Dual Diagnosis Rehab Treatment Center Facilities Program

Dual Diagnosis Statistics

60% of the people diagnosed with a bipolar condition also suffer from addiction
30-50% of the ADHD population suffers from addiction
25% of those diagnosed with anxiety and/or depression suffer from addiction

For those with either an alcohol or other drug disorder, the odds of having the other addictive disorder were seven times greater than in the rest of the population. Among those with an alcohol disorder, 37% had a co morbid mental disorder.
The highest mental-addictive disorder Co-morbidity rate was found for those with drug (other than alcohol) disorders, among whom more than half (53%) were found to have a mental disorder with an odds ratio of 4.5. Individuals treated in specialty mental health and addictive disorder clinical settings have significantly higher odds of having co morbid disorders.
Among the institutional settings, Co-morbidity of addictive and severe mental disorders was highest in the prison population, most notably with antisocial personality, schizophrenia, and bipolar disorders.

Results From the Epidemiologic Catchment Area (ECA) Study

Estimated US population lifetime prevalence rates were 22.5% for any non-substance abuse mental disorder, 13.5% for alcohol dependence-abuse, and 6.1% for other drug dependence-abuse.
Among those with a mental disorder, the odds ratio of having some addictive disorder was 2.7, with a lifetime prevalence of about 29% (including an overlapping 22% with an alcohol and 15% with another drug disorder).

Dual diagnosis rehab treatment centers Facilities Program

With over a decade of general medicine and psychiatry experience, Dr. Mohammad is certified in Addiction Medicine by the American Society of Addiction Medicine and board certified in Neurology. He is the Assistant Clinical Professor of Psychiatry and the Behavioral Sciences at the University Of Southern California (USC), where he is active in research and in teaching and training of residents and students.

Dual Diagnosis Treatment Center and Rehab Facilities Program

Often this underlying cause presents as a clinical depression, an anxiety disorder or any combination of other possible conditions. Upon arrival, each patient is carefully evaluated and assessed through a combination of tests and interviews. Our staff is especially trained to properly diagnose a dual condition. Addictions can fracture relationships, create financial hardship and adversely affect the health of the addict. "The essence of addiction is the compulsive drug seeking and using in spite of the negative, moral, physical and social consequences," says Dr. Akikur Mohammad. "Medical research shows that addiction is tied to changes in brain structure and function, and that it is essentially a brain disease."

Depression, Anxiety, Bi-Polar Treatment - Dual Diagnosis

One of the best dual diagnosis rehab and treatment centers in the country is Malibu Horizon. Other Malibu treatment centers do not offer real scientifically based, psychiatric treatment. Malibu Horizon uses the latest clinical research to offer the most effective treatment protocols.
Addiction is a powerful, destructive force that can often only be conquered with professionals who specialize in dual diagnosis.
When a person has a dual diagnosis, and abusing drugs and or alcohol, they inevitably are self-medicating the psychological condition to help ease their psychological distress. By self medicating, the person is self-soothing their condition(s) with drugs and or alcohol to relieve their discomfort.
At our facility, we treat the entire person to ensure a more fulfilling life and long-term success. At Malibu Horizon, we treat the entire patient. Many centers focus only on the treatment for drug or alcohol abuse. We look beyond the symptoms and address the underlying causes.

Brain Chemistry - Dual Diagnosis Treatment in the Modern Age

Addiction changes the brain in fundamental ways, disturbing a person's normal hierarchy of needs and desires and substituting new priorities connected with procuring and using the drug. The resulting compulsive behaviors that override the ability to control impulses despite the consequences are similar to hallmarks of other mental illnesses. PTSD anxiety disorders and panic disorder can cause a person to self-medicate these psychological issues using alcohol and or illegal street drugs. Long term changes in the brain due to drug and alcohol use can be clearly seen in these brain images. We offer brain imaging (PET scans) for those patients who want to see the difference.

