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Dual Diagnosis

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Dual diagnosis occurs when a person who is need of drug rehab or is already undergoing that or alcohol rehab is also discovered to be suffering from a mental or personality disorder, such as depression, bi-polar disorder, or schizophrenia. (Some health care professionals are also beginning to recognize post-traumatic stress disorder, or PTSD, as a mental or emotion problem. For this reason, they consider those who have PTSD as well as a drug or alcohol problem has falling into the category of dual diagnosis.)

When dual diagnosis exists, it can interfere greatly with addiction treatment. This is especially true if, for some reason, those conducting rehab programs are unaware that another condition besides addiction is present or if the person who has a dual diagnosis has not been taking the medication intended to treat the underlying problem as he should.

It may be helpful to include some symptoms of a mental or personality disorder. These can include, but not be limited to: unstable behavior, as is sometimes manifested in manic-depressive disorder; inability to maintain consistent personal and professional relationships; continuous feelings that abandonment is imminent (whether or not this is the case), and subsequent actions-whether proper or improper-to see that this does not happen. Other symptoms include impulsive or inappropriate behavior in other situations, threats of or attempts at suicide, anger management issues, and dissociative or withdrawing behavior.

If these symptoms are present, and it has not been noted that dual diagnosis exists, those providing addiction treatment can take action to have it determined if dual diagnosis is present and adjust rehab programs accordingly.

It is sometimes difficult for someone who is working with a dual diagnosis patient in drug rehab or alcohol rehab to determine which behaviors being manifested are caused by the mental or personality disorder, and which is caused by drug or alcohol abuse, or the withdrawal from substances of abuse. Many behaviors, such as extreme excitability, hyperactivity, lethargy, or sadness can be present both in mental illness as well as substance abuse.

Further, patients who have a dual diagnosis are often extremely hard to work with. They may be demanding, and may be able to cause feelings of discomfort or guilt in even highly trained therapists. They may be uncooperative, and may often misinterpret (either deliberately or innocently) ordinary statements made by a therapist, and start to feel rejected or hostile.

Many patients with dual diagnosis are often prone to hold the therapist up in their mind as having the solution to all their problems. When failure or setback occurs, as it often will in rehabilitation, they are quick to blame the therapist.

People may wonder why those with mental or personality disorders are more likely to abuse drugs or alcohol. The fact is that the substance being abused may actually alter a person's disorder symptoms. The substance of abuse may make a hyper person more mellow, or may "get rid of the voices in my head", or may even temporarily decrease or suspend the symptoms all together. This can be another factor when implementing addiction treatment. The patient may actually fear the symptoms returning if substance abuse is stopped, and must be assured that other steps will be taken to control the underlying mental or personality disorder.


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