16 March 2020

When two health issues occur at the same time, it is called co-morbidity.
Patients with depression, anxiety or mood disorders can easily turn to drug and alcohol misuse to manage their pain and suffering.
A patient who presents with addiction plus a mental health issue is called Dual Diagnosis. This is an important factor to examine when considering a patient treatment plan with complex needs.
Failure to identify Dual Diagnosis can result in limited effective treatment outcomes, a continuation of the addiction cycle or relapse.
Evidence-based best practice recommends that people with Dual Diagnosis presentations do better in a service that can address both pathologies at the same time.
When to refer
When patients become aware through their own insight or through the observation of others that their substance use is negatively impacting their life, it’s time to refer.
Patients will ask their doctor, “What do I do now and where can I get help?”
Patients with complex issues need a safe place to withdraw and undergo supervision and treatment. They may have concurrent issues such as psychosis, depression, anxiety or suicidal ideation.
When a person is in a highly anxious state, it’s very difficult to identify underlying pathology and associated addiction issues as they compound and sometimes mask each other’s symptoms.
It’s common for complex needs patients to be moved between services e.g. AOD to Mental Health, the Justice System, to Victims of Crime, Veterans Affairs, to NDIS, etc. For this reason, it can be easy to miss a Dual Diagnosis circumstance.
If a patient is in a service with limited resources, their complex needs cannot be addressed and a multifaceted treatment cannot be implemented.
Small, private detox centres that offer all-inclusive service provision, have fewer limitations than other services.
Government and not-for-profit services do excellent work but are frequently under-funded or under-resourced and unable to diagnose and treat complex and compounded issues.
Patients may be exited due to inappropriate behaviour and emotional dysregulation, resulting in high-risk behaviour in the community, such as: self-harm, clients assaults and even suicide or homicide.
Alternatively, over-medication with anti-depressants or anti-psychotics can leads to poor engagement and learning due to somnolence and cloudy cognition.
Watching for signs and symptoms of addiction presentations, with possible Dual Diagnosis issues is important.

Symptoms:

  • Addiction
  • Self harm
  • Suicidal ideation
  • Depression
  • Anxiety
  • Social isolation
  • Loss of sense of self
  • Loss of contact with reality
  • Dissociative states
  • Fugue states (loss of orientation and time, not related to blackouts)
  • High risk for suicide, injury and self-harm.
  • Underlying pathologies never diagnosed
  • Relational, legal, financial and spiritual issues (such as principles and values compromised)

Signs:

  • Lack of self-care
  • Not lucid, not in touch with reality
  • Moving from topic to topic
  • Flattened or monotone speech
  • Highly agitated
  • Erratic in speech
  • Childlike states
  • Catatonic states
  • Agitated, abusive, scattered, erratic
  • Unable to engage

Case Scenario: Female mid 20s

Diagnosis: Autism Spectrum Disorder (ASD) with learning issues, concurrent BPD with complex trauma history.
Frequent presentations to hospital with self-harm and suicidal ideation. IV drug use including opiates and stimulants, supplementing with cannabis.
Kicked out of TAFE for uncontrollable rages and threats to staff and students.
Referred to a local agency that offered her drug and alcohol counselling and a collaborative approach to addressing psycho-social needs and ASD.
Referred to local health service for Dialectical Behavioural Therapy (DBT).
Had psychotherapy with a psychologist including weekly counselling and group work. She had been learning to co-regulate and regulate emotions with a trusted practitioner.

Result: She was found unsuitable for DBT at the local mental health service due to her injecting drug use and substance dependency and needed a drug withdrawal program first.
Problem: Most government and not-for-profit detox services have 1-6 week waiting lists with limited scope for admission for people with complex presentations. Therefore this patient’s options are limited.
Other services have specific requirements on which type of clients they take.
A small, integrative detox facility will help treat patients with complex histories.
A tailor-made treatment protocol involving psychiatrists, nurses, addiction counsellors and remedial staff offer patients a higher level of personal care and supervision.
All protocols follow an evidence-based practice strategy and are created in a collaborative approach.

Relapsing
Recent drug relapse statistics show that more than 85% of individuals relapse and return to drug use within the year following treatment 1.
Practitioners advise that this is even higher with methamphetamine addiction, so it’s important to choose a service that develops a comprehensive relapse prevention plan.
Each patient requires an intensive integrated treatment plan that includes psychological interventions, such as counselling to address trauma and improving psychosocial functioning.
Supplying family support resources is also essential to prevent relapse after the person returns home.
Reference
(1)Sinha, R. (2011). New findings on biological factors predicting addiction relapse vulnerability. Current Psychiatry Reports, 13(5), 398–405.

About Gold Coast Addiction & Treatment Rehab
Referring patients for drug and alcohol withdrawal at Gold Coast Addiction & Treatment Rehab allows underlying pathologies to surface, be observed, diagnosed and treated. We have experts in all areas of addiction and mental healthcare, plus a range of complementary health therapists to support detoxification. Gold Coast Addiction & Treatment Rehab offer private and confidential withdrawal programs for patients needing a high level of personal care and comfort. Our facility has 24-hour medical care, luxury beachfront accommodation and carefully planned meals prepared by a nutritionist. Our treating psychiatrists, counsellors and nursing staff are all highly qualified in AOD and mental health. We work closely with referring doctors and mental health teams to provide a collaborative approach to addiction and Dual Diagnosis.https://goldcoastaddictionandtreatmentrehab.com/

Training
A full outline of psychosocial dysfunction is outlined in the two hour brief intervention program called ‘Chemically Speaking 2’, which is available 24/7 online. The 12 hour ‘Advanced Dual Diagnosis Training’ training is also available online and provides CPD points for professional development for peak bodies around the globe. The next live Dual Diagnosis training, from an integrative holistic framework, is on website. www.dualdiagnosistraining.com.au

Download the pdf here.