Dual Disorders and Dual Diagnosis
The term dual diagnosis is a common, broad term that indicates the simultaneous presence of two independent medical disorders. Recently, within the fields of mental health, psychiatry, and addiction medicine, the term has been popularly used to describe the coexistence of a mental health disorder and AOD problems. The equivalent phrase dual disorders also denotes the coexistence of two independent (but invariably interactive) disorders, and is the preferred term used in this Treatment Improvement Protocol (TIP).
The acronym MICA, which represents the phrase mentally ill chemical abusers, is occasionally used to designate people who have an AOD disorder and a markedly severe and persistent mental disorder such as schizophrenia or bipolar disorder. A preferred definition is mentally ill chemically affected people, since the word affected better describes their condition and is not pejorative. Other acronyms are also used: MISA (mentally ill substance abusers), CAMI (chemical abuse and mental illness), and SAMI (substance abuse and mental illness).
Common examples of dual disorders include the combinations of major depression with cocaine addiction, alcohol addiction with panic disorder, alcoholism and polydrug addiction with schizophrenia, and borderline personality disorder with episodic polydrug abuse. Although the focus of this volume is on dual disorders, some patients have more than two disorders, such as cocaine addiction, personality disorder, and AIDS. The principles that apply to dual disorders generally apply also to multiple disorders.
The combinations of AOD problems and psychiatric disorders vary along important dimensions, such as severity, chronicity, disability, and degree of impairment in functioning. For example, the two disorders may each be severe or mild, or one may be more severe than the other. Indeed, the severity of both disorders may change over time. Levels of disability and impairment in functioning may also vary.
Thus, there is no single combination of dual disorders; in fact, there is great variability among them. However, patients with similar combinations of dual disorders are often encountered in certain treatment settings. For instance, some methadone treatment programs treat a high percentage of opiate-addicted patients with personality disorders. Patients with schizophrenia and alcohol addiction are frequently encountered in psychiatric units, mental health centers, and programs that provide treatment to homeless patients.
Patients with mental disorders have an increased risk for AOD disorders, and patients with AOD disorders have an increased risk for mental disorders. For example, about one-third of patients who have a psychiatric disorder also experience AOD abuse at some point (Regier et al., 1990), which is about twice the rate among people without psychiatric disorders. Also, more than half of the people who use or abuse AODs have experienced psychiatric symptoms significant enough to fulfill diagnostic criteria for a psychiatric disorder (Regier et al., 1990; Ross et al., 1988), although many of these symptoms may be AOD related and might not represent an independent condition.
Compared with patients who have a mental health disorder or an AOD use problem alone, patients with dual disorders often experience more severe and chronic medical, social, and emotional problems. Because they have two disorders, they are vulnerable to both AOD relapse and a worsening of the psychiatric disorder. Further, addiction relapse often leads to psychiatric decompensation, and worsening of psychiatric problems often leads to addiction relapse. Thus, relapse prevention must be specially designed for patients with dual disorders. Compared with patients who have a single disorder, patients with dual disorders often require longer treatment, have more crises, and progress more gradually in dual diagnosis treatment.
Psychiatric disorders most prevalent among dually diagnosed patients include mood disorders, anxiety disorders, personality disorders, and psychotic disorders. Each of these clusters of disorders and symptoms is dealt with in more detail in separate chapters.
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Bill Sword said,
February 16, 2007 @ 2:54 pm
Can you help me with listings of programs which might deal with a dual diagnosis of prescription pain medicine addiction, coupled with the existence of long-term, chronic pain management?
I have had a significant trauma to my left foot, with continued pain and no currently existing surgical interventions (surgical opportunities have all been exhausted).
So there has and still is justification for pain management whether opiates or other means; as I have used prescribed medicines over the last four or five years, I have grown to disrepect the dosage recommendations and continue to take more than prescribed. Tolerance might be a contributing factor but I don’t know how to measure that or apply the tolerance definition/measurement. Increased pain over time and deteriorating physical issues contribute too.
So I don’t know the contributions of the realities associated with tolerance vs increased pain underlying my use of meds.
I have had two to four extreme physical reactions to my abuse of medicine, which resulted in hallucinations, bizarre behaviors and total black out memories throughout these two to four events.
There are other meds I take that might contribute to these factors and especially contributing the events of abuse to the point of physical malady as described.
I embrace the fact that I am addicted….I am an alcoholic with almost five years of sobriety following 45 days of rehab five years ago. Therefore I have some understanding of addiction via those experiences.
Today, I have been 13 days WITHOUT any narcotic pain medicine, therefore I believe that time period is sufficent to indicate I have probably experienced detox over that period. I had little or no discernable withdrawal issues…but the pain gravitates from 3 - 5 on the 1 - 10 pain scale. I am using copious amounts of OTC meds, heat and cold compresses, a TENS unit and 5% Lidocaine patches X4 applied to the skin above and around the surgical site.
Can you recommend a dual program? Are there websites I might visit? Help!!
Nsx said,
February 23, 2007 @ 10:45 am
You can visit www.dual-diagnosis-treatment-center.com, this is a dual diagnosis website with information about this condition and admissions to the facility. Hope that helps.
Dual Disorder said,
March 9, 2007 @ 4:58 am
I have read in one of the posts here a study about dual disorder and dual diagnosis. According to the post, most patients who undergo dual disorder or dual diagnosis treatment had psychological or mental problems first before developing substance abuse. Does that mean that to reduce the number of substance abusers, there should be an increased effort to treat people with psychological problems?
Christina
dual diagnosis program said,
March 29, 2007 @ 12:12 am
Now, I understand more clearly what dual disorders and dual diagnosis are. However, I was hoping to read treatment centers offering dual diagnosis program in this article. Nsx, the link you provided is inaccessible. Maybe, there is another way. Thanks.
–trish