What is Involved in a Dual Diagnosis Assessment Procedure?

Mental health disorders are often at the heart of addiction. People self-medicate to deal with emotional issues, which often sends them into a downward spiral. A dual diagnosis approach is necessary as it addresses both the addiction and the underlying disorder.

Before treatment begins, a mental health professional will typically conduct a dual diagnosis assessment. They will learn about a person’s mental and physical health history to ensure they use the right approach. This article reviews what that assessment involves.

What is Dual Diagnosis Treatment?

People often use drugs to self-medicate mental health conditions. Drugs and alcohol can temporarily relieve anxiety, depression, and other symptoms, but they do more harm than good in the long run. They disrupt brain chemistry, making it difficult to manage emotions and causing problems with work, relationships, and finances.

Dual diagnosis therapy gets to the heart of the problem. It addresses co-occurring disorders, those being the addiction and the underlying condition. The therapy deals with addiction at its root, leading to long-term recovery.

Various evidence-based therapies are used, such as cognitive behavioral therapy, dialectical behavioral therapy, and motivational enhancement therapy. But first, a medical professional will assess the client to determine the best approach.

What is a Dual Diagnosis Assessment?

A dual diagnosis assessment consists of the following steps:

Mental Health Assessment

• Safety First: The first step of the mental health assessment is to ensure safety. The clinic will want to confirm the patient is not a suicide risk or likely to self-harm. They will also assess withdrawal symptoms to ensure there aren’t complications that may require emergency services.

• General Assessment Process: Mental health screening tools and questionnaires are used to assess the client’s mental health symptoms. For example, a PHQ-9 or PHQ-2 may be used to identify and monitor depressive disorders. The Columbia Depression Scale is used to determine suicide risk.

• Psychological and Functional Assessment: During this part of the assessment, the client is asked about their family history and current living situation to determine how stressors may have contributed to mental health issues and drug abuse.

• Which Came First?: A crucial step in dual diagnosis, the doctor will want to assess whether the mental health issue caused the substance use disorder, or if it was the other way around.

Substance Abuse Assessment

Next, medical professionals will ask about the client’s substance use history. They will want to know:

• Which drugs were used?

• How often drugs were taken and the doses

• Previous attempts to stop using drugs- symptoms and outcomes

• The consequences of drug use, including legal, personal, and professional aspects

Physical Exam

A physical exam is essential because it helps doctors determine which medications can be administered if necessary. It can also guide other aspects of recovery, such as an exercise and diet routine. Additionally, some lab tests, such as blood tests, EEGs, and MRIs, can assess mental health.

Dual Diagnosis Outcome

When the comprehensive assessment is complete, the medical professional will offer a diagnosis of the mental health condition. Conditions that commonly co-occur with drug abuse include:

• Bipolar Disorder: This personality disorder is characterized by soaring highs and depressive lows. People affected typically cycle through these emotions for prolonged periods, leading to risky behaviors.

• Anxiety: While anxiety is a common emotion, it can be dangerous if the anxiety is out of proportion to the situation and symptoms are ongoing. For some, it can lead to racing thoughts, difficulty sleeping, panic attacks, muscle tension, and an inability to function.

• Depression: Depression is another emotion many of us experience, but it may be considered a disorder if it lasts for long periods of time, interferes with the person’s social life and activities, causes physical symptoms, or makes it difficult to function.

• Post-traumatic stress disorder (PTSD): This condition occurs in people who have experienced a traumatic incident at some point in their life, such as violence, war, or abuse. The individual will continue to relive the experience through flashbacks and nightmares. They may experience extreme anxiety and avoid places and people that remind them of the incident.

• Schizophrenia: This serious mental health disease causes a person’s thinking, emotions, and behavior to become out of touch with reality. Typical symptoms include hallucinations, delusions, and disorganized speech. A 2006 study reveals dual diagnosis yielded improvements in symptoms for 62.7% of schizophrenia patients based on 10-year outcomes.

• Obsessive-Compulsive Disorder: With this condition, people are obsessed with intrusive thoughts and engage in compulsive behaviors to try to control those thoughts. For example, they may be obsessed with germs and wash their hands in an exacting way to avoid them. However, thoughts and behaviors are not always directly connected.

• ADHD: People with ADHD have trouble concentrating and exhibit restless behavior that can interfere with learning and relationships.

Treatment Plan

Once a diagnosis is made, professional medical advice will be given regarding a treatment plan. Treatment commonly includes

Evidence-Based Therapies

Common evidence-based therapies utilized in mental health care include:

• Cognitive behavioral therapy (CBT) identifies and addresses negative thought processes to guide healthy behaviors

• Dialectic behavior therapy (DBT) is focused on emotional regulation

• Motivational Enhancement (ME) motivates a person to want to get better

• Contingency management (CM) rewards people for positive behavior, such as maintaining sobriety

• Family Therapy – Families are often brought into sessions to identify enabling and codependent behaviors that may contribute to substance use disorders and ensure they provide a healthy environment for their loved one.

• Group Therapy: Individuals share experiences, learning from one another, and understanding they are not alone

• Medical Assisted Therapy (MAT) may be used to control withdrawal symptoms and cravings and help with mood regulation on an ongoing basis. An NIH study reveals that a medicated approach yields high success rates in people with opioid disorders, with 68% detox success.

Holistic Therapies

These include:

• Mindfulness activities such as meditation, yoga, and deep breathing are beneficial to emotional regulation

• Art therapy increases mindfulness, takes one’s mind off drug use, and boosts self-esteem

• Massage may help with relaxation and reduce anxiety

• Acupuncture may also be relaxing and can help with pain and detoxification

• Animal therapy- animals can reduce depression and anxiety

Lifestyle Changes

• Diet and Exercise: A healthy routine increases accountability and self-esteem and reduces stress. A Columbia University Department of Psychiatry report reveals a 3-7% risk of addiction in exercisers as compared to a much higher risk in non-exercisers.

• Healthy Habits: Engaging in activities you enjoy can reduce boredom that leads to drug abuse

• Social Support: People in recovery should seek out other individuals who will support their journey and avoid those who may tempt them to use drugs.

The BNI Treatment Center Offers the Support You Require

BNI Treatment Center is a recommended choice for teen recovery. We take a dual-diagnosis approach, carefully assessing our patients to ensure an individualized treatment plan. Our specialized staff and academic support systems offer the ideal environment for young adults.

Contact us to learn more about what we offer.

FAQs

What does the clinical interview in a dual diagnosis assessment cover?

The clinical interview includes questions about family history, symptom onset and progression, substance use patterns, and severity of addiction.

What standardized tools are used?

Clinicians use several standardized tools in the assessment process, including:

• A structured clinical interview for a DSM diagnosis of mental disorders

• An Addiction Severity Index (ASI) to measure the severity of abuse

• Mental Health Screening Form III/Columbia Suicide Severity Scale: For mental health risks/ suicide assessment

• AC-Ok Screen: To identify substance and mental health issues

How long does a dual diagnosis assessment take?

An assessment may take 1-2 hours, with ongoing risk evaluation throughout the sessions.

Who conducts the assessment?

An assessment can be taken by psychiatrists, psychologists, addiction specialists, or counselors. Sometimes, a primary care doctor is brought in for the physical exam.

Is it safe and confidential?

Yes, in accordance with HIPAA, all information recorded during a dual diagnosis assessment is safe and confidential. The patient must sign a consent before results are shared between doctors in multidisciplinary teams.