Substance Use Disorder and Dual Diagnosis - Essay Example

?Dual diagnosis ‘Dual diagnosis’ is a term used to describe the “patients who meet the DSM-IV criteria for both, substance abuse and psychiatric disorder” (Dale 2001, p. 190). ‘Substance use disorder’ is the psychological disorder which occurs when people become addicted to the substance by abusing it and depending on it (Drake et al. 2003, p.53). The term used for substance use disorder is ‘substance abuse’ (Drake et al. 2003, p.53). ‘Severe mental illness’ is a term used to describe the long term psychiatric disorders which make a person incapable of leading a normal life and handling his mundane responsibilities (Drake et al. 2003, p.53). When substance abuse and severe mental illness co-occurs in a person, then he comes under the medical condition well known as ‘dual diagnosis’ (Drake et al. 2003, p.53). However, it has been found that people falling under the condition of ‘dual diagnosis’ suffer from multiple mental and substance disorders, and not just from two disorders as implied by the term ‘dual’ (Drake et al. 2003, p.54). Hence, the term ‘dual diagnosis’ is quite misleading as it implies only two disorders (Drake et al. 2003, p.54). Moreover, lack of relevant health care services for ‘dual diagnosis’ patients has created many serious risks for the patients. Risk of poor diagnosis It is difficult to effectively manage the plan and the outcomes of the treatment if the mental disorders in the substance users and the substance use disorder in people suffering from mental disorders, are not recognized at the early stage of the treatment (McArdle 2010, p.94). The symptoms related to substance use and symptoms related to mental health problems are quite similar to each other and hence, it becomes difficult to distinguish between them (McArdle 2010, p.94). Moreover, it is very important to recognize the real cause of the patient’s condition, i.e. to know if the real problem is substance abuse or mental disorder. For example, there is a possibility that an underlying mental health disorder which the patient was unaware of, might have led the patient into substance use problem (McArdle 2010, p.94). At the same time, there is a possibility of the mental health disorder developing due to the negative physical, social and psychological consequences occurring due to the substance use problem (McArdle 2010, p.94). The third possibility is that the substance abuse and the mental disorder can occur in same person without any relation to each other (McArdle 2010, p.94). Hence, to avoid the risk of wasting time in giving wrong treatment, it is very important to do a proper assessment of the case when it comes to dual diagnosis. Otherwise, there is a risk of wastage of time and cost due to wrong treatment of the patient. However, proper assessment is not that easy. It is because patients with substance use problem may use combination of multiple substances and this makes the proper assessment more difficult and complicated (McArdle 2010, p.94). According to Nathan (1991), due to the complication related to assessment, previously, the health care professionals used to prescribe a 4-6 weeks of drug free period for patients, so that the symptoms related to mental disorder can be distinguished easily from the symptoms related to substance use (McArdle 2010, p.94). The right assessment is possible only when the symptoms of mental disorder and substance abuse are distinguished and assessed accurately. If the assessment is done accurately, then ‘dual diagnosis’ helps in sorting out the symptoms of co-occurring disorders and makes the recovery easy and fast. Ignorance by professionals There is a shortage of health care systems where the mental disorder and the substance abuse are treated together (Drake et al. 2003, p.54). This separate system for both disorders confuses the clients as they are unable to make sense of the messages regarding treatment and recovery given separately by mental disorder and substance disorder systems (Drake et al. 2003, p.54). The patients also experience rejection and cold treatment from one system as they are directed to other system and are asked to return when the other co-occurring disorder is under control (Drake et al. 2003, p.54). This leads to the risk of patients losing trust in the mental health care services and also generates a risk of increasing the severity of the disorder. If the patient is not given a proper treatment on time, he