Integrated Treatment: Part 1

by Cindy Hardy | |  

What Is Integrated Treatment?

A person with any illness needs to learn as much as possible about that disorder. Education on psychiatric and substance use disorders is an essential part of the treatment process. It is not important to remember the specific facts of any lesson. Facts are simply statements of something that is real and can be verified or backed up. The goal is to gain an understanding of the illness. Understanding means a person is grasping the overall meaning of the facts. The goal of addressing addiction and mental illness is to provide education on the link between mental illness and addiction, as well as an overall understanding of the importance of an integrated treatment approach.

Why Is Integrated Treatment Necessary?

I believe we have two lives, the one we learn with and the one we live with after that.

- - Bernard Malamud

Mental illnesses are disorders that disrupt a person’s thinking, feeling, mood, and ability to relate to others. Just as diabetes is a disorder of the pancreas, mental illnesses are brain disorders that often result in a diminished capacity for coping with the ordinary demands of life. Substance use disorders include substance abuse and substance dependence. Substance abuse is a behavioral problem and substance dependence is a medical disorder of the brain. Substance abuse and dependence results in unhealthy patterns of alcohol and other drug use that lead to significant impairment and distress.

Substance disorders are linked with psychiatric or mental disorders and symptoms in ways that can include: masking or covering up of a mental illness, keeping a person from receiving proper treatment, mimicking or imitating a psychiatric disorder, worsening mental health disorders by increasing symptoms like mood swings, anxiety, paranoia, depression, unusual behavior, illogical thinking, hallucinations, and mental confusion, and complicating the treatment of psychiatric disorders by making treatment planning more difficult, reducing the effectiveness of medications, and preventing a person from developing coping strategies to manage a mental health disorder

It can be difficult to tell where a substance disorder stops and psychiatric disorder begins. How does a person know if depression is the result of substance abuse, substance withdrawal, or a diagnosable depressive disorder? How can a person tell if anxiety is the result of cocaine abuse or an anxiety disorder? How does a person recognize the difference between the mood swings caused from the abused of alcohol (a depressant) and cocaine (a stimulant) or a bipolar disorder? That’s right, it’s hard to tell the difference!

Only by reducing substance abuse or working towards abstinence does it become clear if the symptoms were caused by continued alcohol and another drug use. If mental health symptoms are still present after abstinence, it may be possible a person has a co-occurring psychiatric disorder, depending on the severity of the symptoms. Why mention the goal of abstinence early with individuals that may be in the pre-contemplation stages of change? The process of establishing the goal of abstinence is often a long and tortuous one; it should begin as early as possible. Identifying the goal of abstinence does not, of course, demand threatening those in recovery with rejection, demanding agreements, or exacting promises of compliance. It means explaining to those in recovery the value of abstinence and offering help to achieve it.

What Are Co-Occurring Disorders?

Co-occurring disorders or dual diagnosis is when a person has a mental health disorder and a substance use disorder. Each disorder is primary and independent of the other disorder. This means each disorder has a life of its own and is not dependent on the other disorder for its cause, continuation, or progression. Each disorder does not have an affect on the other in the disease process, as well as in the recovery process, in the same way other co-occurring medical illnesses affect each other like diabetes and heart disease.

This is the reason a dual diagnosis requires dual treatment. Long-term, simultaneous treatment of psychiatric disorders and substance disorders are necessary for success. Serious and Persistent Mental Illnesses (SPMI) like schizophrenia or mood disorders, as well as substance dependence, are medical disorders. At first that statement may sound strange, but it is important to begin to think of these illnesses as medical disorders.

First, it is true that these disorders are medical disorders of the brain. All organs of the body can experience a disorder, malfunction, imbalance, or deficiency that results in either a short or long-term illness. For example, pancreatitis is a medical disorder of the organ called the pancreas. A heart condition is the result of the malfunction of the heart. Diseases of the thyroid are caused by an imbalance in the thyroid gland. Diabetes result from a deficiency in the pancreases. Likewise, the brain is also an organ of the body and can be vulnerable to disorders, malfunctions, imbalances, or deficiencies. serious and persistent mental illnesses (SPMI) and substance dependence are also medical disorders of an organ of the body…the brain.

Second, it helps a person to understand they are not their illness. A disease, illness, or disorder does not define a person. A person with diabetes is a person first. The same is true for a medical disorder of the brain, whether it is a mental illness, addiction, or both. A person is still an individual with unique qualities and strengths. They are simply a person with a medical problem that needs treatment and a recovery plan.

Third, identifying these disorders as medical disorders leads to acceptance. It is not helpful for people to judge themselves for having a medical condition. This is true for all illnesses, but especially psychiatric and substance disorders. Judgmental thinking may be a caused by a mistaken weak character in the case of a psychiatric disorder or weak willpower in the case of substance dependence. Understanding that both disorders are medical disorders can lead to a non-judgmental acceptance. Acceptance can then pave the way for the willingness for integrated treatment for those who need it the most.

Check out Part 2 here.

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