Dual Diagnosis changes the normal hierarchy of needs and desires

In fact, the Diagnostic and Statistical Manual of Mental Disorders (DSM), the definitive resource of diagnostic criteria for all mental disorders, includes criteria for drug use disorders, distinguishing between two types: drug abuse and drug dependence. Drug dependence is synonymous with addiction. By comparison, the criteria for drug abuse hinge on the harmful consequences of repeated use but do not include the compulsive use, tolerance (i.e., needing higher doses to achieve the same effect), or withdrawal (i.e., symptoms that occur when use is stopped) that can be signs of addiction.
The overlap of brain areas involved in both drug use disorders and other mental illnesses suggests that brain changes stemming from one may affect the other. For example, drug abuse that precedes the first symptoms of a mental illness may produce changes in brain structure and function that kindle an underlying propensity to develop that mental illness. If the mental disorder develops first, associated changes in brain activity may increase the vulnerability to abusing substances by enhancing their positive effects, reducing awareness of their negative effects, or alleviating the unpleasant effects associated with the mental disorder or the medication used to treat it.

Dual Diagnosis Triggers Self Medication of the Underlying Psychiatric Condition

The high prevalence of dual diagnosis between drug use disorders and other mental illnesses does not mean that one caused the other, even if it appeared first. In fact, establishing causality or directionality is difficult for several reasons. Some symptoms of a mental disorder may not be recognized until the illness has substantially progressed, and imperfect recollections of when drug use/abuse started can also present timing issues. Still, three scenarios deserve consideration:

1.Drugs of abuse can cause abusers to experience one or more symptoms of another mental illness. The increased risk of psychosis in some marijuana abusers has been offered as evidence for this possibility.

2.Mental illnesses can lead to drug abuse. Individuals with overt, mild, or even sub clinical mental disorders may abuse drugs as a form of self-medication. For example, the use of tobacco products by patients with schizophrenia is believed to lessen the symptoms of the disease and improve cognition.

3. Both drug use disorders and other mental illnesses are caused by overlapping factors such as underlying brain deficits, genetic vulnerabilities, and/or early exposure to stress or trauma.

All three scenarios probably contribute, in varying degrees, to how and whether specific dual diagnosis manifest themselves
Because mood disorders increase vulnerability to drug abuse and addiction, the diagnosis and treatment of the mood disorder can reduce the risk of subsequent drug use. Because the inverse may also be true, the diagnosis and treatment of drug use disorders may reduce the risk of developing other mental illnesses and, if they do occur, lessen their severity or make them more amenable to effective treatment. Finally, because more than 40 percent of the cigarettes smoked in this country are smoked by individuals with a psychiatric disorder, such as major depressive disorder; alcoholism; post-traumatic stress disorder (PTSD) ; schizophrenia; or bipolar disorder, smoking by patients with mental illness contributes greatly to their increased morbidity and mortality.

Childhood ADHD and Later Drug Alcohol Problems - Dual Diagnosis

Numerous studies have documented an increased risk for drug use disorders in youth with untreated ADHD, although some suggest that only a subset of these individuals are vulnerable: those with co morbid conduct disorders. Given this linkage, it is important to determine whether effective treatment of ADHD could prevent subsequent drug abuse and associated behavioral problems. Treatment of childhood ADHD with stimulant medications such as methylphenidate or amphetamine reduces the impulsive behavior, fidgeting, and inability to concentrate that characterize ADHD . However, some physicians and parents have expressed concern that treating childhood ADHD with stimulants might increase a child's vulnerability to drug abuse later in life. Recent reviews of long-term studies of children with ADHD who received stimulant therapy found no evidence for this increase. However, most of these studies have methodological limitations, including small sample sizes and non randomized study designs, indicating that more research is needed, particularly in adolescents.

How Common is Dual Diagnosis?

Many people who regularly abuse drugs are also diagnosed with mental disorders and vice versa. The high prevalence of this co-morbidity has been documented in multiple national population surveys since the 1980s. Data show that persons diagnosed with mood or anxiety disorders were about twice as likely to suffer also from a drug use disorder (abuse or dependence) compared with respondents in general. The same was true for those diagnosed with an antisocial syndrome, such as antisocial personality or conduct disorder. Similarly, persons diagnosed with drug disorders were roughly twice as likely to suffer also from mood and anxiety disorders.

