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Difficulties in Diagnosing and Treating Comorbidity By: Joseph L. Lagos In order to understand the difficulties involved in treating dually diagnosed individuals, it is fundamentally important to recognize what this disease is, and how it has been approached by society. The term dual diagnosis, (also known as co-occurring disorders or comorbidity), commonly refers to patients with both mental illness and substance abuse disorders. It has been estimated by the U. S. Substance Abuse and Mental Health Services Administration (SAMHSA), that 4 million people in the United States have a co-occurring serious mental illness and substance abuse problem.
Furthermore, substance abuse is the number one co-occurring disorder among individuals with severe mental illness such as schizophrenia and bi-polar disease (Kranzler and Rounsaville, 1998). It is widely accepted that people with mental disorders are at greater risk of developing substance abuse problems than those without mental disorders (Springer, Mcneece, and Arnold, 2003). Comorbidity has had a significant impact on American society, with millions of tax dollars spent annually on incarceration and hospitalization. In many cases comorbidity results in homelessness, violence, and exposure to serious infections such as HIV and hepatitis. Dually diagnosed patients have poorer clinical outcomes than individuals with only one disorder, greater difficulty in gaining access to health services, and tend to leave treatment programs earlier than others (Hoff, Rosenheck, Sernyak, et al. , 1999). A contributing factor to the difficulties in treating the dually diagnosed can perhaps be found in the traditional treatment methods utilized.
In the past, drug and alcohol treatment was carried out with intense and confrontational methods; designed to break down the patients denial; while treatment methods for the mentally ill, on the other hand, have been carried out in a benign, supportive and non-threatening manner. Patients in drug treatment programs are expected to have some awareness of the problems caused by substance abuse, but the same cannot be said of individuals diagnosed with severe mental illness. Under the traditional approach, dually diagnosed individuals are likely to deny substance abuse, be unmotivated to engage in, or outright resist treatment and confrontation. Treatment interventions have evolved in recent years, with the goal of providing non-judgmental acceptance of all symptoms and experiences related to both mental illness and substance disorders (Sciacca, 1997); but the influence of the War on Drugs has also evolved, emphasizing treatment within criminal justice system (Springer, Mcneece, and Arnold, 2003). The impact of this utilitarian policy on the dually diagnosed drug offender and society is undeniable, it is estimated that: sixteen percent of people in jail have some degree of mental illness (Ditton, 1999), the cost to tax payers $ 1. 2 to 1. 8 billion per year in California alone (Izumi, Schiller & Hayward, 1996). In reply to staggering costs, some argue that many of mentally ill drug abusers would not be recognized as being mentally ill, unless placed in an environment where mandatory observation is required, such as prison or hospital; that of course is debatable.
Upon release from jail the individual may have lost housing and public benefits, have trouble following up on referrals to community based mental health treatment, or may simply be denied services by treatment centers; this, ultimately contributes to the high recidivism rate, ultimately translating to more expense for the taxpayers. Considering the daunting scope of the comorbidity issue, and the inflexible nature of the War on Drugs policy, it makes sense that appropriately-funded, condition-specific treatment must be woven into the criminal justice system and into communities, to derail the destructive cycle of comorbidity. References Ditton, P. (1999). Mental health and treatment status of inmates and probationers. Retreived September 28, 2006, from The Center on Juvenile and Criminal Justice Web site: web Hoff, R. A. , Rosenheck R.
A. , Sernyak M, et al. (1999). A comparison of VA to public sector mental health patients: The Connecticut outcomes study. Proceedings of the 1999 Annual Meeting of Veterans Affairs Health Services Research and Development. Izumi, L. , Schiller, M. , & Hayward, S. (1996).
Corrections, criminal justice and the mentally ill: Some observations about costs in California. Retreived September 26, 2006, from the Pacific Research Institute Web site: web Kranzler, H. R. & Rounsaville, B. J. (1998). Dual diagnosis and treatment: Substance abuse and comorbid medical and psychiatric disorders. New York: Marcel Dekker, Inc.
Leaver, J. (2006). Dual diagnosis. In The encyclopedia of mental disorders. Retrieved September 26, 2006, from web Sciacca, K. (1997). Removing barriers: Dual diagnosis and motivational interviewing.
Retrieved September 26, 2006, from web Springer, D. W. , Mcneece, C. A. , & Arnold, E. M. (2003). Substance abuse treatment for criminal offenders: An evidence-based guide for practitioners. Washington, DC: American Psychological Association Substance Abuse and Mental Health Services Administration. (2004). 4 million have co-occurring serious mental illness, substance abuse.
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Research essay sample on Difficulties In Diagnosing And Treating Comorbidity
