Outpatient Treatment for Co-occurring Disorders
Mental illnesses can take many forms, and people who have different types of mental illnesses may seem to have very little in common. For example, someone with schizophrenia might feel as though life is moving along at a fast clip, and it’s hard to catch up with all of the data that’s tossed about on a daily basis, while someone with depression might feel as though the minutes stretch into hours, with no end in sight. It’s hard to find commonality, at times, when the illnesses cause such very different symptoms.
There are some areas, however, in which people with mental illnesses do share common ground. For example, many people with mental illnesses also have addiction issues. People with these co-occurring disorders may struggle to handle the details of everyday life, and if they’re not provided with appropriate treatment, both conditions can become much harder to handle. Outpatient treatment programs may provide the lifeline people like this need in order to get well.
Understanding the Connection
It’s not unusual for mental illnesses and addictions to take hold within the same person. For example, the National Institute on Alcohol Abuse and Alcoholism reports that those with a history of alcohol dependence have a fourfold increase in the risk of major depression, when compared to people who don’t have an alcohol abuse history. Other studies have found similar links between abusive drugs and mental illnesses.
For some, the drug use stems from the need to medicate distress caused by mental illness. For example, the Treatment Episode Data Set from 2010 found that people with co-occurring mental disorders were more than likely to abuse prescription drugs, cocaine and heroin, when compared to those without these mental illness issues. The researchers suggest that these college students were using these drugs in order to medicate their mental illness symptoms, and that they moved from using the drugs to abusing them in a desperate search to find relief.
Other people come to mental illnesses via drug use. The chemistry is complex, and researchers haven’t quite figured out all of the complex details that go into an issue like this, but some drugs do seem to cause persistent changes within the brain that can lead to profound mental illness. A study of one such link, published in Schizophrenia Research, examined people who took marijuana. Here, researchers suggest that people with a family history of schizophrenia seem to awaken that disease when they use marijuana, developing psychosis. Others without a family history of schizophrenia don’t experience these symptoms.
Other addictive drugs have been linked to the development of other mental illnesses, including:
- Anxiety disorders
- Personality disorders
- Bipolar disorder
It’s possible that shared brain abnormalities contribute to these two disorders, meaning that people who are at risk of developing one issue are at high risk of developing the other. It’s also possible that both conditions can cause damage, and the ongoing damage from one condition allows the other to take hold. It is clear, however, that both conditions can work together and they can strengthen one another. As a result, a person with both conditions can feel significantly more impaired than a person who has just one problem.
Components of Care
Medications can play a huge role in the healing process for people who have mental illnesses. Unlike addictive drugs that can do damage and make a mental health issue much worse, prescription medications can correct chemical imbalances and soothe distress. With appropriate treatment, people with mental illnesses might feel less likely to self-medicate with addictive drugs. In an outpatient program, people might need the help of family and friends, however, so they take their medications appropriately instead of abusing their drugs and taking improper dosages.
Medications alone can’t solve the issues experienced by a person with a Dual Diagnosis. Therapy can help them to learn more about their behavior, and this could help them to stop abusing drugs and handle their mental issues in a more effective manner. Unfortunately, it’s not always easy to get people to participate in therapy. According to the National Alliance on Mental Illness, many people with co-occurring disorders struggle with denial and a lack of insight about their addiction issue. In essence, people like this may just not believe that they have a problem, and they may continue to use and abuse drugs until their minds are changed about the severity of the problems they’re facing. Therapists can be key allies in bringing about this change. In outpatient therapy, people can learn more about how their mental illnesses impact the way they think and the way they behave, and they can learn more about how to deal with their mental distress without leaning on drugs. Early, tentative sessions may just focus on education and breaking through denial, while later sessions focus on bringing about a significant behavior change.
Group work is traditionally seen as an important part of healing for people with co-occurring disorders, and some people may find that aspect of the work to be beneficial. In a group setting, they can learn more about how others have dealt with similar issues, and they can pull together their own plans for handling their distressing thoughts. However, some people with co-occurring disorders struggle with group settings, as they have a deep distrust of people they don’t know, compounded by an inner hostility toward authority figures. People like this might be excused from group work altogether, as it might not help them.
Types of Treatment
In 2004, of the facilities responding to the National Survey of Substance Abuse Treatment Services, 35 percent had special programs just for people who had co-occurring disorders.
Facilities that did offer this kind of care provided clients with services they might not find in other programs, including:
- Hepatitis B testing
- Social services support
- HIV testing
- Outpatient family counseling
- Domestic violence counseling
Programs like this are providing a comprehensive service that can help clients improve their lives on many fronts, and this kind of wraparound care is considered ideal for people who have Dual Diagnosis issues. There are some programs, however, that don’t provide quite this level of care.
Basic programs for addiction might sprinkle in therapies that could be beneficial for people with Dual Diagnosis concerns, including medication management and targeted therapy, but these programs might not provide the same level of intensive, multi-faceted help. Programs like this might not be ideal for someone with severe mental illness concerns, but they could be acceptable options for people with low levels of distress.
Providing care for co-occurring disorders on an outpatient basis can bring about great results. Insight levels can improve, drug use rates can drop and people can continue to lean on the love and support of their families as they heal. Unlike inpatient programs, in which the person is pulled away from the support of home, outpatient programs allow the person to maintain important ties, and that could be they key to long-term success.
Multiple studies have been conducted, comparing this kind of care with other treatment options available, and outpatient programs have fared quite well. For example, a study in the journal Health Technology Assessment found that people who participated in day treatment programs fared no better on clinical or social outcomes, when compared to people who received outpatient care. These hospitalization programs are much more expensive, and they can require a much more intensive time commitment, but it’s clear that they don’t provide a significantly superior form of care.
Success in outpatient care is dependent on the individual in treatment, however, and some people choose to leave their treatment programs before they are complete. These people may believe that they don’t really need the help of a treatment program, or they may find that therapy is just too hard or too painful to continue with. Leaving a treatment program before it’s complete could spell disaster, as people who leave early often return to their poor habits. Therapists do their part to retain clients, but families can help by providing encouragement and support to those who continue to work on their addiction issues. A stable home environment, full of encouragement and support, could provide therapeutic help that’s impossible to find in a clinical setting.
Finding a Solution
Sometimes, families know all too well that the person they love has a mental illness lying beneath an addiction. It can be difficult to confront people like this because, as mentioned, they may have low levels of insight about their problems and they may react with anger or sadness when the issue is brought up for discussion. The person’s therapist might be able to help the family deal with the problem, but if the person doesn’t have a therapist, an interventionist might be a good resource for the family. These professionals specialize in pulling together conversations about addiction and mental illness, and they can help the family determine what to say and how to say it, without causing the person additional distress.
Some families don’t have confirmation that the person they love has a mental illness. These families might be relieved to learn that Dual Diagnosis programs often provide screening for new clients. By choosing a facility like this, the family might be able to get a firm diagnosis of mental illness, and with this information in hand, the therapist can pull together a program that can help.
No matter what situation the family might be in, it’s vital to take action. We can help. Foundations Recovery Network specializes in helping people with addictions, mental illnesses or both. Please call us to find out more about our program options.