Dual Diagnosis

Dual Diagnosis

A person with dual diagnosis has both a psychological challenge and an addiction problem. These conditions occur together frequently. About half of the people who have one of these conditions will have the other one at some point in their lives. The interactions of the two conditions can worsen and exacerbate on another. Risk factors for both issues include genetics, stress and trauma. The relationship between the two seems to have a strong learning component. An individual may use drugs or alcohol to try to feel better temporarily, commonly referred to as self-medicating behavior.  

The most common co-occuring conditions with addiction are: 

Generalized Anxiety Disorder (GAD)             

GAD involves excessive worry and difficulty controlling the worry.  The worry can be associated with multiple physical symptoms. The anxiety, worry or physical symptoms may cause clinically significant distress or impairment in social, occupational or other important areas of functioning including addictive behaviors that are being used to help manage these symptoms. 

Panic Disorder 

Panic Disorder is the experience of panic attacks followed by ongoing concern and worry about having another panic attack and/or worry about the possible consequences of a panic attack.  The symptoms include rapid heartbeat, feeling like one is having a heart attack, difficulty breathing and feeling as if one may faint or pass out.  

Obsessive Compulsive Disorder

Obsessions are distressing and persistent thoughts that are associated with anxiety. Compulsions, on the other hand, are behaviors or actions that are designed to reduce the anxiety associated with the obsessive thought. 

Social Anxiety

Social anxiety is painful and it can interfere with social functioning, and relationships. Avoidance is the behavior most often associated with social anxiety. 

Depression/Mood Disorders 

Mood related symptoms include sadness, irritability, depression and anger. Many depressed individuals are also anxious and nervous. When experiencing depression thinking may be characterized by self criticism, negative predictions about the future and negative interpretations/ thinking about current events.

Post Traumatic Stress Disorder (PTSD)

Experiencing a traumatic event(s) can have a profound impact on our lives. If you have experienced a single or multiple traumatic events you may experience: Recurrent, involuntary, and intrusive distressing memories, flashbacks, and dreams of the traumatic event(s). Trauma can result in difficulty experiencing positive emotions such as happiness, joy, satisfaction or love. Trauma can also result in irritability and hypervigilance (increased alertness to danger and threat).  Concentration problems and sleep problems also occur frequently with PTSD. 

Impulse control (anger, gambling, kleptomania) 

ICDs have some clinical overlap with OCD although this relationship is not yet completely understood. Impulse control disorders are characterized by recurrent behaviors disproportionate to outside stressors and not better explained by another psychiatric diagnosis.

In the case of anger (intermittent explosive disorder) outbursts occur that can have legal and occupational difficulties.

Treatments that we offer for these co-occurring conditions

Acceptance and Commitment Therapy (ACT) is an empirically-based psychotherapy.  ACT is an extension of traditional cognitive behavior therapy techniques. ACT methods have been shown to help clients cope with a wide variety of clinical problems, including depression, anxiety, stress, substance abuse, and even psychotic symptoms. The general goal of ACT is to increase psychological flexibility. 

Cognitive Behavioral Therapy (CBT). Cognitive therapy is a form of psychotherapy that has been demonstrated to be very effective in the treatment of co-occurring conditions. Cognitive therapy is an active, structured, directive form of therapy that focuses on the thoughts, beliefs and behaviors that accompany psychological disorders. In cognitive therapy, the individual learns to identify, evaluate and change the thoughts, beliefs and behaviors. 

Eye Movement Desensitization and Reprocessing (EMDR) Therapy involves processing upsetting trauma-related memories, thoughts and feelings. EMDR asks people to pay attention to either a sound or a back and forth movement (Bilateral Stimulation) while thinking about the trauma memory (desensitization). EMDR has been found to be an effective treatment for PTSD, OCD anxiety disorders and addiction (DeTUR method). 

DeTUR™ targets the triggers that lead to urges desensitizing them, and reducing potential relapse. In achieving reprocessing, triggers no longer stimulate the need to use or act out, and the new response becomes the positive treatment goal of coping and functioning successfully in life.

DeTUR™ (Desensitization of Triggers and Urge Reprocessing) is an empirically supported method developed and refined by AJ Popky, Ph.D. DeTur integrates elements of cognitive-behavioral therapy (CBT), and the Alternative Information Processing (AIP) model of Eye Movement Desensitization Reprocessing Therapy (EMDR). Cognitive therapy (inter-weaves) are utilized during the bi-lateral stimulation of EMDR Therapy to rapidly process the desensitization of relapse triggers and accelerate the recovery and healing process. Unlike Standard EMDR where the focus is more on the clients past DeTUR is focused more on the present and future.

Successful results have been reported across the spectrum of addictions and dysfunctional behaviors: chemical substances (nicotine, marijuana, alcohol, methamphetamine, cocaine, crack, heroin/methadone, and others), eating disorders such as compulsive overeating, anorexia and bulimia, along with other behaviors such as sex, gambling, shoplifting, anger outbursts, and impulsive control disorders (such as trichotillomania and intermittent explosive disorder).