1. Module 7: Assignment 2 Review Paper –Power Point Presentation James A. Cox, Jr. Advanced General Psychology Psy-492 UB Dr. Brandy Goldston-Blount February 23, 2010 Argosy University

2. Who Are The Dual Diagnosed? Dual diagnosis occurs when someone has both an alcohol or drug problem as well as a mental disorder. These conditions frequently occur simultaneously. People with drug and alcohol problems tend to experience anxiety disorders, schizophrenia, depression, and personality disorders. If the mental problem occurs first, it can sometimes lead people to use alcohol or drugs that make them feel better in the short term. If the substance abuse occurs first, over time, it may lead to emotional and mental problems (Buggey, 2007). In order to get better, someone with a dual diagnosis must treat both conditions. First, the person must go for a period of time without using alcohol or drugs. This is called detoxification. The next step is rehabilitation for the substance problem and treatment for the mental disorder. This step might include medicines, support groups and talk therapy (Lindesmith, 1905-1991). Alcohol and drug abuse disorders constitute one of our society’s greatest health concerns. According to the 1999 National Household Survey on Drug Abuse, an estimated 14.8 million Americans are current users (used within the past 30 days) of illicit drugs such as sedative-hypnotics or barbiturates, opiates, hallucinogens and stimulants (SAMHSA, 2000). An estimated 3.6 million people met the diagnostic criteria for dependent on illicit drugs (SAMHSA, 2000). Alcoholism, or alcohol addiction, is a progressive disorder and afflicts approximately 8.2 million adults and youth in the United States (SAMHSA, 2000). Co-occurring mental health and substance abuse disorders are common. More than half (52 percent) the people surveyed who had ever been diagnosed with alcohol abuse or dependence had also experienced a mental disorder at some time in their lives. An even larger proportion (59 percent) of people with a history of other drug abuse or dependence also had experienced a mental disorder (Hood, 2005). Mental health problems often predate substance abuse problems by 4 to 6 years; alcohol or other drugs may be used as a form of self-medication to alleviate the symptoms of the mental disorder. In some cases, substance abuse precedes the development of mental health problems. (American Journal of Public Health | November 2003). For instance, anxiety and depression may be brought on as a response to stressors from broken relationships, lost employment, and other situations directly related to a drug-using lifestyle (Herscovitch, Ph.D. 1996). 2

3. The American Psychiatric Association The American Psychiatric Association strongly and unequivocally affirms its position that all substance-related disorders are diagnosable mental illnesses for which effective treatments are readily available. Furthermore, the American Psychiatric Association strongly opposes the exclusion of substance-related disorders from legislation or programs that pertain to parity of insurance coverage, access to healthcare services, and quality of care. Other chronic illnesses such as heart disease, diabetes, and asthma, among others, are not subject to the same restricted limits on access to and coverage of care as are substance-related disorders. The American Psychiatric Association considers such exclusion of substance-related disorder diagnoses and patients with these disorders as discriminatory and contrary to the scientific findings of the clinical, research, health economics and policy communities (Longshore, 1998). A model that integrates the treatment of patients with a dual diagnosis of psychosis and addiction has been developed on a general hospital psychiatric unit. The model emphasizes the parallels between the standard bio-psychosocial illness-and-rehabilitation model for treatment of serious psychiatric disorders and the 12-step disease-and-recovery model of Alcoholics Anonymous for treatment of addiction. Dual diagnosis patients are viewed as having two primary, chronic, biologic mental illnesses, each requiring specific treatment to stabilize acute symptoms and engage the patient in a recovery process. An integrated treatment program is described, as are the steps taken to alleviate psychiatric clinicians’ concerns about patient involvement in AA, and addiction clinicians’ discomfort with patients’ use of medication. (Narcotics Anonymous World Services, 1998). About one third of individuals with alcohol use disorders and one half of individuals with drug use disorders have a co-morbid psychiatric diagnosis (Lindesmith, 1905-1991).The dually diagnosed individuals seek treatment services more often. And have worse outcomes after treatment than individuals with only substance use disorders (Narcotics Anonymous World Services, 1998). Recently, general guidelines have been proposed for the treatment of dual diagnosis patients (Longshore, & Hsieh, 1998). Evaluations of inpatient programs based on these guidelines suggest that integrated treatment for substance abuse and dependence and psychiatric disorders is effective (Shaveson, 2001). However, in the current era of cost containment, most treatment programs for substance use disorders will not have the resources to create dual diagnosis specialty programs. Patients with substance use and psychiatric disorders will most likely receive treatment in primary programs for substance abuse and dependence. Thus, research on aspects of treatment for substance abuse and dependence that are particularly beneficial for dual diagnosis patients is important. A present study focuses on the yearly outcomes of patients with substance use disorder who had a co-morbid psychiatric disorder and participated in a naturalistic multisite study of Department of Veterans Affairs treatment programs for substance use disorders. 3

