Even with the advancements made in the subjects of biology, health, and to an extent mental health, society as a whole still has large strides to make when it comes to the treatment of psychiatric disorders, as well as addictive tendencies. The medical community has still not come to any viable conclusion as to the best treatment plan for either, and certainly not for both at the same time, especially when they fuel each other as in most cases in people with both problems. A dual-fronted approach, aimed at addressing both issues co morbidly is clearly the most effective and widely used treatment, yielding the best overall long-term results. However, there is also the paradox of handing substance abusers mind-altering drugs, as well as a few other issues.
First it is important to understand the reason psychiatric patients are generally very hard to treat. Though the neurotransmitters involved in mood and emotions are well-known to be GABA, noradrenaline, serotonin, and dopamine, these cannot be measured in any adequate way. For instance, if one has a heart attack due to high blood pressure, the underlying problem of high blood pressure can be monitored with a cuff and some mercury, and thus treated appropriately.
That being said, although no two people are exactly the same, humans are physiologically similar enough to establish a normal range in which said blood pressure should fall between. The problem with the brain is that although physiological similar as well, no “normal” range can be established for GABA, noradreneline, serotonin, or dopamine, because they cannot be measured. If a person were to have a portable CAT scan machine they lived under more may be understood, but this is just not possible.
Therefore, for people suspected of having, or diagnosed with, a psychiatric disorder, very often the severity, type, and treatment plan revolving around the disorder is judged in much the same way tornadoes are measured–by the carnage left behind. Unfortunately, this is not purely metaphorical. An incorrect diagnosis, and therefore the administering of incorrect medication, can have far-reaching implications themselves. For instance, treating a person with Bipolar Disorder with certain antidepressants has been shown to induce mania and worsen the condition of certain patients. Often patients bounce from diagnosis to diagnosis, and medication to medication, before any type of relief, if any, is obtained.
Therefore, the current preferred model of treating patients with psychiatric disorder is approached from both a cognitive and a pharmacological perspective, obviously depending on the severity of the patient when as they initially present. This concept stays true to the comfort of the patient, while promoting long-term relief more effectively.
In an ideal situation Psychologists and Clinical Social Workers, virtually synonymous in the modern mental health field, see a patient first. This therapist is then supposed to present an initial evaluation, generally more lengthy than other sessions to determine how to proceed. Obviously there are extreme situations involving psychosis or suicidal tendencies, but leaving them the exception, the therapist will either want to see the patient to continue to Cognitive Behavioral Therapy alone, or they will add a referral to a Pharmacologist, or a Psychiatrist, for an evaluation for medication.
There are some Psychiatrists that are not simply Pharmacologists, and do perform their own psychotherapy. Some patients choose to remain with their current therapist, while seeing a separate Psychiatrist for their medication prescriptions. Therapy models like CBT (cognitive behavioral therapy) as well as DBT (dialectical behavior therapy) are heavily utilized to help patients with dual-diagnosis psychiatric disorders. The point is the generally accepted best treatment for people with anxiety or depression, which are now seen as cyclical and co-dependant, as well as any other psychiatric disorder, is a combination of changes of cognitive thinking and medication. Unfortunately, although this looks wonderful on paper, medication in a broader sense can be a larger problem.
According to the National Alliance on Mental Illness citing the Journal of the American Medical Association, not only are 50% of people affected with major mental disorders are also affected by substance abuse problems, as well as the 53% of substance abusers that suffer from another psychiatric disorder. These figures are truly staggering when considering the prevalence of both in today’s society, and must be closely analyzed (NAMI, 2012).
There are many commonly abused drugs easily available to anyone looking. The use of alcohol is becoming thrust into the mainstream, illustrated simply by the cast of “The Today Show” constantly drinking wine at ten in the morning, and the use of marijuana is becoming more socially acceptable. Drugs such as cocaine, and its dirt cheap and potent equivalent crack, are fast acting and short-lived, adding to their extreme addictiveness. The streets are filled with illegal pills with a higher purity level than the heroin they were derived from. The point is that mind-altering substances are more readily available, cheaper in many cases, as well as highly addictive alternatives to seeking real psychiatric help, and often the stigma that accompanies it.
These substance abusers, which are in many cases self-medicating, are placed into rehabilitation programs that push treatment plans with little cognitive impact. Many of these programs rely heavily on what is known as the 12-Step model of addiction recovery. This model relies heavily on the addict finding a connection with a higher power, admitting their powerlessness over their addiction, turning their addiction over to their higher power, and seeking forgiveness for past wrong doings related to one’s drug or alcohol use. Through the program, addicts pair with other recovered addicts, attend meetings and follow twelve steps to spiritual, physical and mental health. The 12-step program is the staple for Alcoholics Anonymous and Narcotics Anonymous- support groups utilized by addicts both in and out of treatment to help them recover from their disease.