might lose the chances of getting a treatment at the right time and this can aggravate his condition. Hence, the integrated medical health systems were created specially for the patients with ‘dual diagnosis’ (Drake et al. 2003, p.54). Risk of different illnesses and self destructive behavior The risk of developing different types of diseases and illnesses is very prominent in people suffering from ‘dual diagnosis’ (Bennett & Gjonbalalaj-Morovic 2007, p.49). It is especially prominent in cases where a person is suffering from mental disorders which are developed due to substance use disorder. Risk of developing health problems like HIV and AIDS is the most significant amongst the population coming under ‘dual diagnosis’ (Bennett & Gjonbalalaj-Morovic 2007, p.49). According to study by Carey, Carey and Kalichan (1997), the practice of unsafe sex increases substantially in people who become addicted to substance use (Bennett & Gjonbalalaj-Morovic 2007, p.49). Moreover, if a person suffering from substance use is also suffering from mental disorder associated with it, then it doubles the chances of high risk behavior in the patient (Bennett & Gjonbalalaj-Morovic 2007, p.49). Studies conducted to find the risks of ‘dual diagnosis’ have revealed many severe risks related to ‘dual diagnosis’. A study by McKinnon and colleagues (1996) has revealed that injection drug use is prevalent in 17.5% of sample psychiatric patients, using drugs during sex is reported by 35% of patients and 30% of people bought drugs by trading sex in return (Bennett & Gjonbalalaj-Morovic 2007, p.49). All these self-destructive and unsafe behaviors which are related to mental problems associated with substance use increase the risk of transmitting HIV and AIDS (Bennett & Gjonbalalaj-Morovic 2007, p.49). Thompson and colleagues (1997) studied the samples of 145 psychiatric inpatients ad outpatients in Australia and found that 15.9% of patients suffering from ‘dual diagnosis’ were using injection drug and this figure is ten times higher than the use of injection drug in general population (Bennett & Gjonbalalaj-Morovic 2007, p.50). Moreover, The study of data from the 1992 ‘National Survey of Veterans’ by Hoff, Beam-Goulet, and Rosenheck (1997) revealed that “the combination of PTSD and substance abuse increased the risk of HIV infection by almost 12 times over individuals with either disorder alone” (Bennett & Gjonbalalaj-Morovic 2007, p.50). These figures show how severe is the risk of developing life threatening diseases and illnesses among people falling under the ‘dual diagnosis’ condition. Hence, it is not surprising to know that people suffering from mental disorder associated with substance abuse go in severe depression and become self destructive. Drake(1995) has found that an increased rates of violence, suicide and suicidal behavior is prevalent among people suffering with ‘dual diagnosis’ (Dale 2001, p. 191). McKeown and Leibling (1995) found that inability to manage problems at home and lack of knowledge and skills at work makes it difficult for people with ‘dual diagnosis’ to handle the responsibilities of personal and professional life successfully (Dale 2001, p. 191). Hence, homeless has also been found to be prevalent in people with ‘dual diagnosis’ (Dale 2001, p. 191). Moreover, as Drake (1995) has revealed, the lack of compliance with medication worsens the psychological and psychiatric symptoms in patients (Dale 2001, p. 191). Co-existence of disorders of different nature makes recovery difficult to achieve. In such conditions, only the ‘dual diagnosis’ treatments given through integrated systems can help people suffering from co-existing disorders in achieving fast and smooth recovery. References Bennett, M.E. and Gjonbalalaj-Morovic. The Problem of Dual Diagnosis. In: M. Hersen, S.M.Turner and D.C. Beidel, eds. 2007. Adult Psychopathology and Diagnosis.5th Ed. New Jersey: John Wiley & Sons, pp 34-77. Dale, C. Dual Diagnosis. In: C.Dale, T.Thompson and P.Woods, eds. 2001. Forensic Mental Health: Issues in Practice. London: Harcourt Publishers Ltd. Ch.18. Drake, R.E., et al., Implementing Dual-Diagnosis Services for Clients with Severe Mental Illnesses. In: R.N. Rosenthal, ed. 2003. Dual Diagnosis.New York: Brunnet-Routledge, pp 53-68. McArdle, S. Polysubstance Use and Personality Disorder. In: P.Philips, O.McKeown and T.Sandford, ed. 2010. Dual Diagnosis: Practice in Context. West Sussex: John Wiley & Sons, pp 89-101. Read More