Mixing Substance Abuse and Mental
Health Disorders
By Rich Bayer, Ph.D.
In the spring of 2002, Jenny found herself in the
hospital. She had just attempted suicide. For a few months prior to her
hospitalization, she had felt deeply depressed and had been drinking
excessively.
She
was in need of treatment.
From
the hospital, she was referred to a local counseling agency for outpatient
psychotherapy. When she started at the agency, she was diagnosed with
bipolar disorder (manic-depression) and alcohol dependence. She had what
is called “co-occurring disorders,” a mental health disorder combined
with a substance use disorder.
Jenny
worked hard to improve. She kept frequent appointments for individual
therapy and soon also began attending a day program designed specifically
to help clients with co-occurring disorders.
Within
a couple months, she started doing better. Her depression began to lift.
In addition, she gained some control over her addiction as she began
staying sober for longer and longer periods of time.
Jenny
felt that the therapy and day programming turned things around for her.
She came to understand how her mental health symptoms interacted with her
substance abuse. She identified an emotional cycle common to most people
with co-occurring disorders. When her mental health symptoms increased so
did her desire to drink. But if she drank, her mental health symptoms
became more uncontrollable. She improved emotionally by learning some
non-drinking ways to reduce her stress and minimize her mood swings.
Overall,
she has been consistent with treatment and made slow but steady progress.
At this point she has been sober since December 2002 and she manages her
moods more effectively than ever. She continues with psychotherapy and
attends a local support group. She also attends Cecil Community College
where she’s studying to become a counselor.
This
case history was provided by Becky Raughley, LCSW-C, CCDC, a Cecil County
expert in co-occuring disorders. “Jenny experienced a positive,
successful outcome,” Raughley says, “an outcome that was enhanced by
the type of treatment she received. It has been shown in study after study
that clients with co-occurring disorders fare better in programs which
provide integrated treatments for both the mental health and the substance
abuse disorders.”
Raughley
has been specifically trained in treating clients with co-occurring
disorders. She is a licensed clinical social worker and a certified
chemical dependency counselor who has worked in this field for more than a
dozen years. Recently she has been appointed the Coordinator of
Co-Occurring Services at Upper Bay Counseling and Support Services, Inc.
Facts
about Co-Occurring Disorders
As
just mentioned, people with co-occurring disorders have a mental health
diagnosis as well as a substance use diagnosis. Previously this problem
was known as “dual diagnosis.”
Raughley
reports that some of the typical mental health conditions common in
co-occurring disorders include depression, bipolar disorder,
schizophrenia, and anxiety disorders including post-traumatic stress
disorder (PTSD). The substance use disorders include “substance abuse”
or “substance dependence,” depending on the severity, and usually
identify the substance or substances the person is addicted to.
It’s
also interesting to note how common the co-occurring disorders really are.
This has been studied extensively and the results are consistent. Among
people who have a mental health diagnosis, 50% also have a substance use
disorder. Among those who have a substance use disorder, 30% have a
co-occurring mental health diagnosis.
A
Better Treatment Model
For
years, researchers such as Kenneth Minkoff, M.D., of Harvard Medical
School, and Fred Osher, M.D., of University of Maryland, have studied
individuals with co-occurring disorders and they have come to the same
conclusions. People with co-occurring disorders are best treated in
clinical settings that provide therapy for both disorders.
They
call it “integrated treatment.”
They
learned what works partly by observing what doesn’t work. Traditionally,
substance abuse clinics are separate from mental health clinics. They each
hire different types of professionals and offer different types of
treatment.
But
in a system like this, what happens to clients with co-occurring
disorders? Typically, they bounce back and forth from one treatment
setting to the other and get only partial help in each setting. Even
worse, they often hear treatment recommendations at one that are at odds
with what they hear at the other.
For
example, according to Raughley, substance abuse clinics typically
under-diagnose mental health disorders. Also they may be quick to call a
client “in denial” who is temporarily struggling with mental health
symptoms.
On
the other hand, therapists at mental health clinics have been seen as
“too soft” on substance abuse, as not holding their clients
accountable enough. In addition, in the mental health setting, clients
have traditionally found it easier to misrepresent the extent of their
substance use.
These
are just a few reasons why it makes sense to treat clients with
co-occurring disorders in a single, integrated setting. It ensures that
clients will be properly diagnosed, that they won’t get mixed messages,
and that they’ll be able to establish a therapeutic relationship with a
professional who has been cross-trained in treating addictive and mental
health disorders.
There’s
one other reason too. Based on outcome measures, integrated treatment
works better for clients with co-occurring disorders than does treatment
at separate mental health and substance abuse clinics.
I wonder how many people in our community would
benefit from a program providing integrated treatment?
------------------------------------
Rich Bayer, Ph.D., is the
CEO of Upper Bay Counseling and Support Services, Inc. and a practicing
psychologist.
For More Information Contact:
Upper Bay Counseling and Support Services, Inc.
200 Booth Street, Elkton, MD 21921
Tel: 410-996-5104
Toll Free: 877-587-7750
FAX: 410-996-5197
Internet: info@upperbay.org
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