Dual Diagnosis and Gender

Gender is also a factor in the specific patterns of observed co-morbidities. For example, the overall rates of abuse and dependence for most drugs tend to be higher among males than females, and males are more likely to suffer also from antisocial personality disorder. In contrast, women have higher rates of amphetamine dependence and higher rates of mood and anxiety disorders.
A particularly active area of co morbidity research involves the search for genes that might predispose individuals to develop both addiction and other mental illnesses, or to have a greater risk of a second disorder occurring after the first appears. It is estimated that 40-60 percent of an individual's vulnerability to addiction is attributable to genetics; most of this vulnerability arises from complex interactions among multiple genes and from genetic interactions with environmental influences. In some instances, a gene product may act directly, as when a protein influences how a person responds to a drug (e.g., whether the drug experience is pleasurable or not) or how long a drug remains in the body. But genes can also act indirectly by altering how an individual responds to stress or by increasing the likelihood of risk-taking and novelty-seeking behaviors, which could influence the development of both drug use disorders and other mental illnesses. Several regions of the human genome have been linked to increased risk of both, including associations with greater vulnerability to adolescent drug dependence and conduct disorders.
The rate of smoking in patients with schizophrenia has ranged as high as 90 percent.
Some areas of the brain are affected by both drug use disorders and other mental illnesses. For example, the circuits in the brain that use the neurotransmitter dopamine a chemical that carries messages from one neuron to another are typically affected by addictive substances and may also be involved in depression, schizophrenia, and other psychiatric disorders.

Dual Diagnosis and Antidepressants

Indeed, some antidepressants and essentially all anti psychotic medications target the regulation of dopamine in this system directly, whereas others may have indirect effects. Importantly, dopamine pathways have also been implicated in the way in which stress can increase vulnerability to drug addiction. Stress is also a known risk factor for a range of mental disorders and therefore provides one likely common neurobiological link between the disease processes of addiction and those of other mental disorders.

Principles of Effective Treatment

1. Addiction is a complex but treatable disease that affects brain function and behavior. Drugs of abuse alter the brain structure and function, resulting in changes that persist long after drug use has ceased. This may explain why drug abusers are at risk for relapse even after long periods of abstinence and despite the potentially devastating consequences.

2. No single treatment is appropriate for everyone. Treatment varies depending on the type of drug and the characteristics of the patients. Matching treatment settings, interventions, and services to an individual's particular problems and needs is critical to his or her ultimate success in returning to productive functioning in the family, workplace, and society.

3. Treatment needs to be readily available. Because drug-addicted individuals may be uncertain about entering treatment, taking advantage of available services the moment people are ready for treatment is critical. Potential patients can be lost if treatment is not immediately available or readily accessible. As with other chronic diseases, the earlier treatment is offered in the disease process, the greater the likelihood of positive outcomes.

4. Effective treatment attends to multiple needs of the individual, not just his or her drug abuse. To be effective, treatment must address the individual's drug abuse and any associated medical, psychological, social, vocational, and legal problems. It is also important that treatment be appropriate to the individual’s age, gender, ethnicity, and culture.

5. Remaining in treatment for an adequate period of time is critical. The appropriate duration for an individual depends on the type and degree of the patient's problems and needs. Research indicates that most addicted individuals need at least 3 months in treatment to significantly reduce or stop their drug use and that the best outcomes occur with longer durations of treatment. Recovery from drug addiction is a long-term process and frequently requires multiple episodes of treatment. As with other chronic illnesses, relapses to drug abuse can occur and should signal a need for treatment to be reinstated or adjusted. Because individuals often leave treatment prematurely, programs should include strategies to engage and keep patients in treatment.

