Treatment of dual diagnoses and comorbidities
In psychiatric medicine, comorbidity refers to the presence of more than one mental disorder in a patient in a certain period of time with comorbidity not being limited to two disorders but to one (or several) mental disorder(s) and one (or several) disorder(s) caused by substance abuse. If one of the two is a substance-related disorder, this is often called a dual diagnosis, but mostly only if both disorders are found in one and the same year.
According to the German Council on Alcohol and Addiction(Fachverband Sucht)(2007), the following comorbidities were identified in particular in the context of the long-term treatment of alcohol-dependent patients:
- Anxiety disorder[/one_third]
9.4 % of Germans suffer from personality disorders. But much less will need treatment. Their number tends to decrease with age. Urban population and socially disadvantaged groups are affected more. The criteria are met, among others, by 30 to 40% of polyclinic patients and 40 to 50% of inpatients in psychiatric and psychosomatic hospitals. There is a strong specific correlation between cluster B personality disorders (anti-social, borderline, histrionic or narcissistic personality disorders) and alcohol/drug abuse or addiction. The same comorbidities are also known in the case of drug addiction and use of multiple substances.
We see that 33% of people with a disorder caused by substance abuse also suffer from a mental disorder. Thus, we recognize that persons with a mental disorder are generally at a much higher risks of developing substance abuse or vice versa. The risk of suffering from an additional substance abuse-related disorder is twice as high in the case of affective disorders (depression and/or manias) or anxiety disorders. Furthermore, the risk of developing an addictive disorder is five times higher in persons with schizophrenia and approximately 30 times higher in persons with a dissocial personality disorder.
In most cases, the mental disorder appears before the substance disorder. A substance disorder usually appears 5-10 years after a mental disorder. While personality disorders almost always and anxiety disorders in approximately 80% of cases manifest themselves before a substance disorder, there is a balance in the case of affective disorders. Independent of the type of addictive disorder, more than 35% of those affected by it suffer from at least one, 15% also of two comorbidities. When differentiating mental comorbidities, a depression is found in almost 21% of cases. In addition to the addictive disorder, depression goes along with an anxiety disorder in 6-10% of cases. In up to 4% of cases, a personality disorder occurs together with affective disorders. It is often not possible to differentiate whether a depression is substance-induced or constitutes a comorbidity.
As a matter of principle, dual-diagnosis patients (DDPs) receive counseling, therapy and rehabilitation offers that are tailored to their individual needs, combining, modifying and integrating effective interventions for mental and substance disorders . In view of the frequent lack of motivation in addicts that is also typical for DDP patients, treatment stages were developed that set in early, in some cases even before the actual therapy.
The treatment stages are as follows:
- Integrating the patient in a trusting therapeutic relationship (alliance for treatment and awareness of the need for treatment) in the analysis stage ;
- Helping the patient who is now integrated in a therapy to become motivated to accept a health-oriented psychiatric intervention (conviction and motivation to change)in the stabilization stage;
- Assisting the motivated patient to acquire personal abilities and obtain social support to control his disorders and pursue his goals (active treatment and change) in the problem management stage.
- Supporting the stable, remitting patient through relapse prevention and enabling the transfer of new competencies.
If integrated therapy offers are not available, as is often the case, this may result in a “ping-pong therapy” where patients are passed back and forth between the two approaches: addiction therapy and therapy of the mental disorder. The consequences are premature discontinuation of the therapy, insufficient therapy response, poor treatment results, high relapse rates, rehospitalizations with the corresponding subsequent costs creating a “revolving door” effect. Our therapy offer avoids this effect.
The key elements of a dual-diagnosis treatment with us are:
- Crisis intervention with withdrawal of the addictive substance on an inpatient basis, mental stabilization, diagnostic tests and indication for integrative therapy.
- The integrative therapy should include interventions for both disorders which are coordinated with regard to time and content and, ideally, take place in the context of a treatment program or with one and the same therapist.
- The therapies should be oriented towards the four treatment stages: analysis, stabilization, problem management and relapse prevention.
Our treatment concept consists of the initial detoxification, followed by a weaning stage aimed at reaching abstinence, supplemented by psychosomatic therapy offers, e.g. for the treatment of dual diagnoses. We don’t just treat the addiction and our structural options for a broad approach to a solution are abundant. Thereby, we create the prerequisites for treating patients who are not optimally accommodated in a psychosomatic hospital.
Please see below for more information on dual diagnoses treated at our center: