Drug Rehab Centers for Co-Occurring Disorders

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1. The Assessment Phase
2. Types of Facilities
3. Therapeutic Options
4. Support Groups
5. Medications
6. Finding the Right Facility

People who have a co-occurring disorder have a mental health issue in addition to their addiction issue. The two problems tend to wind around one another, like the threads in a carpet, and it can be difficult to pull those threads apart and deal with them separately. Tug on one strand and the other strand comes along as well. In order to truly heal, both conditions must be treated, and since they cannot be separated, they must be treated at the same time. The best drug rehabilitation centers that provide care for co-occurring disorders are designed to do just that.

This article will outline the fundamentals of a comprehensive multi-disciplinary program designed to address co-occurring disorders. This is the sort of care we provide at Alta Mira, and our psychologists, counselors and consulting ASAM-certified physicians have a significant amount of specialized training and experience in handling these complicated issues. If you have any questions about the best treatments for co-occurring disorders, or you’d like to learn more about our programs, please contact us today. Our admissions counselors are standing by to take your call.

The Assessment Phase
Almost any mental illness can walk alongside an addiction problem, but according to a study published in the Journal of Substance Abuse Treatment, these mental illnesses were most common in people who required care for substance abuse:

  • Mood disorders
  • Anxiety disorders
  • Post-traumatic stress disorder (PTSD)
  • Antisocial personality disorder
  • Borderline personality disorder

Some people who have mental illnesses know the names of their illnesses, and they might have received care for those conditions in the past. People with schizophrenia, for example, might have begun to exhibit symptoms of the disease during adolescence, and they might be quite adept at describing what schizophrenia is and how the condition is typically treated. Other people, however, may have absolutely no idea that they’re struggling with a mental health issue, and they may blame the symptoms they feel solely on their addictions. Obtaining an accurate diagnosis is essential, as it allows experts to pull together an appropriate treatment plan, so most rehab centers for co-occurring disorders provide a thorough screening for mental illness, regardless of whether the patient claims to know of the disease or not.

Some conditions are relatively easy to spot and diagnose, while others can be slightly more complex, especially if the person has multiple issues all in play at the same time. In general, it’s best for a mental health professional to conduct the screening for mental illnesses, so a proper diagnosis is made. Facilities that offer care for co-occurring disorders often have licensed mental health professionals who are qualified to administer these tests and evaluate the responses accurately.

There are multiple tools experts can use to assess mental health, according to an article published by the State of Minnesota Department of Human Services, and some facilities use multiple tests to screen their clients. These screening tools often take the form of questions. One such tool, known as the K6, asks clients to provide responses on a scale of zero to four, with zero as the low point, when asked these questions.

During the past 30 days, how often did you feel:

  • Nervous
  • Hopeless
  • Restless
  • Depressed
  • That everything was an effort
  • Worthless

The results of tests like these, along with screening tests for drug and alcohol abuse, can help providers to determine what sort of care might be best to provide meaningful help for the person.
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Types of Facilities

It’s true that people who have co-occurring disorders can obtain some level of care from a standard program for addiction. But, people with co-occurring disorders often have difficulties that are so severe, and so troubling, they need additional care. For example, the State of Oregon Addictions and Mental Health Services Department reports that people with co-occurring disorders are more likely to be hospitalized and use emergency room services, and they die at an average age of 45.1 years, compared to 76.6 years for other people who live in Oregon. Addressing problems that are this severe often means looking for facilities that are specifically designed to address co-occurring disorders.

Various Programs
According to the Substance Abuse and Mental Health Administration (SAMHSA), addiction programs can be split into four distinct groups:

  • Basic programs can provide care for one disorder, but other disorders might be treated elsewhere.
  • Intermediate programs can provide some care for other disorders, providing medications for mental illness, for example, but they do not provide a complete level of care for multiple issues. This is true of many family-systems programs based on the Minnesota model of care.
  • Advanced programs can provide care for multiple conditions, and they often have licensed staff that can prescribe medications as well as provide classes on mental illness. Some programs like this do contract out services to other agencies, however.
  • Fully integrated programs combine the treatment of multiple disorders, essentially providing holistic, whole-person care under one roof.

Integrated programs are ideal for people with co-occurring disorders. Here, they can learn a significant amount about both their addiction and their mental illness, and they can receive medication management for both conditions as well.
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Success Story

“Alta Mira saved my life. After years of destruction to my mind and body, I was able to eliminate all chemicals and shed the guilt and shame. I am leaving her with a new found passion for life and will forever be indebted.”

– Adam W., April 24, 2013

Therapeutic Options

People with co-occurring disorders rely on strong connections with their therapists. At the same time, they may be deeply suspicious of other people, and feel unable to build up the types of relationships they crave. In order to address these seemingly contradictory characteristics, some therapists begin their work by providing motivational interviewing at the beginning of treatment. Here, the person in treatment is encouraged to think about why treatment is important, and how it will allow the person to live a life that is healthier and happier. The technique is gentle as well, meaning that the person can go through therapies without feeling attacked or belittled in any way.

Therapy for co-occurring disorders often includes a significant amount of psycho-education. Individuals will need to know how the conditions work, and how they combine, in order to care for those conditions for the rest of their life. Didactic education can help, as can asking the person to watch videos. Some therapists also provide reading materials to allow the person to study alone, outside of the office. In subsequent sessions, the therapist and the client discuss the materials in detail.

To deal with mental health issues, some therapists use a technique known as dialectical behavioral therapy (DBT). In this form of therapy, the person is asked to identify the thoughts and feelings that seem to make life harder. Then, the therapist attempts to help the person take control of those thoughts and feelings, transforming them from something damaging into something positive and helpful. This type of treatment can be particularly helpful with people who have borderline personality disorder. The therapist and the person form a tight team that works together to overcome the problems the individual faces in regulating temper and interpreting emotions.

People with anxiety disorders are sometimes provided with exposure therapy, in which they are slowly acclimated to the item, memory or situation that causes them intense fear. This exposure might happen in real time, or it might be imagined or visualized instead. The process happens slowly, one tiny step at a time, so the person is able to become accustomed to dealing with low levels of fear, instead of being overwhelmed with fear all at once. This type of therapy is most helpful when the person is in a safe environment working with a trusted therapist.

Cognitive behavioral therapy (CBT) sometimes augments these approaches. Here, the person is asked to think about situations or memories that seem to trigger a craving to use substances. Then, through homework assignments and intense talks, the person comes up with action plans for avoiding these situations or dealing with them as they arise. This technique can be a bit confrontational, and many people with co-occurring disorders don’t handle confrontation well, so the therapy is often modified to move at a slower, gentler pace.
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Support at Alta MiraSupport Groups

Many top addiction programs ask people in recovery to join support groups such as Alcoholics Anonymous, Narcotics Anonymous, or SMART Recovery. These meetings, made up of peers and not medical professionals, can be sometimes difficult for people with co-occurring disorders to deal with. They might find the concept of open discussions distressing, or they might feel as though they are being judged by other people in the room. Some days, they may not be able to attend these meetings at all, due to their fears. Such individuals may do better in Dual Recovery Anonymous or Emotions Anonymous where all participants are dealing with co-occurring disorders.

Integrated programs allow people to set their own pace for recovery, and therapists do not push people into care or punish them for expressing difficulty. If people cannot handle a group meeting that day, they might be allowed to skip it altogether until they are feeling better. Providing this form of gentle encouragement can be incredibly helpful for people with co-occurring disorders.
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As SAMHSA makes clear, people with mental illnesses often need medications in order to soothe their symptoms and allow them to participate in care and effectively engage in treatment. Similarly, people in the early stages of recovery from addictions might also need medications in order to help them cope with the withdrawal process. Taking multiple medications, all at the same time, can be dangerous if knowledgeable medical professionals are not in charge. Medications can combine and cause damage to the organs, and some medications seem to cancel one another out.

In integrated programs, a psychiatrist on site can prescribe the medications needed for psychiatric illnesses and an ASAM-certified physician might  prescribe medications to assist with ongoing withdrawal symptoms. Close collaboration between the psychiatrist, the physician and nursing staff is critical. In inpatient programs, the medication is provided at scheduled times, ensuring that the person never misses a dose.
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Finding the Right Facility

Most facilities that offer care for co-occurring disorders will describe their care as “comprehensive,” or they will use the words “co-occurring disorders” or “dual diagnosis” on their websites and marketing materials. These facilities will also have licensed staff members who are qualified to handle both kinds of conditions, and they will also acknowledge that they have treated these sorts of issues in the past.

People with co-occurring conditions benefit when they are in charge of their care, and allowed to provide input on what sorts of treatments are provided for the problems they face. Some people are quite savvy about their mental health issues, and their intrinsic knowledge should be allowed to infuse the programs pulled together. Facilities that allow patients to provide this input, and that allow programs to be deeply customized based on client feedback, might be good choices.

At Alta Mira, we provide customized care for people with co-occurring disorders, on an inpatient and outpatient basis. At Alta Mira, we provide customized care for people with co-occurring disorders, on an inpatient and outpatient basis. We also provide a significant amount of aftercare. People with co-occurring disorders often need an extensive amount of care long after their formal programs have been completed, and we make sure to provide this level of care to each patient we serve. Please call us to find out more.
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Drew PaxtonAbout Drew Paxton

Drew Paxton is the Executive Director of Alta Mira Recovery Programs. His experience in the technology and recovery industries spans over three decades. | LinkedIn