6. Behavioral therapies, including individual, family, or group counseling,are the most commonly used forms of drug abuse treatment. Behavioral therapies vary in their focus and may involve addressing a patient's motivation to change, providing incentives for abstinence, building skills to resist drug use, replacing drug-using activities with constructive and rewarding activities, improving problem-solving skills, and facilitating better interpersonal relationships. Also, participation in group therapy and other peer support programs during and following treatment can help maintain abstinence.

7. Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies. For example, methadone, Buprenorphine, and naltrexone (including a new long-acting formulation) are effective in helping individuals addicted to heroin or other opioids stabilize their lives and reduce their illicit drug use. Acamprosate, disulfiram, and naltrexone are medications approved for treating alcohol dependence. For persons addicted to nicotine, a nicotine replacement product (available as patches, gum, lozenges, or nasal spray) or an oral medication (such as bupropion or varenicline) can be an effective component of treatment when part of a comprehensive behavioral treatment program.

8. An individual's treatment and services plan must be assessed continually and modified as necessary to ensure that it meets his or her changing needs. A patient may require varying combinations of services and treatment components during the course of treatment and recovery. In addition to counseling or psychotherapy, a patient may require medication, medical services, family therapy, parenting instruction, vocational rehabilitation, and/or social and legal services. For many patients, a continuing care approach provides the best results, with the treatment intensity varying according to a person's changing needs.

9. Many drug-addicted individuals also have other mental disorders. Because drug abuse and addiction, both of which are mental disorders, often co-occur with other mental illnesses, patients presenting with one condition should be assessed for the other(s). And when these problems co-occur, treatment should address both (or all), including the use of medications as appropriate.

10. Medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug abuse. Although medically assisted detoxification can safely manage the acute physical symptoms of withdrawal and can, for some, pave the way for effective long-term addiction treatment, detoxification alone is rarely sufficient to help addicted individuals achieve long-term abstinence. Thus, patients should be encouraged to continue drug treatment following detoxification. Motivational enhancement and incentive strategies, begun at initial patient intake, can improve treatment engagement.

11. Treatment does not need to be voluntary to be effective. Sanctions or enticements from family, employment settings, and/or the criminal justice system can significantly increase treatment entry, retention rates, and the ultimate success of drug treatment interventions.

12. Drug use during treatment must be monitored continuously, as lapses during treatment do occur. Knowing their drug use is being monitored can be a powerful incentive for patients and can help them withstand urges to use drugs. Monitoring also provides an early indication of a return to drug use, signaling a possible need to adjust an individual's treatment plan to better meet his or her needs.

13. Treatment programs should test patients for the presence of HIV/AIDS, hepatitis B and C, tuberculosis, and other infectious diseases as well as provide targeted risk-reduction counseling, linking patients to treatment if necessary. Typically, drug abuse treatment addresses some of the drug-related behaviors that put people at risk of infectious diseases. Targeted counseling focused on reducing infectious disease risk can help patients further reduce or avoid substance-related and other high-risk behaviors. Counseling can also help those who are already infected to manage their illness. Moreover, engaging in substance abuse treatment can facilitate adherence to other medical treatments. Substance abuse treatment facilities should provide on site, rapid HIV testing rather than referrals to off site testing. research shows that doing so increases the likelihood that patients will be tested and receive their test results. Treatment providers should also inform patients that highly active antiretroviral therapy (HAART) has proven effective in combating HIV, including among drug-abusing populations, and help link them to HIV treatment if they test positive.

ref: principles of addiction treatment NIDA

Other Resources for Drug Rehab Treatment Center Information

National Institute on Drug Abuse

American Medical Association - Alcohol & Drug Abuse

National Institute on Alcoholism

American Society of Addiction Medicine

Substance Abuse Mental Health Services Administration

More NIDA Resources

White House Drug Policy

California Drug Abuse Programs

USA Prescription Drug Help

Medline Plus

Family Help - Alanon

Drug Addiction Medline Plus

Narcotics Anonymous

SMART Recovery

What to Look for in a Dual Diagnosis Rehab Treatment Center

Alcoholics Anonymous