Lesson 13: Co-occurring Disorders - Part 2 Attention Read and Reflect on this Article on Dual Diagnosis Learning Outcomes Upon completion of this lesson's material, students will be able
Teaching Stigma and Mental Illness "Mental Illnesses" have often been considered separately from Substance Use Disorders. This is probably more a reflection of psychiatric politics than empirical fact. There has been a long struggle to destigmatize mental illness which in the past had often been seen as a shameful problem and a reflection of a weak mind or defective character. A parallel process was taking place with alcohol and drug problems which had long been seen as primarily "sin" with the remedy being repentance and reform In the 1980's the "Broken Brain" model began to take over for anxiety, depression and other mental illnesses By the 1990's many mental illnesses were considered "biologically based", that is to say that the primary determinants were not behavioral or psychological or sociological but neurological Stigma and Alcohol A parallel process was taking place about the same time with issues related to alcohol being decriminalized so that people were asked to go to treatment rather than the drunk tank. Drugs continue to provoke more ire and judgement than alcohol perhaps because we have chosen by-in-large to make their possession and use criminal matters in contradistinction to alcohol (which actually causes more disability) In any case, the conclusion is that all mental disorders are biologically based with psychological, social, and spiritual dimensions and for purposes of understanding causes and treatment can be considered in the same ways beginning with an understanding of the neurological substrate but also including all other dimensions that are relevant to preventing and treating them Is it harder to treat "dual diagnosis" than single diagnosis?
The points made above are all part of the demystification of working with people with co-occurring disorders. We don't treat a person who is alcoholic and schizophrenic but rather the person struggling to live with these as well as other complex issues. Do we need special knowledge or special tools? Amazingly enough, "No!" What we need is to find out how the person views him/herself, his/her world and his/her issues and then to help them set their priorities based on what they want out of life. Most people when interviewed in an empathic affirming way will spontaneously affirm that they don't want to live with the consequences of untreated addiction and mental health problems. If they do not, we need to accept this and give them space while staying in touch. What often prevents us from doing this is the anxiety of friends, relatives, agencies, law enforcement, DHHS about how the person is behaving. And we can continue to work with all of these both as advocates for our client and as messengers to our clients for these often very legitimate concerns. Where special knowledge and special tools come in is as we explore with the client ways to address their concerns. At that point we need to know about medications and therapies and how co-occurring disorders affect one another. But what we do as MHRT/C's is simply to keep on applying the principles of psycho-social rehab whether we are dealing with a person who only has a mental illness or whether they also have a SUD or even a triple diagnosis with a developmental disorder. Click the graphic to visit Co-Occurring Disorders | SAMHSA Other professionals you can refer to:
Why has treating dual diagnosis traditionally been considered to be a specialty for "experts"?
Change from ineffective and unhappy and dysfunctional to effective, happy and doing well is the key.
The old "wisdom": therapy doesn't work for SMIs
The key is a Rehabilitation Approach
Assessment Lesson 13 Quiz
Lesson 13 Discussion Imagine that you are a person with a co-occurring SMI and SUD. Write a few paragraphs on 1) attitudes, 2) experience and 3) knowledge that you would want from an MHRT/C assigned to your case. What would make you talk to the worker's supervisor or ask to be assigned to a different worker? Remember, you mist post TWICE in EVERY discussion board. Your first post should address the topic of the discussion (like the one above) and your second post must be a reply to ANOTHER students' post...your reply should be MORE than just a "I agree!" or "Very cool!" It should be "substantive" by expanding on the students post, asking a questions, adding your own thoughts to what they have said, etc.
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