Dual Diagnosis Treatment Philosophies in Adolescents

Dual diagnosis, or co-occurring disorders, is the theory that the client gets better results when treatments for substance abuse and mental health disorders are integrated. High rates of both conditions support integration and cross-training of therapy professionals. Adolescents with dual diagnoses have specific concerns regarding parental consent and willingness to participate.

History

• Since the 1990s, diagnoses of mental health disorders and substance abuse issues have been common. In the past, treatment of one condition was administered independently of treatment for the other. For instance, a client seeking treatment for depression might get medication from one therapist and seek treatment for an addiction from another therapist. In other cases, clients seeking treatment for substance abuse might also be prescribed narcotics for other conditions. Records were not integrated.

Treatment Philosophy

• Treatment of youth is a priority based on brain development and capacity to change behaviors. According to data from Sharon Hunt, "The likelihood of adolescent substance use and dependence is strongly associated with younger age of onset, severity of emotional and behavioral problems, true across age and gender." The term "dual diagnosis" represents substance abuse and mental health issues appearing together in both adults and adolescents. Co-occurring disorders are so prevalent that professionals have changed the intake process to screen for both substance abuse and various types of anxiety, depression or learning disorders.

Integration of Treatment

• Treatment models for dual diagnosis are most successful when addressed with family counseling. Family inclusion can address any bias held toward mental health or substance abuse. Adolescents are often forced to come to treatment because of a legal or parental ultimatum.

  Treatment professionals know about the prevalence of dual diagnosis, but have not been successful in retaining clients, or supporting their clients along a continuum of care.

Adolescent Considerations

• These clients do not necessarily commit to the treatment because they view it as forced upon them. Often adolescents feel victimized in treatment. Many have not developed proper social skills, or the ability to conceptualize future goals.

Drug Therapy

• Drug therapy is difficult for substance-abuse counseling because it is replacing one use activity with another legal use. It has been effective when used for co-occurring disorders. Common drugs for dual diagnosis are methadone, naltrexone, and suboxone. These prescribed medications work best when approached with family psychotherapy, or the community reinforcement approach in counseling.