4. The overall goal is to examine a model of substance abuse The overall goal is to examine a model of substance abuse and dependence treatment outcomes for dual diagnosis patients that will highlight treatment factors related to enhanced post treatment functioning (Hood, 2005). A model of treatment factors associated with outcome in dual diagnosis patients clinicians who work with dual diagnosis patients emphasize several interrelated key factors in treatment. Contrary to traditional substance abuse or dependence treatment philosophy, dual diagnosis treatment experts recommend more liberal use of psychotropic medications in order to address psychiatric symptoms (Shaveson, 2001). In addition, they recommend encouraging patients’ active participation in program activities maintaining a well organized program structure and providing clear rules. Supportive approaches, rather than confrontation (Shaveson, 2001), and practical orientation in terms of working on future goals are seen as advantageous for dual diagnosis patients (Rabinoff, 2006). Intensive programs that offer treatment and counseling to address a variety of issues like substance use, psychiatric symptoms, housing issues, employment issues, and legal, family and medical problems are also recommended for these patients (Rabinoff, 2006). Clinicians focusing on treatment of dual diagnosis patients emphasize change on cognitive and behavioral factors assumed to underlie substance use. As for patients with primarily substance use disorders, changing cognitive factors, such as expectancies for substance use, have also been noted as important for dual diagnosis patients (2008). (The Brown University Digest Behavioral, 2008). Factors that are emphasized include patients’ skills in relapse prevention and involvement in 12-step programs (Narcotics Anonymous World Services, 1998). Programs with dual diagnosis treatment orientation, as outlined above, are considered to be more conducive to changing these cognitive and behavioral factors (Lockwood, Durante, Lawton & Paintin, 2008). Participation in services after discharge and continuing case management are also considered necessary components for successful treatment of dual diagnosis patients (Glenn, 2003). Dual diagnosis patients who attend more aftercare show a greater reduction in substance use and psychiatric symptoms, have lower readmission rates and increased functioning at work (Longshore, & Hsieh, 1998). 4

5. References: : Addiction Theory & Application, 27(11), 8. Retrieved from Academic Search Premier Database Lindesmith, Alfred Ray, 1905-1991. Addiction and opiates/Alfred R. Lindesmith. p.; cm. originally published: Chicago: Aldine, 1968. American Journal of Public Health | November 2003, Vol 93, No. 11 Buggey, T. (2007, summer). A Picture Is Worth.... Journal of Positive Behavior Interventions, 9(3), 151-158. (2008). ADDICTION Research Roundup. DATA: The Brown University Digest of Herscovitch, G.A. Ph.D. (1996). Cocaine the Drug and the Addiction. Gardner Press, nc. Longshore, D., & Hsieh, S. (1998). Drug Abuse Treatment and Risky Sex: Evidence for a Cumulative Treatment Effect? American Journal of Drug & Alcohol Abuse, 24(3), 439-451. Hood, Ernie. Environmental Health Perspectives, Dec2005, Vol. 113 Issue 12, pA 812, 3p, 3 color; (AN 19030621) Rabinoff, M. Dr, (2006). Ending The Tobacco Holocaust. (1sted). Author’s Publishing/Elite Books. Shaveson, L. (2001). Hooked Five Addicts Challenge our Misguided Drug Rehab’ System. The New Press, New York, 2001. Lockwood, M., Durante, L., Lawton, K., & Paintin, K. (2008). Reviews. Public Policy Research, 15(4), 229-232. Narcotics Anonymous World Services (1998). Narcotics Anonymous. (5thed). Narcotics Anonymous World Services Office- Canada. 150 Britannia Rd. E. Unit 21Mississauga, Ontario, L4Z 24A, Canada. Glenn, D. (2003). What To Do About Your Brain Injured Child (2nded). The Gentile Revolution Press, 2003. 5