Posts tagged: dual diagnosis

“A physical sensation crawls up my arm as I avoid compulsions. But if I complete it, the world resets itself for a moment like everything will be just fine. But only for a moment.” —  Mardy M. Berlinger

Obsessive Compulsive Disorder (OCD) was briefly discussed in the previous blog written about Anxiety Disorder and Substance Abuse Disorders. In this blog, we are going to dive deeper into this type of anxiety disorder. We are going to further our understanding of OCD and the misconceptions on how the term is used in society. For example, you may have heard someone say something along the lines of, “I totally have OCD. I’m such a neat freak”. Phrases like these are not intended to insult those with OCD, rather they are used to relate to others and are an attempt to feel understood. However, as someone with OCD, I am offended and frustrated when I hear things like this. OCD is so much more than just wanting things to be in order.

So what exactly is OCD and how does it differentiate between those who like cleanliness and/or those who experience intrusive thoughts?

Many people prefer clean environments but it does not haunt their day or confine them to their homes. Intrusive thoughts happen to everyone and are quite normal. An intrusive thought is an unwelcome involuntary thought, image, or unpleasant idea. Most of the time we are able to brush them off and move on with our day. However, people with OCD are not and these thoughts ruminate and become obsessions. These normal behaviors or thoughts become impairments for those with OCD.

OCD is a type of anxiety disorder, characterized by reoccurring thoughts that cause distress, anxiety and fear and cannot be easily brushed off. Some people with OCD attempt to relieve themselves from these disturbing thoughts by performing compulsions. This type of anxiety disorder is chronic, lifelong and can be extremely destructive to one’s life and relationships.

There are five subtypes of OCD:

1. Contamination Obsessions with Washing/Cleaning Compulsions: Those with this type experience discomfort and excessively clean to avoid these anxiety provoking thoughts/fears of things being contaminated.
2. Harm Obsessions with Checking Compulsions: Those with this type have distressing thoughts related to harming yourself or others and using compulsions/rituals to relieve your anxiety. This does not mean that those with these thoughts want to harm themselves or others. It’s actually quite the opposite. For example, you may have fear of running someone over and therefore pull over every couple minutes to check under your car to make sure that no one is there or hurt.
3. Hoarding: This is a more commonly known type and has received media attention in shows like “Hoarding, Buried Alive”. This type actually has its own classification in the DSM. This type involves hoarding collecting numerous items that have limited value and eventually consume your living space. Hoarding is accompanied by a deep emotion attachment to these items and a fear of loosing these them. People with this type can obsessively collect anything from newspapers, old toys, to even trash and fecal matter.
4. Obsessions Without Visible Compulsions: This type is often invisible since there are not visible compulsions but is instead characterized by unwanted obsessions relating to sexual, religious, or aggressive themes. Invisible compulsions include mental rituals such as reciting certain words, counting in your head, and excessively praying. People with this type usually avoid triggers because the thoughts that surface are so disturbing.
5. Symmetry Obsessions with Ordering, Arranging and Counting Compulsions: People with this type feel a strong urge to rearrange things in a particular order that feels just right. People with this type usually exhibit perfectionism and will think or say things to themselves over and over again until it is performed “perfectly”.

There is also additional obsessive compulsive related disorders in the DSM: Skin Pricking Disorder, Hair-Pulling Disorder, Body Dysmorphic Disorder and OCD related disorders induced by a substance or another medical condition.

In most cases of OCD and in Substance Abuse Disorders, people feel helpless and controlled by their OCD and/or or their compulsions to use drugs and/or alcohol.

It is estimated that more than 25% of those who seek treatment for OCD also meet criteria for a Substance Abuse Disorder. Many times people with OCD will try to self medicate with alcohol or drugs to cope with the destructive and repetitive thoughts. And many times people with OCD and/or a Substance Abuse problem will try to hide their struggles.

Why is this dual diagnosis so dangerous?

1. People with OCD and Substance Abuse disorder are more likely to be jobless and living on unemployment/ disability.
2. Substance Abuse users with OCD are more likely to isolate themselves and be confined by their home.
3. Hospitalization is more likely to occur.
4. There is a higher risk of suicide for those suffering from both OCD and Substance Abuse Disorder.
5. There is an increased possibility of relapse.

What does treatment look like for those diagnosed with OCD and Substance Abuse Disorder?

More often than not, people with OCD and Substance Abuse Disorder will not seek treatment themselves, which makes the involvement of family and friends vital. Intervention might be required as the first step before one can start treatment.  The next step involves finding a treatment center that treats these dual diagnoses.

OCD may require treatment centers and professionals to personalize the treatment plan even more than normal. People with OCD may need shorter therapy sessions or may have anxiety in group therapy (a form of therapy used in Substance Abuse Disorder). However, these barriers make it impossible for recovery.

Treatment for OCD and Substance Abuse Disorder usually requires motivational interviewing (goal oriented and client focused counseling), cognitive behavioral therapy (negative thoughts are challenged to alter certain behaviors), group therapy, family counseling and education, and stress reducing therapies like meditation.

If you have or know anyone experiencing OCD and Substance Abuse Disorder, it may feel like a battle between two versions of yourself. But you don’t have to fight this battle alone or for long. Treatment and recovery is possible and everyone deserves to live a life with a healthy and integrated version of themselves.

