan that is well-suited to the case.


Exceptions for Integrated Treatment


First and foremost, the existing substance abuse disorder and mental health challenge should be independent of each other. For instance, hallucinations alongside hallucinatory drug abuse may not qualify, unless it results to long-term schizophrenia.

Dual Diagnosis Treatment Options:


The treatment methods and options widely vary. There are thousands of permutations when it comes to the combination of drugs and mental health problems. Hence, there are thousands of treatment methods as well. Take note that each individual and each case is unique and will require a special approach made just for them. Added to this is the fact that patients have their own social needs and life experiences thus further complicating things. No matter how varied, there are some common methods found in every treatment:


  • Methodical Planning – this phase will require cooperation from the patient and the family. The professional will ask a number of details, and from this details, the treatment model will be planned.
  • Detox – an integrated treatment model will always include detox, the process of removing the presence of the abused substance in the body.
  • Counseling and Education – this may not seem medically necessary, but it does help boost the morale and will of an individual undergoing rehab. It helps lift off the curse of stigmatizations, self-blame and many psychological aspects that will be an obstruction to the road to sobriety.


How To Prepare for Integrated Treatment


The most important factor here is to cooperate with the professionals. The treatment methods to be executed will largely depend on what details you give your professionals. Hence, providing the most accurate and detailed information to your specialist is of utmost importance. Such details can include (but is not limited to):


  • History of substance abuse
  • History of substance use for medical purposes
  • Medical History
  • Significant Life events
  • The presence of other forms of addiction (sex, gambling, alcohol, etc.)
  • Social Life (has he recently abandoned his peers, family, etc.)
  • Behaviors the client did not have before
  • Traumatic Experiences
  • Stress-inducing activities
  • Rehabilitation history (if any)


There are times that clients will not disclose all of their substance abuse details for fear of stereotyping and attracting lawyers and cops at their door. In such cases, treatment will prove to be very difficult as the treatment model will spontaneously change as the undisclosed substance abuse disorders reveal themselves.  Worse, it can be very expensive as more medications will be used to undo the possible drug interactions.


Alternatives to Integrated Treatment


Let’s face it. Integrated treatment will be a costly endeavor. Thus, people end up looking for alternatives. The bad news is there is no alternative to integrated treatments. There are unviable substitutes like sequential treatment and parallel treatment, but it will become more expensive in the long run. Would you rather undergo sequential treatment ten times than a single integrated treatment? Of course not. That will be very expensive, and it will devour the time you could have enjoyed outside rehab. The good news is, there are ways you can utilize to help you pay for your dual-diagnosis treatment such as insurance, sliding scale fees, and state sponsorship.




Whether insurance companies will like it or not, non-grandfathered plans are required to cover mental health. The Mental Health Parity and Addiction Equity Act requires health plans that have mental health coverage to minimize restrictions on the mental health aspect. That is, such plans can never make mental health restrictions as strict as physical health limitations. This aspect of MHPAEA is reinforced by the Affordable Care Act, as it requires health plans to cover mental health. Hence, you can usually rest assured that your insurance will cover your integrated treatment. However, you should be wary that insurance will not instantly cover your rehab. There will be factors such as copayments and out-of-pocket maximums that will burden you for a while until the insurance will pay for a hundred percent of the expenses.


Sliding Scale Fees


Some rehab facilities (especially state-sponsored ones) will offer sliding scale fees; fees that will scale according to your financial status. Thus, if you fall below a certain threshold of income, you will have to pay less for the rehabilitation.


In addition, there are state-specific programs you can utilize. There is also the Medicare, Medicaid and, for the veterans, Tricare. The latter three have their own eligibility requirements.


Symptoms of Dual-diagnosis


Just like the treatment itself, symptoms of co-occurring disorders are unique as well.  These symptoms will vary from individual to individual and widely depends on the combination of the substance abused and the existing mental health problem.  Thankfully, there are general telltale signs warning that a person is in dire need of help.


