dual diagnosis

Dual Diagnosis: What is it? Am I a Candidate for Treatment?

What Is Dual Diagnosis?

As the name suggests, dual diagnosis describes patients that have been diagnosed with two different disorders: one being a mental disorder, like depression or bipolar disorder, and the other, a substance abuse problem, which could be alcohol or drugs. Since most people with a mental disorder can have quite easy access to both, it is not unlikely for them to develop a dependence on these substances.

More often than not, a lot of people will actually try to find comfort or a way to numb the pain by drinking or using drugs, so those two walk hand in hand quite frequently. In fact, a national survey done in 2014 revealed that 7.9 million people in the U.S. alone suffer from both a psychiatric disorder and an addictive disorder. According to the National Institute of Drug Abuse, 6 out of 10 addicts also have another disorder – that is a 60% chance that an addict is a dual-diagnosis worthy patient.

It is still not possible to say why mental disorders and addictions tend to coincide more often than not, but there are many theories and studies to try to understand dual-diagnosis patients. It seems as though one affects or triggers the other, no matter which one is apparent first. While children and teenagers with psychological disorders (such as attention deficit hyperactivity disorder) are considered at higher risk of becoming addicted than other children, it seems drug abuse alone can also accelerate the course of mental illnesses. Either can come first when it comes to dual-diagnosis addicts.

Symptoms

Dual-diagnosis patients can be diagnosed with a number of different “combinations” of disorders. Therefore, symptoms will vary a lot from person to person, depending on which substance they are addicted to and which mental disorder they have. While keeping in mind that a lot of symptoms from withdrawal are also common in mental disorders (anxiety, depression, and even hallucinations, for instance), some symptoms or signs to look out for are:

  • Going overboard when consuming drugs and/or alcohol or doing it too often
  • Putting themselves in risky or dangerous situations (especially worse if doing so by impulse)
  • Changing behaviors and routines drastically
  • Noticing symptoms unrelated to the withdrawal of alcohol or illegal substances alone
  • Symptoms that won’t go away after getting treatment for addiction
  • Social isolation or generally avoiding events that used to bring pleasure
  • Family history of either one of the conditions (substance abuse and/or mental illness)
  • Difficulty accepting, starting, or following instructions for treatment
  • Not managing to do daily tasks like proper personal hygiene or groceries
  • Be aware of a change in thought processes: if they become too incoherent, disillusioned, or too dark, bordering or becoming suicidal

It is because so many of the symptoms tend to overlap between disorders that addicts need to receive a proper diagnosis in order to know how to proceed when seeking the right treatment for them. Each disorder requires its own kind of treatment, and not just because they are separate illnesses. One of the main problems is that they affect each other mutually, meaning that if one is not treated correctly, it could bring on symptoms of the other – especially in the case of not treating the mental illness, as it could be the root of the consumption of substances.

Besides keeping an eye on the symptoms listed, in order for you to know whether you might be a dual-diagnosis patient, you might need to visit different types of specialists. While drug or alcohol abuse can be considered a mental illness in and of itself, it requires different approaches to treatment than, say, borderline disorders. For instance, while anxiety can be a symptom of withdrawal, chronic anxiety is different, more persistent, and not just related to substance abuse, so it needs to be treated accordingly.

Treatment and Prevention

Dual-diagnosis cases can be treated in many different ways, and while the diagnoses are an obvious factor to be considered when being treated, other aspects of the patient will dictate which treatment option would be best for them. Age, family history, drug intolerance, type of substance, frequency and amount of use, drugs previously used in treatments – all of this must be taken into consideration.

One of the methods commonly used along with other programs is behavioral therapy. Most of them focus on changing habits and frequent thought processes that might bring a patient to harmful behavior as well. While that alone cannot be the only method applied to help dual-diagnosis patients, it has proven quite effective when included in programs. Additionally, some of the other techniques used are detoxification (when needed), group therapy, and any medical supervision recommended.

