Difficulties in Diagnosing and Treating Comorbidity
Uploaded by Jlagos on Oct 19, 2006
Difficulties in Diagnosing and Treating Comorbidity
By: Joseph L. Lagos
In order to understand the difficulties involved in treating dually diagnosed individuals, it is fundamentally important to recognize what this disease is, and how it has been approached by society.
The term “dual diagnosis”, (also known as “co-occurring disorders” or “comorbidity”), commonly refers to patients with both mental illness and substance abuse disorders. It has been estimated by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA), that 4 million people in the United States have a co-occurring serious mental illness and substance abuse problem. Furthermore, substance abuse is the number one co-occurring disorder among individuals with severe mental illness such as schizophrenia and bi-polar disease (Kranzler and Rounsaville, 1998). It is widely accepted that people with mental disorders are at greater risk of developing substance abuse problems than those without mental disorders (Springer, McNeece, and Arnold, 2003).
Comorbidity has had a significant impact on American society, with millions of tax dollars spent annually on incarceration and hospitalization. In many cases comorbidity results in homelessness, violence, and exposure to serious infections such as HIV and hepatitis. Dually diagnosed patients have poorer clinical outcomes than individuals with only one disorder, greater difficulty in gaining access to health services, and tend to leave treatment programs earlier than others (Hoff, Rosenheck, Sernyak, et al., 1999).
A contributing factor to the difficulties in treating the dually diagnosed can perhaps be found in the traditional treatment methods utilized. In the past, drug and alcohol treatment was carried out with intense and confrontational methods; designed to break down the patient’s denial; while treatment methods for the mentally ill, on the other hand, have been carried out in a benign, supportive and non-threatening manner.
Patients in drug treatment programs are expected to have some awareness of the problems caused by substance abuse, but the same cannot be said of individuals diagnosed with severe mental illness. Under the traditional approach, dually diagnosed individuals are likely to deny substance abuse, be unmotivated to engage in, or outright resist treatment and confrontation.
Treatment interventions have evolved in recent years, with the goal of providing non-judgmental acceptance of all symptoms and experiences related to both mental illness and substance disorders (Sciacca, 1997); but the influence of the War on Drugs has also evolved, emphasizing treatment within criminal justice system (Springer, McNeece, and Arnold, 2003). The impact of this “utilitarian policy”...