  • Inability to sleep
  • Loss of hygiene and deterioration of physical health
  • Tremors
  • Needle marks (due to intravenous use of the substance)
  • Paleness or blushing
  • Dishonesty
  • Oversensitivity
  • Forgetfulness
  • Lack of enthusiasm and self-esteem
  • Difficulty in paying attention
  • Paranoia
  • Disturbance in Social Life (abandoning friends, befriending drug addicts)
  • Significant weight change, be it increase or decrease
  • Sleeping for days (especially stimulant users after their energy outburst)
  • Obsessive-compulsive behaviors like returning home three times to make sure the appliances were unplugged
  • Obsession with privacy
  • Stealing


In addition, there are drug-specific symptoms such as sore, painful jaw from teeth-grinding during ecstasy high or dry lips for crack. Keep in mind that no matter what drug is abused, immediate attention is necessary. Long-term abuse will lead to more and more mental health problems.


The Stigma of Dual-diagnosis


You know what the worst part of suffering from the co-occurring disorder is? Seeing how cruel people can be. Yes, drug addicts are stigmatized and so are people suffering from mental health problems. Surely, the worst case of stereotyping will be true for a person suffering from both addiction and mental health problems.


The problem is people who do not have the technical background in drug abuse, psychiatry, and psychology view addiction as a problem that can instantly be solved by mind-over-matter means. People think that substance abusers can simply sit down somewhere, jaw-dropped, eyes staring into nothingness and contemplate about their faults and then stand up with a sudden realization of the destruction brought by the drugs and the instant will to change. Thus, SUDs sufferer ends up stigmatized and are stereotyped to have a weaker will compared to other people.



There are three main reasons why individuals are stigmatized:

  • Fear – individuals who have mental illness or/and should be feared and kept out of societies
  • Authoritarianism –individuals who have some form of addiction are seen as irresponsible individuals and will not pull their own weight thus people see them as a burden they have to carry.
  • Benevolence –individuals need to be cared for. [1][2]


All those reasons lead to reduced independence and autonomy, thus hampering the lives of the sufferers and even depleting their interest in seeking treatment or even adhering to current treatment. Thus, stigma is an important factor to be addressed in treating individuals.


People who agree with the stereotypes mentioned above (or whatever stereotypes exist) tend to develop prejudice [3]. The patient will tend to anticipate those prejudice, thus ending up stereotyping themselves as well. Hence, there are three stages of self-stigmatization; awareness (of the existing prejudice), agreement (the sufferer accepts the prejudice as truth) and application (self-stigmatization) [4] . This is another fact that can hamper the journey to sobriety and is one of the major issues addressed by counselors.


Why should a substance abuser undergo detox, NOW?


It is now or never. One may suffer from denial and go like “Hey, I can be sober by myself.” Sadly, going cold turkey will do more harm than good. Furthermore, the intertwined addiction and mental health problem will worsen each other over time. Added to this is the extreme stigma faced by the substance abuser. If left unattended, the stigma will spark more and more mental health conditions, which will then ignite more addiction problems that will potentially worsen the stigma AND the mental health problems. As you can imagine, it is a cycle of self-destruction that will do no good. It is now or never. Going cold turkey is not the key. Professional attention is necessary.  


1.] Taylor SM, Dear MJ. Scaling community attitudes toward the mentally ill. Schizophr Bull 1981;7:225-40

2.] Brockington IF, Hall P, Levings J, Murphy C. The community’s tolerance of the mentally ill. Br J Psychiatry 1993;162:93-9.


3.]Corrigan PW, Bink AB, Schmidt A, Jones N, Rüsch N. What is the impact of self-stigma? Loss of self-respect and the “why try” effect. J Ment Health 2015;13:1-6.  

4.]Corrigan PW, Powell KJ, Rüsch N. How does stigma affect work in people with serious mental illnesses? Psychiatr Rehabil J 2012;35:381-4