Dual Diagnosis and Coexisting Disorders

Overview:

One of the most difficult group of clients to assess are clients with substance use/abuse/dependence issues and additional mental health issues as well.  Often it is difficult to determine if the symptoms are the result of taking compounds or from some other cause.  For example, depressive disorders often appear similar to symptoms of alcoholism while manic disorders often mimic individuals who are taking stimulants.  Thus, assessments for substance abuse often include mental status exams or other techniques.  Often chemical addictions counselors without specific training or less than a master’s degree lack the knowledge and experience to work with dual diagnosed individuals.  Even then, counselors need to work closely with appropriately trained Clinical Psychologists and/or Psychiatrists.  Consequently, appropriate supervision and consultation is mandatory to work with this group of clients. 

In addition to working with clients, alcohol/drug abuse counselors will need to work with their colleagues in the mental health system.  Often counselors in both systems tend to disregard the other’s competency.  Consequently turf battles often result with the client getting caught in the middle.  Work with the dually diagnosed client requires a team approach, and each group has specific skills that can benefit the client.  Consequently, this instructor encourages addictions counselors to regularly meet for coffee, correspond, and develop working relationships with their mental health colleagues.  Working together ultimately helps both systems.

Goals:

To review general issues of dual diagnosis and common psychological disorders that co-occur with substance use.

Objectives:

To learn about issues related to dual diagnosis. 

To review some psychological disorders which occur with substance abuse.

Outcomes:

1. To identify specific psychological disorders that commonly occur with substance use/abuse.

2. To identify general mental health issues that commonly occur with a dually diagnosed client.

3. To understand that compound use often causes psychological symptoms or mimic psychological disorders.

4. To understand that compound use can often cause, exacerbate, or can mask psychological disorders..

5. To recognize that additional supervision is often necessary for working with dually diagnosed clients.

KSAs:

14.  Be familiar with medical and pharmaceutical resources in the treatment of addictive disease and other substance-related disorders.

15.     Understand the variety of insurance and health maintenance options available, and appreciate the importance of helping clients access those benefits.

21.     Understand the importance of ongoing supervision and continuing education in the delivery of services.

35.  Seek appropriate supervision and consultation.

Tasks:

1. Read Assessment and Treatment of Patients with Coexisting Mental Illness and Alcohol and Other Drug Abuse (TIPS Manual 9).  Pay special attention to the following sections:
   

• Chapter 3; the different philosophical approaches to treatment.

• Exhibit 3-1 and chapter 4 that addresses the different philosophies.

• Each of the different major disorders.

• Pharmacological management.
  

2. Identify one specific psychological disorder and write a paper describing how symptoms of this disorder might mimic substance abuse.  What are some symptoms you might see?  Where would you place a person with a psychological disorder in the DSM IV criteria?  Send this paper to your instructor’s e-mail address.

3. Finally, identify some psychological disorders you might see while being a substance abuse counselor.  What worries you about these types of clients?  Recognize whom you do not want to work with and educate yourself about clients with these types of diagnoses.  Share your thoughts with your classmates in the on-line discussion.

Discussion