The Evolution of Dual Diagnosis Treatment (And How it Affects Your Recovery)

“Dual diagnosis treatment” is a new catchphrase in the recovery industry; if you’ve been doing your research, you’ll see it everywhere
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“Dual diagnosis treatment” is a new catchphrase in the recovery industry; if you’ve been doing your research, you’ll see it everywhere from academic studies to rehab websites. But why is dual diagnosis treatment important for you and your recovery journey?

Dual Diagnosis

Simply put, dual diagnosis is the term for a substance addiction coupled with a mental health concern. For example, if you are addicted to prescription painkillers and you’re also dealing with depression and anxiety, then you have a dual diagnosis.

This post will provide an overview of the history of dual diagnosis treatment in the United States, and a discussion of how the evolution of dual diagnosis treatment impacts your recovery today.

As you learn more about what works, what doesn’t and why, you’ll be empowered to make well-informed decisions about your own treatment plan.

The Prevalence of Dual Diagnosis

Until recently, many people believed that there was little overlap between addiction and mental health conditions. Dual diagnosis was seen as fairly unusual. However, statistics show that dual diagnosis is actually the norm for people dealing with addiction. Today, we know that most people who abuse substances have a concurrent mental health condition.

Though some people do have purely physical addictions, most are coping with physical addictions that came into being as a result of mental and emotional drivers.

According to the National Alliance on Mental Illness (NAMI) website’s Mental Health by the Numbers page:

“Among the 20.2 million adults in the U.S. who experienced a substance use disorder, 50.5%—10.2 million adults—had a co-occurring mental illness.”

Many in the recovery industry believe that those numbers are much higher, but even so, this is an astonishing statistic. Likewise, the 2011 National Survey on Drug Use and Health found that:

“Among the 18.9 million adults with a past year substance use disorder, 42.3 percent (8.0 million adults) had a co-occurring mental illness in 2011.”

Clearly, there is a strong connection between substance abuse and mental health. Yet if mental health concerns impact at least half of individuals with addictions, then why isn’t dual diagnosis treatment standard in the recovery industry? In order to answer that question, we need to look at past approaches to addiction treatment and see how these traditions persist in present-day rehabs.

One Past Approach: Sequential Treatment

Integrated dual diagnosis treatment is very much a modern development. In times past, the preferred approach to addiction treatment was called “sequential treatment”.

The theory behind sequential treatment was that addiction treatment and mental health treatment should be separate. Recovery professionals thought that individuals needed to stabilize one aspect of their lives before addressing another. In many cases, individuals were required to undergo treatment for their substance abuse issues before they’d be eligible to receive mental health treatments. The results of sequential treatment proved poor over time. As the DualDiagnosis.org article Dual Diagnosis Treatment states:

“‘Sequential treatment’ was the norm before the 1990s … Clients with a Dual Diagnosis were excluded from one area of treatment until they were considered stable in the other … [Yet] research showed that [sequential treatment] led to a higher rate of relapse.”

Another Past Approach: Parallel Treatment

When a growing body of evidence suggested a correlation between mental health issues and addiction, a protocol known as “parallel treatment” came into being.

In parallel treatment, an individual receives professional services for both addiction issues and mental health concerns concurrently. Nevertheless, the division between addiction and mental health treatment persists in that the support teams operate independently. The individual’s doctors and therapists rarely communicate with one another.

As such, there’s a lack of continuity and cohesiveness to the treatment approach. It can even be counterproductive. For example, if a psychiatrist prescribes a medication and doesn’t consult with the individual’s therapist, the individual may experience side effects that affect their ability to progress in therapy.

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