Prevention is also possible, and even from an early age. Receiving early diagnosis of a psychiatric illness such as ADHD, anxiety, or depression can help not just to get treated for the disorder, but it can actually prevent the development of a substance abuse problem, as it is almost impossible to prevent exposure. Early exposure, in fact, has proven to be a trigger, so being mindful and careful of that might also lower the risks of someone becoming addicted.

You Can Get The Help You Need With Us

At Granite Mountain Behavioral Healthcare, dual-diagnosis patients can count with all the help they need when getting rid of their substance abuse problem for good. While it might seem like so much work right now, as you have to deal with two different issues, it is achievable. If you have tried methods before and they failed, this does not mean you are hopeless. Relapse is quite common, especially in dual-diagnosis cases, but they are not a sign of weakness – they just mean you need to keep trying.

We will be more than happy to meet with you and find out what your needs are, so we can work on a plan that will work for you. We offer outpatient programs that are essential for anyone who might need to keep on with their routines, no matter the reason. While dual-diagnosis patients need to look out for two different illnesses and seem to have to do double the work, we also offer a special Recover Strong program, which will additionally help with self-image and self-esteem while also providing a way to improve your social life – one less thing to worry about.

So whether you know this program interests you or you just want to hear more about the benefits we offer, contact us today. Visit our website for all the needed contact information. We are here to help: no matter how many hoops you need to go through, we are here to see you get to where you need to be on the trip to a healthier you.

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Creating a Different Outcome

How Will It Be Different This Time Around?

If you or a loved one has been through treatment for substance use disorder one or more times in one or more different facilities, and have yet to find lasting recovery, you are most likely asking yourself what will be different this time. This is a question which can plague the thoughts of those attached by bonds of affection to an addict. While there is no simple answer to this question I do believe I can give some helpful suggestions which can greatly increase the likelihood of success. 

When dealing with any disease of the brain, such as addiction, it is very challenging to know how to help a loved one “fix” their problem.  One reason for this is that brain science is still very much in its adolescent period. Our understanding of the brain and its functions is growing rapidly, but it has only been in  the relatively recent past that we have been able to begin to understand its functioning. This is as true with our understanding of addiction as it is for any other brain disease, as a result we are in the very beginning of our ability, as a community, to offer comprehensive solutions for those suffering from addiction.

Another aspect of the difficulty is that addiction is characterized by problems of perception.  Addicts suffer from high levels of delusion, cognitive dissonance, and other perceptual challenges that can make self-report and consistent decision making challenging, at best. The behavior patterns that can follow from these perceptual challenges can make assessment and treatment hard to manage for an individual.  

Third, and not unimportantly, the social stigma surrounding addiction can make it hard for an individual to feel confident in seeking needed help.  This is true certainly true leading up to the initiation of treatment. It is also true during recovery, when an addict may be suffering internally but is unwilling or unable to ask for the help he or she needs.

Commitment to Change

“Nothing Changes Until You Change Something”

Having a commitment to change is indispensable for the addict themselves. Much has already been written about this elsewhere. For our purposes today I am talking about the families commitment to change.  Often within a family afflicted with addiction there are dynamics that exist that are preventing each member from experiencing happiness and contentment.   Living with an addict and trying to cope with his or her behavior is most often a tremendous strain on loved ones.

One such dynamic that can develop is a tendency to treat information and secrets as a form of emotional currency.  When this is present within a family unit, trust and connection are the price paid. Left unchecked this can result in one or more members of the family suffering some form of attachment disorder. Instead of secrets and individual alliances transparency and togetherness need to be the aim.  Finding time and methods to communicate with one another honestly and transparently is vitally important for both the addict and his or her family.

Another form of trouble can be enabling behavior of members of the family toward an addict. This can take many forms but the simplest may be providing material support in the form or financial assistance (for rent, phone, car, other bills, etc).   In my experience very few addicts recover while they are still able depend on others for material support. For long term recovery it is indispensable that recovering addicts feel the full weight of responsibility for their lives. Of course we want to encourage this to happen in safe ways, that said, its importance cannot be overstated.  

