Co-occurring, or “dual diagnosis,” is a term frequently used in the mental health field but what does it really mean?
A client who is classified as having a co-occurring diagnosis is someone who is abusing drugs or alcohol and/or has a dependence on such substances, and also a mental health disorder (such as depression, anxiety, bipolar, etc.). The addiction often stems from a client using their drug of choice to cope with the symptoms of the mental disorder. For example, someone suffering from an anxiety disorder might use alcohol to calm his or her nerves.
Justin’s Struggle With Substance Abuse and Mental Health Issues
Justin is a 22-year-old student in his senior year at college He lives on campus. His grades are poor and it’s unlikely he will graduate on time. He’s irritable, angers easily and is having trouble concentrating. Justin’s been smoking weed and drinking excessively, due in part to peer pressure, but also to help him to cope with his anxiety. His advisor has referred him to the student-counseling center for evaluation.
How Is a Co-occuring Disorder Diagnosed?
Co-occurring diagnosis can sometimes be difficult for mental health professionals to diagnose – frequently the drug/alcohol abuse will mask the symptoms of the mental health disorder. However, there are some key patterns someone with co-occurring diagnosis may exhibit: (1) Mental health symptoms may worsen during treatment – the alcohol or drugs may help the client to feel better but prevent them from developing healthy coping skills; (2) the user may be resistant to treatment – while the client might discontinue substance abuse, they will find it hard to cope as the symptoms of the mental disorder become more prevalent.
How Do We Help Clients Struggling With Co-occurring Diagnosis?
Co-occurring diagnoses must be treated simultaneously in order to achieve successful results, beginning with the complete abstinence of all substances. The counselor will work with the client to develop a treatment plan that addresses both conditions; this is also called “integrated treatment.”
Features of treatment may include:
–Shared decision-making: the client will determine his/her goals and work directly with the counselor to develop a treatment plan.
–Long-term perspective: recovery varies for each person and everyone takes a different path. The process must be accepted as a lifelong journey.
–Multiple interventions: people with co-occurring diagnosis have different needs. Treatment needs to be individualized for the client.
–Relapse prevention: a plan needs to be established to help keep the client motivated in their treatment and prevent relapse.
Justin and His Journey to Getting Help
With his parents support and at the recommendation of the school counselor, Justin will enter an inpatient treatment facility for a minimum of five days to safely detox from alcohol. He will then attend an intensive outpatient group including individual counseling, three days a week, which will be supplemented with Alcoholics Anonymous meetings.
This integrated approach will address Justin’s addiction as well as his anxiety. Justin, his advisor, school counselor, and his treatment team will meet monthly to review his goals and progress. Eventually, Justin will transition to outpatient therapy. This treatment will support him in continuing his journey to staying sober and helping him to continue learning and apply coping skills to manage his anxiety.
Author: Carolyn Deck, LSW
Carolyn has experience working in both the mental health and substance abuse fields. She loves working with individuals and couples with relationship issues, dual diagnosis, and trauma. Her therapy is spending time at the beach.