It is helpful for those struggling with addiction to live in a structured sober environment.  The Last House Sober Living in Los Angeles California is a highly structured sober living and a great place for people with OCD to recover.

Dual Diagnosis Treatment

What is Dual Diagnosis

Dual diagnosis, aka co-occurring disorders, is a term used for individuals who struggle with both a mental disorder and alcohol or drug abuse. With dual diagnosis, either disorder can begin to appear first. People who struggle with a mental health condition will sometimes turn to drugs and/or alcohol as a form of self-medication. In turn, people who have an alcohol or drug dependency can worsen the effects of an underlying mental health condition.

If somebody is diagnosed with co-occurring disorders, they need to treat both conditions with each illness requiring a treatment plan of its own. If a treatment is going to be effective, the person needs to quit using alcohol or drugs. Finding the kind of integrated care necessary to overcome dual diagnosis can be challenging due to the completely different cultures of the mental health and substance recovery fields.

Symptoms of dual diagnosis are unique

The signs and symptoms of dual diagnosis will vary based on the type of mental disorder that is diagnosed and the drug of choice that accompanies it. To help you better understand, let’s say you know somebody who is struggling with alcohol abuse and bipolar disorder, the symptoms here will be different than those of an individual who is struggling with a heroin addiction and depression. The one thing that most dual diagnosis patients have in common is that they find it incredibly difficult to cope with their disorders and function on a day-to-day basis. Most often people with dual diagnosis struggle with:

• Unemployment or an inability to maintain a job
• Poverty
• Maintaining a functional relationship
• Chronic health complications
• Legal issues
• Mood swings and uncontrollable emotions

If you didn’t already know, your loved one’s personal struggles will make it nearly impossible to depend on them. They may have episodes during family gatherings, be unable to take care of themselves and hinder their family’s ability to live a normal life. When the drug problems and emotional issues of your loved one begin to affect other people in the family, it is time to seek out treatment.

How to Treat Dual Diagnosis?

Integrated intervention is one of the best ways to treat dual diagnosis effectively. Integrated intervention is when an individual is treated for both their mental illness and drug addiction. In the 1990’s, patients were refused to be treated for their mental illness until they were able to conquer their drinking problem. This way of thinking is outdated to say the least, and doctors know that to cure a patient, effectively, both issues need to be addressed.

You and your treatment provider should work together so you both understand how each condition affects the other and how to make the treatment as effective as possible. Everyone will need their own unique treatment plan, but here are some common methods used today:

Detoxification – Detox is one of the first major hurdles for somebody with dual diagnosis. As you might expect, inpatient detox is typically more effective than outpatient as far as safety and sobriety. When a patient goes the route of inpatient detox, they are monitored at all times by a trained staff member; this can last for up to seven days. In some cases, the staff member will attempt to wean a person off the substance by administering tapering amounts to lessen the impact of withdrawal.

Inpatient Rehab – Inpatient rehabilitation is often the best treatment for somebody experiencing a mental disorder and showing patterns of drug dependency. With inpatient rehabilitation, they can receive medical and mental health care around the clock. A good treatment center will provide medication, support and therapy to help treat an individual suffering from dual diagnosis.  Intensive Outpatient Programs can also be a very effective treatment for addiction.  Thrive Treatment is a IOP program with great ratings.

Sober Living – Essentially the same thing as a group home or sober house, a residential treatment center whose main objective is to help the newly sober avoid relapse. Since these homes are often not run by a licensed professional, the level of quality care will vary. Many of these homes have been criticized, so do your research before you choose one.  The Last House is a great example of a highly reviewed sober living that works.

Psychotherapy – This can be a big part of treating a dual diagnosis patient effectively. More specifically, cognitive behavioral therapy teaches people how to cope with and alter ineffective thinking patterns.

Self-help & Support Groups – The feeling of dual diagnosis is one that is challenging and isolating. In support groups, members can share frustrations and celebrate achievements. People with dual diagnosis can find others with the same affliction and receive referrals for specialists as well as recovery tips from peers. In a support group, everybody has the same goal: to get better. This kind of setting will provide individuals with a clean space that can support the growth of healthy relationships.

Receiving the treatment you or your loved one needs to cope with dual diagnosis can be difficult. Most rehabilitation facilities work with a variety of addictive behaviors, but don’t usually provide the necessary treatment for the underlying mental disorders. Traditionally, substance abuse and mental disorders have always been treated separately. Recently, addiction experts noticed the importance of integrating the treatment of substance abuse and mental disorders to form a single recovery program. The treatment of dual diagnosis should be its own discipline, combining components of substance abuse treatment with the best practices in psychiatric care.

If one of the two dual diagnosis disorders is left untreated, both will usually get worse. The combination of two separate disorders can lead to a poor response to treatments and an increased risk of other serious medical complications.

If you or a loved one is suffering from dual diagnosis, they’re not alone. Based on a national survey on drug use and health, more than eight-million people in the U.S. alone suffer from mental disorder and substance abuse simultaneously. Admitting that there is a problem is the first and most important step towards recovery. The next step is to get you or your loved one the quality care they need to get better.