Above are just two examples of the ways in which an addict’s behavior can impact a family, and the healing that needs to take place for a family to begin moving in a healthier direction together.  These changes can be quite difficult, especially if long standing patterns of behavior are present. Both individual and family counseling can be a great help. There are also many support groups, such as ALANON and ALATEEN, for the families of addicts that can be incredibly helpful.

Creating a Life of Meaning and Connection

A Happy Life Is A Life With Meaning and Purpose

Years of active addiction causes a hyperactivity within the stress and avoidance centers of the brain (primarily within the amygdala, and ventral hippocampus).  Practically speaking this means that within an addicts brain stress is felt more acutely than in the brain of an average person. There is no greater stress for humans, as social animals, than exclusion.  Throughout the years of active addiction addicts have lived lonely lives. This, of course, is primarily driven by their own behavior. The brain can heal itself, through a process of neuro-regeneration, but this takes time.   It is crucial then, especially in early recovery, that an addict is able to create a lifestyle that is centered around connection and community. This of course, can take many forms. Involvement with a 12-step fellowship or other recovery community is a great start.  Ideally though, the move toward connection should not end there. Family involvement, meaningful work, volunteerism, and social hobbies can all be utilized to create connection, community, and meaning in the life of a recovering addict.

Moving Toward Impactful Aftercare

Treatment Is Just The Beginning To A Life Long Journey Into Long-Term Recovery

Addiction is most often accompanied by one or more underlying co-morbidities. Most often unprocessed trauma or a mental health condition. It is imperative for long term recovery that these co-morbidities be addressed with a professional on an ongoing basis.  Treatment in most facilities lasts for between 30 and 90 days. This is truly not enough time to fully treat any trauma or mental health challenge. Increasingly, treatment centers are taking an active role in helping patients connect with professionals within a patient’s local area to continue the work that is started while under the care of the facility.  If a patient or the family is not given these resources from a facility they need to take it upon themselves to seek them out. Even in cases where there is no co-morbidity present it can be wise to continue treatment at a lower acuity level. This can take the form of out-patient treatment, or work with a local addiction specialist.

While the above should not be considered a comprehensive picture of how to make treatment succesful it can be regarded as creating a helpful starting point. Each individual and each family will have their own needs and consultation with one or more professionals is advisable. That said if:

  1. If the family moves together in the direction of long term health

  2. The addict can create a life of connection and community

  3. And, a meaningful aftercare plan is put in place and executed

Then, you will be well on your way toward lasting recovery.  If after reading this you have any questions or you feel that we, at Granite Mountain, can be of any assistance to you and your family please do contact us through our website or by phone at 844-878-3221 we are here to help.

Until next time
Your friend in service,

Rob Campbell


If you or someone you love is in need of help for substance use disorder don’t hesitate to call us. Reach out to us today to get the help you need and the life you deserve.

Addiction in the Age of Brain Science

Studying The Brain Functions

In this talk Markus Heilig presents new findings in the science of addiction, as viewed from a neuroscientific view point. Dr Heilig is a professor of psychiatry and the founding director of a new Center for Social and Affective Neuroscience at Linkoping University. His research group studies brain processes connected to stress and negative emotionality and how these contribute to psychiatric disorders including addictive disorder.

In this video Dr Heilig illustrates the role social exclusion plays in the addictive cycle. He begins the talk by illustrating that while early on in an addicts using history the brain’s reward center is primarily responsible for triggering using behavior, this is not the case by the time an addict is seeking help. At this point in the life cycle of addiction the individual is not being motivated by the brain’s reward center he or she is now being driven to action through the brain stress and aversion system. That is to say early on in someone’s substance use, they are trying to capture a good feeling, but by the end they are trying to avoid feeling miserable.  The stress and aversion system has been compromised in such a way that it is overactive. The addicts brain is super sensitive to feelings of stress, anxiety, and fear. Meaning that in the absence of a mood altering substance the addict is plunged into a state of misery.

