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Concurrent Disorder (Dual Diagnosis)

What are Concurrent Disorders (Dual Diagnosis)?

Hope Rehab Dual Diagnosis Depression

The term concurrent disorders – or dual diagnosis – refers to the combination of mental health and substance misuse issues. Examples of concurrent disorders include PTSD or clinical depression and alcohol addiction, ADHD and cocaine addiction, or Generalised Anxiety Disorder and Benzodiazepine dependency. It is often impossible to separate mental health and addiction because so many doctors misdiagnose addiction and confuse the symptoms. We know this because so many clients regain mental stability and normality once they address their addiction. Substance use is often regarded as “self-medicating” the symptoms of the emotional and mental disorders listed below:

Please Note: Hope successfully treats many clients with common mental health issues such as depression and anxiety, usually together with addiction. However Hope Rehab is not a substitute for a psychiatric unit and do not have a psychiatrist onsite. We know our program is ideal for clients suffering with many types of mental health issues. We work closely with the Doctors/Psychiatrists at the hospital opposite who provide all our detox and medication needs. All clients must undergo a formal psychological assessment with our team and need to be able to function safely in our community. The reason we are selective is to protect all clients from unnecessary disappointment and disruption. If you are in any doubt please double check with our admissions department.

It is common for people with Mental Health issues to turn to using addictive and illicit substances to improve coping abilities, feel better, or decrease and numb feelings. Some call it “putting out fires with gasoline”. The problem is that self-medicating may work at first, providing the person with relief from their restless brains. However, the pain and the problems are now burning out of control and the gasoline ultimately makes the problems worse.

How Frequently do Mental Health Issues Coexist with Substance Misuse?

While there are variations as to the degree that substance abuse and mental health disorders coexist depending on the mental health diagnosis or type of substance abuse someone is struggling with, the general rule is that it is more likely than not that both are present at the same time.

What is the Link between Mental Health and Substance Use Problems?

The link between mental health and substance use problems is manifold:

For example:

NOTE: Hope is not a substitute for a psychiatric unit, we do treat depression, anxiety and most personality disorders together with addiction. However, we do not treat patients with enduring paranoid schizophrenia, self-harm or TBI. Also Hope is not a specialist eating disorder clinic although our program is appropriate. For further clarification please speak to our admissions team.

It is therefore important to understand that Mental Health and substance problems interact with one another in multiple and complex ways, and these interactions changes both the course and the outcome of the problems individuals experience. In short, it’s complicated!

Why is it Important to Know about Concurrent Disorders?

Compared to an individual suffering from either an addiction OR a mental illness alone, individuals suffering from concurrent disorders are more likely to:

How are Concurrent Disorders assessed?

Given the complexity and multiple ways in which mental health and substance use problems interact, an assessment of such problems requires skill and time, and it is rarely complete or accurate if completed in one short session. Not surprisingly, individuals are often misdiagnosed and therefore at risk for receiving inadequate, unnecessary or insufficient treatment for their problems. A comprehensive assessment by a skilled clinician trained in the areas of mental health and substance use is therefore highly recommended. At Hope Rehab Center, we provide skilled care through our multidisciplinary team, and we often work in collaboration with clients’ physicians to guarantee best possible treatment outcomes for our residents.

A Word about Medication

Many individuals suffering from anxiety or depression enter rehab with prescribed medications, such as antidepressants for depression or anti-anxiety medication. All too often, residents are eager to stop taking such medication in an attempt to be completely ‘drug-free’. It is, however, very important to distinguish between medications prescribed by a medical professional for the treatment of a diagnosed mental health problem on the one hand, and illegal substances often taken excessively on the other hand. While the former often brings about mood stabilisation and increase levels of day to day functioning, illegal substances tend to have the opposite effect: they destabilise, make for unpredictable moods and behaviours, and interfere with individuals’ functioning in all areas of life.

While a desire to rely on non-pharmacological tools such as mindfulness and thought challenging to manage one’s moods is very much desirable, making changes to established medication regimes typically results in at least temporary instability and should, therefore, be carefully timed, planned and monitored. At Hope Rehab, we work in careful collaboration with residents’ prescribing physicians prior to considering making any changes to established medication regimes. Naturally, there are exceptions to this rule considering the potential for misuse or abuse of some prescription medications, most notably benzodiazepines, opiate medication and ADHD medications.

While these types of medications may alleviate suffering if taken as prescribed and for the general population, they are potentially dangerous in the hands of an addict. For these reasons, we at Hope Rehab suggest a planned gradual cessation of these types of medications, ideally prior to entry into treatment, or as part of early recovery.

Tim Hamilton & Pat Samples – The Twelve Steps and Concurrent Disorders

The most common types of mental health problems that people tend to experience with addiction would include:

How Concurrent Disorders are treated at Hope Rehab

As mentioned before: Misdiagnosis happens in some cases, as substance abuse and mental health conditions can be confused due to similar symptoms and consequences. This usually means that when the addiction is treated successfully the client stabilises.

