Dual Diagnosis
Dual Diagnosis in substance misuse means having an addiction as well as a mental health disorder such as depression, generalised anxiety disorder, bipolar disorder, obsessive compulsive disorder, post-traumatic stress disorder, phobias, schizophrenia or personality disorders, to name a few.
How often do patients have dual diagnosis?
In such cases, it’s essential to treat both problems, not just one of them. A 14-28-day detox helps us remove the main addiction element and allows us to focus on relapse prevention and treatment of any mental health disorder through our outpatient programmes.
Finding the root cause of addiction is essential. It’s not just about a successful detox. The New Life Centre team are dedicated to making sure you have the best chance of being addiction-free now and in the future. Relapse Prevention is key.
Dual diagnosis may occur in up to 70% of all addiction including behavioural addictions such as gambling, sex or porn addiction. Treating both disorders is essential to recovery.
How does it work? (A hypothetical patient)
During an assessment, a patient with a heroin addiction might is also found to suffer from recurrent bouts of anxiety and depression over several years, with periods of abstinence from heroin. Multiple detoxes have been undertaken but relapse has unfortunately occurred within a few months. During our assessment, we find that there were flare-ups of mixed anxiety and depression which triggered some of the relapses.
Our patient underwent a successful 14-day detox with The New Life Centre and moved onto our Relapse Prevention programme, received a naltrexone implant and solution-focused & integrated talking therapies looking at triggers and behaviours linked with addiction. A mental health treatment plan was initiated using non-addictive medication, psychological therapies and lifestyle and self-help strategies to optimise wellbeing through support networks, diet, exercise, sleep and additional resources.
Services involved
Individual therapy is integral to dual diagnosis treatment because it can specifically address not only the issues surrounding someone’s substance misuse but also the symptoms, they experience because of their mental health disorder.
Relapse prevention and psycho education supports an individual to understand and therefore alter their behaviours.
When necessary after a careful assessment and exploration of all options, medication management is often part of dual diagnosis treatment. Medication may help treat symptoms of the mental health disorder, but only as part of a holistic treatment plan, which should aim to promote better outcomes for the addiction treatment programme.
What makes our dual diagnosis treatment different to others?
- Dual Diagnosis is a clear focus in the assessment
- One unified treatment team – often so-called ‘dual diagnosis’ services use separate teams and may not be led by a consultant psychiatrist for the mental health component
- Shorter and streamlined detox from primary substance – in the majority of cases, this can be completed in 14-28 days. Some other programmes can take weeks to detox patients, especially from opioids such as co-codamol, morphine, tramadol, heroin, methadone or buprenorphine. Drops out rates in long detoxes can be high and annual rates of abstinence can be low. Costs for some private programmes can be significantly higher.
- Simple aim for abstinence. There is no use of substitution therapy at The New Life Centre.
Who is involved in dual diagnosis treatment?
Our multi-disciplinary teams can draw upon:
Consultant psychiatrist, GPs with special interest in addiction and dual diagnosis, mental health nurses, psychological therapists and clinical support staff.
How effective is it?
97% success rates of completion of initial detox, prior to moving onto the consolidation and relapse prevention phase with treatment of co-existing mental health or chronic pain. For opioid patients using the BONDS protocols*, internal audit data shows that 67% of patients reported abstinence at 12 months1. Prior to the use of implants from 2006 onwards, published data for opioid patients shows a 51% abstinence at 12 months for those medical protocols (historic data was from those BONDS protocols used at Detox5, not The New Life Centre at Broughton).
*Outcome measures recorded at a time in previous years when Dr Amal Beaini was previously providing the BONDS protocols from the Detox5 service, not The New Life Centre at Broughton. We are very pleased to say that these BONDS medical protocols are now part of The New Life Centre at Broughton. Detox5(TM) has closed a few years ago. Abstinence data at 12 months did not include those patients who could not be contacted or lost to follow up.
REFERENCES
- Beaini AY, (2019). BONDS Protocol, history and audit data. Unpublished internal document.
- Beaini AY et al (2000, October). A compressed opiate detoxification regime with naltrexone maintenance: patient tolerance, risk assessment and abstinence rates. Addiction Biology, 1;5(4):451-62. doi:10.1111/j.1369-1600.2000.tb00215.x.