Understanding The Damage

This damage to the brain, and its particular instantiation is complicated by our very nature a social group orientated primates. For us, as humans, one of the most profound stressors is social exclusion, being marginalized. The particular problem for addicts in this respect is that their lifestyle creates, by its nature social exclusion. Acute experiences of these stressors drive craving. Intense craving causes relapse. Relapse begets behavior that results in social exclusion. This cycles is repeated over and over again. Dr Heilig states, that unless we can create an intervention in this cycle by offering alternative measures to diffuse the stress the addict has little hope of recovery.

While neuroscience may be a long way from “curing” addiction. As a discipline they have begun to take the problem seriously. At Granite Mountain Behavioral Healthcare we also take addictive disorder seriously. Our program is based on current neuroscientific research. We engage in physical exercise as a way to generate neuroregeneration within our patient population. In effect we are working to undo the damage to the brain’s stress and aversion system that has rendered it hyperactive. We do this in a community setting that is grounded in an effort to help our patients feel a real sense of connection with each other and with the staff. Working to minimize or eliminate feelings of social exclusion within our community. We are attacking the addictive cycle on at least two fronts each day.

As the science of addiction continues to evolve so will our program in lock step. We are committed to bringing to bear the newest advances for the benefit of our patients. We are currently working to develop a fully realized nutritional component to our program. This element of programing won’t simply be about nutrition for general health and wellbeing. Rather it will be a nutritional plan specifically designed to support and create neuroregeneration.

If you or a loved one is suffering from addiction please contact us.

Until next time
Your friend in service,
Rob Campbell
VP of Communications & Market Development


If you or someone you love is struggling with substance use disorder please contact us today

Patient Brokers, Who’s Responsible and What Can be Done?: Part 1

By now I’m sure many if not all of you reading this are familiar with the terms “patient broker” or, “client broker”.  If you are not what the terms refer to is an individual who for a fee, paid by a treatment facility, will make a referral to that facility.  The way that this often works is that the broker “identifies” an addict in need of help, and then the broker starts calling treatment centers and negotiating a fee for placement.  These fees can be in excess of $5000 dollars per client. Thus referrals are made not based on clinical need, therapeutic fit, or really in any way meaningfully tied to the interests of the patient.  Rather these placement decisions are being made on the financial incentive for the facility and the broker. I want to spend a few minutes today sharing with you my thoughts on this problem and perhaps begin to describe a better way forward for our industry and our patients.

The Hydra of Our Industry

Sly And Cunning

Patient brokers come in many different forms.  Many are individuals with no professional background in addiction treatment at all.  These individuals quite literally will troll 12 step meetings, local detoxes, and in some instances even the local skid row,  trying to identify individuals who are suffering from addiction and desperate for help. When they find somebody they approach them under the guise of being able to help them find treatment. Many represent themselves as working directly for treatment centers when in fact they do not.  They will assure the individual addict that they can get them help, that they can get them to a safe place, that they can help them get sober. When the addict, desperate for a new life, agrees to seek treatment, the brokers work begins. The broker will begin calling treatment centers.  Leading not with questions about the therapeutic validity of the facility’s work but with the insurance information. The most valuable are those with PPO insurance with out-of-network benefits. the line between this sort of activity end human trafficking seems murky to me.

Not all patient brokers are this blatant, or have quite this level of amorality.  Many come in the form of professionals. Some are Therapeutic Placement Consultants, some are Interventionists.  Brokers of this stripe will charge a family anywhere from a few hundred to a few thousand dollars with the promise, again, of being able to help an addict to recovery.  After collecting money from the family and doing their work they turn around and “sell” the human being to the highest bidder. Often times in this sort of arrangement it is not on a per head basis.  Rather payment comes in the form of large year end “bonuses”. I know of one program that pays their “best” therapeutic placement consultant $50,000 at the end of the year. I try not to be a cynical person, but it is hard for me to see how a many thousand dollar payment would not influence placement decisions.   Many times these financial arrangements are not disclosed to the families of the addict. By not disclosing this information the family is not in a position to make a free and informed decision. I want to be clear that in no way am I alleging that all placement consultants or all interventionists operate in this way.  There are many highly competent, highly trained, and highly ethical individuals in both of these positions across the country. I have had the pleasure of knowing, and working with many.