Another approach often utilized to treat addicts with addiction is known as the Recovery Model, or the recovery approach. Recovery is generally seen in this approach as a personal journey rather than a set outcome, and one that may involve developing hope, a secure base and sense of self, supportive relationships, empowerment, social inclusion, coping skills, and meaning. Although both the 12-Step recovery model and the Recovery Approach both rely on finding a deep and meaningful connection, there differences lie in where that strength can be found. Unlike the 12-Step model of recovery, the Recovery approach relies on fostering a positive sense of self, rather than a connection with a higher power.
The proverbial “Twelve-Step Program” as well as the Recovery model of treating addiction, though helpful for some, is not by any means a replacement for the true cognitive changes needed to address underlying issues. These detoxification and drug rehabilitation programs are extremely rigid in nature, and often do not accommodate people of alternate belief systems. The major things they do not do, however, is treat the underlying cause of the substance abuse, often rooted in mental illness.
In the article “Treating Adolescents for Substance Abuse and Comorbid Psychiatric Disorders” from August of 2003 Dr. Paula Riggs makes the claim that adolescent drug-abusers often have psychological issues. Specific characteristics named include behavioral problems as well as environmental issues. Dr. Riggs states that these factors, important in development, are often stunted, which can result in a host of psychological issues, and thus substance abuse issues (Riggs, 2003).
Dr. Riggs cites specifically early developmental disorders such as Oppositional Defiance Disorder, Attention-Deficit Hyperactivity Disorder, or Learning Disabilities as psychological reasons for substance abuse. Placement in specialized classes, underdevelopment, or behavioral issues can isolate a child, or make them feel inferior to their peers. This is the direct application of early developmental issues and the onset, as well as the perpetuation of further substance abuse The article goes even further, citing early drug use as a possible reason for the onset of depression, anxiety, or ADHD (Riggs, 2003). This in many ways makes it not too far-fetched to conclude that psychiatric disorders and substance abuse are somewhat codependent.
Coming to this conclusion, it is only natural that the best way to approach substance abusers and psychiatric disorders is on a very thin line. The research seems to show an empirical correlation between the two, as well as the underlying reason for both–which can be codependent. Therefore approaching a patient with both issues, it is important to maintain a balance between different types of treatment.
Combining these treatment approaches, as with everything psychological, should be evaluated on a patient-to-patient basis for various reasons. If, for instance, a patient presents abusing alprazolam and has a history of anxiety, this patient is clearly attempting to medicate his or her own underlying issue, and perhaps a stronger, or longer acting, benzodiazepine should be employed. On the other hand, if the same patient presented with a long history of substance abuse issues, a less addictive alternative is probably a better choice. If the same patient presented with a habitual cocaine problem on the other hand, it is important to consider a diagnosis such as ADD or ADHD, and employment of safer psychostimulants.
This is why an accurate assessment of a patient is critical in the treatment particularly of substance abusers. There are many with addictions or psychological disorders that will manipulate their doctors to obtain the medicines they want. Therefore, a specific model called the Integrated Dual-Diagnosis Treatment (IDDT) is definitely the best course of action, as a co-morbid treatment model. The particular treatment model, as explained by the IDDT Clinical Guide from Foothills Behavioral Health Partners, includes a very healthy balance of formal cognitive behavioral modification and therapy, medication when appropriate, as well as the group support offered in many drug rehabilitation programs (IDDT, 2013).
A key component of the IDDT model is the support given in all aspects of a patients’ life, with the emphasis being on communication between the various channels of communication. This model also allows for a quick change in direction, and encourages the participation of the patient in his or her own treatment plan. This is particularly important when considering the comfort of a psychiatric patient is integral in their treatment, as well as a potential relapse into a former substance-abusing lifestyle. Motivation is also a very key part in the IDDT model—specifically keeping the patient motivated towards his or her own recovery through constant positive reinforcement. In addition, IDDT provides a long-term treatment program, which can make all the difference (IDDT, 2013).
A February article published by Fox News cited a recent scientific study that genetically linked ADHD, autism, Bipolar Disorder, and Schizophrenia. This is the first time DNA-evidence can be used to successfully link psychiatric disorders, and specifically to one gene responsible for “encoding calcium channels in the brain” (Fox, 2013). While this opens the possibility for new treatments in the future, and it shows promise in the field of Psychiatry, it provides no instant gratification. For the time being, the IDDT model remains superior in comorbidly treating patients with addiction issues as well as psychiatric ones.
“Five Major Psychiatric Disorders Share Common Genetic Link.” Fox News. FOX News Network, 28 Feb. 2013. Web. 05 June 2013. <http://www.foxnews.com/health/2013/02/28/five-major-psychiatric-disorders-share-common-genetic-link/>.
“Integrated Dual-Diagnosis Treatment (IDDT) Clinical Guidelines.” Foothills Behavioral Health Partners, n.d. Web. <http://www.fbhpartners.com/providers/pdfs/IDDT_Clinical_Guidelines.pdf>.
“NAMI – The National Alliance on Mental Illness.” NAMI. N.p., n.d. Web. 05 June 2013. <http://www.nami.org/Template.cfm?Section=By_Illness>.
Riggs, Paula D. “Abstract.” National Center for Biotechnology Information. U.S. National Library of Medicine, 22 Jan. 0006. Web. 05 June 2013. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851046/>.