At Hope Rehab, firstly we take away the drugs or alcohol and only allow safely prescribed medications. We provide individualised care – this means the treatment path you follow will be based on an assessment of your exact needs. Our team is experienced at working with clients who have a concurerent disorders.

The addiction treatmen program here at Hope Rehab Thailand includes a number of approaches that have a good track record for helping people with dual diagnosis:

Cognitive-Behavioural Therapy (CBT) is concerned with identifying and eliminating patterns of thinking that are holding you back in life. It can be effective in the treatment of a number of conditions such as depression, anxiety disorder, obsessive thoughts, and self-esteem issues. It is also a clinically proven way of dealing with addiction. Our CBT program will provide you with tools to help you set goals and achieve them.

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Mindfulness is a type of meditation practice that teaches you how to live in the present moment and experience your thoughts and feelings in a more objective way. It can be effective for managing depression, anxiety, and obsessive thinking, and it is an excellent tool for relapse prevention.

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Learning to live in the present moment also helps you develop emotional sobriety, and it can eventually lead to serenity. We use the Minnesota Model here at Hope Rehab because we’ve seen how effective the 12-step program can be to help our clients build a solid sobriety. This path can also work if you are dealing with a dual diagnosis. The way you experience your dual diagnosis is going to be unique to you, but our individualised approach to treatment means we almost certainly have a path that is going to work for you. Contact us now to find out more.

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After a successful treatment of the concurrent disorders and a recovery program to follow up, many sufferers find their symptoms subside, and life takes on a healthy direction.

Hope Medication Policy

Note: Please bring your doctor’s contact details with you so you and the Hope team can seek appropriate advice if necessary.

Prescribed Medications: Any long-term medications from your Doctor, are best to bring in a plentiful supply to cover you for up to 2 months minimum. Most clients extend longer than a month. We can source some meds from our local Doctor and Hospital.

Medication storage: All medication must be handed over to Hope staff on admission. We generally store all medication in our safe and dispense from the support office at structured times, whether prescribed by your doctor or ours. After a client settles in, we may decide to allow some meds or vitamins deemed harmless, to be taken to rooms and self-supervised.

Narcotic (intoxicants) medications (including pain meds and Benzodiazepines)

Some “mood-altering” drugs and medications (e.g. Xanax/Codeine) are not encouraged in the Hope therapeutic program, as we require all clients to be on a similar emotional level in the community. So, substitutes or careful reduction may be necessary and are effective and manageable. This may require consultation with your doctor or our local doctor. Please let your doctor know about our specific policy regarding this group of medications, as they may be willing to help change medications before you join us.

Anxiety and sleep medication

Beta blockers for enduring anxiety and natural sleep meds are allowed at Hope, so long as they are supervised. Simple and mild medications such as low dose ‘Seroquel’ for short periods can be highly effective in helping clients through difficulties in the early stages of our program. Our resident nurse or hospital doctor will screen anyone requiring such help. The team at Hope have valuable experience and training that we use to help our clients in accordance with accepted good practice.

General medication issues

Many clients arrive on anti-depressants and mood-stabilizers prescribed by their doctors. Clients often ask to stop these meds which is a healthy sign of commitment to recovery. However, Hope staff are not permitted to make these kinds of decisions. So we ask that before coming to Hope you contact the prescribing doctor to get his/her feedback and consent. We can also help you contact the doctor for advice once you have arrived. Family and people close to you may also provide a different perspective so may be consulted. You may additionally be asked to sign a waiver stating that you have taken appropriate advice and are making an informed decision with our support.

Psychiatric medications are very sensitive and must be properly adhered to for safety. We feel it would be irresponsible for Hope staff to allow clients to stop taking psychiatric drugs. If not carefully coordinated by the prescribing doctor, this could trigger unnecessary MH episodes. When making changes to medications, it may also be a good idea to get feedback from those people who are closest to you.

Please arrange to bring the correct supply of your regular medication. Some meds are not available in Thailand or are very expensive and timely to acquire. We suggest at least two months’ supply.

Standard detox (Heroin and Alcohol)

At Hope Rehab we follow common detox protocols for Alcohol and Heroin detoxes. We work together with doctors at our local hospital who provide Diazepam prescriptions for alcohol detox. We also work together with the Bangkok Methadone/Subutex program who provide the prescriptions covering opiate detox and reductions. Some clients bring their own detox medication from their country of origin. Staff at Hope are specially trained by the Royal College of General Practitioners UK to administer and coordinate standard detox programs. We aim to keep all clients safe and comfortable whilst withdrawing. You may be asked to take anti-seizure meds for a short period to ensure safety. For more information please check our detox page.

ADHD & ADD medication

Stimulants such as Adderall, Concerta, or Ritalin are not suited to the Hope community or program. These drugs are far from ideal for addicts as they pump up the human reward system. Some clients who are prescribed these meds have found it triggered their addiction and caused serious life problems so are keen to stop, which we support. Some clients wish to continue using these medications, so we ask them to reduce to a low dose. This is because we have noticed hyper-manic behavior and a lack of emotional connection with others. We suggest Strattera (non-stimulant) as an alternative appropriate ADHD medication. Please let your prescribing doctor know about our policy.

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