The Buy-Side

Bad Actors Ruin It All

The bad actors in the industry give anyone trying to do a professional job with high standards of conduct a bad name.  It would be very easy to just cast blame at the brokers and say that they are the problem. This, in my view, is not true.  They are without hesitation a part of the problem, but only a part. Another part of the problem are the facilities who work with these individuals.  In any transaction the “buy” side has as much culpability as the “sell” side. If collectively treatment centers refused to buy patients the brokers would have no one to sell to, and the problem would go away.  The persistent nature of this issue appears to be a reflection of an inadequate understanding on the part of treatment facilities of how to engage patients and their families in a meaningful way, how to create meaningful relationships with clinicians and other providers who are already engaged with the population of addicts.  In some ways it is a failure of innovation on the part of treatment facilities. As long as facilities continue to be willing to buy their patients there will be individuals willing to sell them patients.

 

Root Cause

I believe that the problem runs even deeper than these two aspects.  The true nature of the problem is associated with the stigma we as a community still have in regards to those suffering from addiction.  Many in our communities, in the face of the science attached, still want to believe that if an addict wanted to change enough they would.  As a consequence of this belief they view (often unconsciously) addiction as a moral failure, or a failure in character. As a result our communities are less concerned with how addicts are treated when compared to the care and concern we express toward other sufferers of chronic disease.  Can you imagine an oncology hospital “buying” cancer patients, or a memory specialist “buying” patients suffering from Alzheimer’s without public outrage? I have a hard time imagining such a situation. What then is the difference? All are chronic diseases, which cause massive destruction to the lives of the suffer and those tied to them by affection.  The difference, as stated above, is in the way society views these diseases. If we want to change the outcomes for those suffering from addiction we need to change the way, we as a society, view addiction. We need to end the stigma.

 

Moving Toward A Solution

How do we move toward a solution?  The most immediate answer I see to this dilemma is to raise the bar of entry into the industry for professionals.  In any domain, a low bar of entry allows bad actors in. We need to adopt a standard of professionalism across the industry.  We need increased oversight and licensing requirements for those working in the field. By doing this we will make it harder for those with bad intentions to get in, we will be able to identify and stop them sooner, and will make it more transparent who can be relied on.  This will only happen when our industry demands it of ourselves. If we do this it will give us time to change the stigma attached to addiction. It will restore the public’s faith in us as a means of recovery for those suffering from addiction.

In the next part of this series we will be examining the proposed state bill in Arizona that is currently under consideration, and whether or not it will adequately address the problem.  In subsequent segments we will present interviews from each side of this issue. I believe that it is only in honestly facing a problem that we can begin to heal from it. We can and must do more.

 

Until next time
Your friend in service,
Rob Campbell
VP of Communications & Market Development


If you or your loved one is in need of help for substance use disorder please call us today @ 1.844.878.3221

Changing the Stigma of Addiction

In the above video clip Michael Botticelli makes a compelling argument for the necessity of changing the stigma attached to addiction. In it He makes an impassioned plea from personal experience. At one point in the clip he makes the statement that he feels more comfortable coming out as a gay man than being transparent about his history of addiction. This he feels after more than twenty years in recovery. Those of us who have addiction in our lives either actively or in our past don’t need to be told this. We know first hand about the stigma of addiction.

I have not had a drop of alcohol in my body for more than nineteen years and still find myself hesitant to disclose my recovery to people outside the recovery community. I want to be clear, I am in no way ashamed of my past. Perhaps it sounds paradoxical but, the single greatest thing to ever happen to me is that I became an alcoholic. How many people move through their lives feeling not quite right, being sad, isolated, or alone but don’t know why? I felt all these things and more. When alcoholism finally brought me to my knees, and I had nowhere to turn I found my answer. Through treatment and membership in a 12 step fellowship I was able to understand why I felt the way I did. I was also offered a solution. I have accepted that solution and have since been able to enjoy a life beyond my wildest dreams. A life of purpose, meaning, and connection.

I do not bring this up to be self congratulatory. On the contrary I want to illustrate what is possible for every single person suffering from a substance use disorder if they are able to access treatment and recovery. In his talk Mr. Botticelli makes the point that the stigma attached to addiction is the single greatest hindrance to people who need help getting it. As a community we need to begin to recognize addiction for what it is. A brain disease, a medical condition. If we are to come to grips with our current opioid epidemic we need to begin to treat those afflicted as what they truly are, sick people who need help. There is no doubt this can be hard to do, but it is necessary.

I agree with Mr Botticelli that in order for this to happen those of us who have overcome this disease need to be open about that fact. This may enable those around us to begin to form a different viewpoint about addiction. They may be able to see that as Mr. Botticelli states, “people are more than their disease.” Moving forward I am committed to being open and candid about my own recovery with anyone who asks. I will weather the inevitable questions, the confusions, the awkward attempts at “protecting” me. I will do this not for myself, but as an example that addiction does not define a person, that as with most other diseases we can and do recover.

 

Until next time
Your friend in service,
Rob Campbell
VP of Communications & Market Development


If you or someone you love is in need of help for substance use disorder please give us a call today. We understand and we are here to help.


 

https://www.ted.com/talks/michael_botticelli_addiction_is_a_disease_we_should_treat_it_like_one#t-570345

 

“The Opposite of Addiction is Connection”

An Inability To Connect

In his Ted Talk from TEDGlobal London, Johann Hari makes the statement that, “the opposite of addiction is not sobriety, the opposite of addiction is connection.” This powerful statement is at once a message of hope to those suffering from addiction and an indictment of the way our culture has treated addicts for the last 100 years. Mr. Hari spent three years studying addiction by traveling the world speaking to individuals on all sides of the issues. What he was left with was an understanding that behind and underneath addiction of all sorts is an inability to connect, to engage in a life of purpose. While I do not agree with everything Mr Hari says during his talk, I am passionate about this idea of connection. The most common experience for any addict is a feeling of isolation and inability to connect in a meaningful way with others and the world around them.

Overcoming The Mental Challenges

In order to overcome addiction and transform our lives we need to do many things. First we need to be in a community that encourages connection and commitment. Many addicts find this community in treatment. In this safe community we can take the next step which is to address the root causes of the lack of connection. For many this will be some form of trauma they have suffered which causes their lack of connection. For others it is underlying behavioral or mental health disorders. Therapeutic measures can be utilized to great effect in both sets of circumstances. Once an individual has begun this work the next step is to find a life of purpose that they can show up for. There are as many ways to find a life of purpose as their are individuals. The challenge for many who suffer from addiction is they don’t know how to go about it.

Constantly Seek Purpose

At Granite Mountain BHC we first find purpose in the gym, and in the commitment to our peers not to quit. We build from this initial purpose by drawing parallels from our experience in the gym to the rest of our lives, and by creating meaningful connections within our Granite Mountain community. If I can meet and overcome challenges during the Recover Strong group, maybe I can push through when I’m having a bad day at work, or my relationships are difficult. Our clients are able to transform their lives through the three pillars of commitment, connection and community. At Granite Mountain they are able to experience connection with their peers, staff, and themselves. This connection is at the heart of their purpose as they strive to better themselves and the community they are a part of. After their time with us they are then able to take these three pillars back to their community of origin and continue building upon this foundation, a life of meaning and purpose.

Please take a moment to view this inspiring video, and perhaps re-conceive what you think you know about addiction.

 

Until next time,

Your friend in service,
Rob Campbell

VP of Communications and Market Development


If you or someone you love is in need of help for substance use disorder please give us a call today. We understand and we are here to help.