Doweiko (2015) defines a dual-diagnosis patient as one that has both a substance use disorder and a mental illness.

KL 200 word reply

Doweiko (2015) defines a dual-diagnosis patient as one that has both a substance use disorder and a mental illness. For many years the belief was a person would develop a mental disorder as a result of their substance abuse, however, evidence disproves that theory and it is important to treat both disorders. Four various models have attempted an explanation for dual-diagnosis, in which the first model suggests both disorders point to an undiscovered factor, the second suggests substances were used by mental illness patients to treat their disorders, the third suggests the substance use disorder will go away when the mental illness is treated, and the fourth suggests patients with a mental illness are more sensitive to the effects of drugs (Doweiko, 2015). The fourth theory does have some evidence to back it up. Within the United States, it is estimated that 4 million people have been dually diagnosed, however, the process of deinstitutionalization has caused my psychiatric facilities to close, and many physicians remain uneducated in dual-diagnosis (Doweiko, 2015).

Psychiatric disorders such as ADHD, depression, anxiety, eating disorders, dissociative disorders, OCD, and schizophrenia are all common within dual-diagnosis patients. An estimated 21% of patients who have depression have an alcohol use disorder, while 9% have a substance use disorder (Doweiko, 2015). Treating patients with both depression and an SUD costs five times more than treating a patient with just an SUD, and becomes complicated when the substances being used either increase the depression or mask the prescriptions being used to treat it (Doweiko, 2015). Similarly, diagnosing patients with both a substance use disorder and schizophrenia also proves to be a challenge. Approximately 40-50% of patients diagnosed with schizophrenia develop an SUD, and as such have a 460% higher chance of developing an SUD than the average person (Doweiko, 2015). Diagnosing a patient with an SUD and schizophrenia becomes difficult when the symptoms of the substance use become confused with the symptoms of the schizophrenia (Doweiko, 2015). Other disorders, such as eating disorders, are also common within dual-diagnosis patients. Alcohol is most commonly abused in patients with an eating disorder to suppress the appetite (Doweiko, 2015).

Dual-diagnosis patients become complicated in their treatment, as they are 8.1 times more likely to resist their treatment than the average person by refusing their medication, continuing their drug use, and taking medications that only enhance their desired effect (Doweiko, 2015). The stages of treatment for a dual-diagnosis patient includes establishing the client-counselor relationship, helping the client gain motivation for change, active treatment for both disorders, and relapse prevention (Doweiko, 2015). Within the addiction cycle, the person suffering from a dual-diagnosis can become more susceptible to the effects of the drugs being used as evidenced in the “super sensitivity” model (Doweiko, 2015). The problem with this, is the patient may begin with pain, seek relief through their substance of choice, become more susceptible to the substance because of their pre-existing psychiatric disorder, and relapse or cycle back through the addiction cycle to try and overcome their pain again. Simultaneously treating both disorders have had more success of reaching long-term abstinence rates, because this form of treatment helps to diagnose and control the psychiatric disorder without cutting out the substance use fully, and then being able to explain to the patient why it is important to abstain from using a substance (Doweiko, 2015). Relapse becomes a concern as the psychiatric disorder is controlled, because the substance can become more enticing, however, the therapist can reduce the harm done this way, through slowly helping the client abstain from the drug use after treating the psychiatric disorder (Doweiko, 2015).

When caring for dual-diagnosis patients, I think of the famous verse in Matthew, “Come to me, all you who are weary and burdened, and I will give you rest (11:28, NIV).” These particular patients are struggling with more than just one disorder and are undoubtedly weary and burdened. I think it is important for the Christian counselor or therapist to embody this principle of rest, where these clients can comes as they are and seek treatment and rest. The goal within therapy would be to diagnose both disorders and treat both disorders, but ultimately point them to Jesus who can give them the rest and the healing they are seeking, which causes them to continuously enter back into the addiction cycle.

DT 200 word reply

A person that suffers from a dual diagnosis is said to have a mental illness along with a substance abuse disorder also known as a SUD.  Studies show strong data that a person with a mental illness will also suffer from a substance abuse disorder.  The text talks about four possible models for a dual diagnosis conditions (Doweiko, 2015).   The first model suggests that the SUD and mental illness both reflect a common undiscovered factor. The second theory says that those that suffer from a mental illness will use self-medicating to cope with their illness.  The third theory says that SUD is secondary to the primary diagnosis of a mental illness and will resolve itself once the mental illness is controlled. There is limited research to support this theory.  The last model says that those with a mental illness are more prone to abuse drugs (Doweiko, 2015).

There is research strongly suggests that there is a relationship between a mental illness diagnosis and a  SUD.  The first disorder is ADHD.  According to the text ADHD deflects a dysfunction of the dopamine neurotransmission system of the medial forebrain region of the brain (Doweiko, 2015).  This is said to be the same activity that occurs in the brain of a person that uses cocaine.  Schizophrenia is the next disorder.  This illness has been proven to be difficult to prove the correlation between SUD and mental illness.  However, research has shown that patients with schizophrenia have a 460% higher chance of developing a SUD than the average person (Doweiko, 2015).

When looking at anxiety disorders many researchers feel that due to the disorder there is a higher chance that the patient will self-medicate and this is turn causes a dependence on substances that can be abuses.  Obsessive -Compulsive Disorder is the fourth most common psychiatric disorder found in the United States (Doweiko, 2015).  The percentage of patients that have OCD and concurrent SUD is disagreed upon by researchers.  Many patients that have OCD are more likely to be drawn to alcohol or benzodiazepines.

Depression affects approximately 15 million people in the United States.  The text defines depression as “the subject experience of profound sorrow, pain, hopelessness, and despair” (Doweiko, 2015).  Patients that experience depression have a higher chance of developing a SUD than those that do not have depression.  In relation to Posttraumatic Stress Disorder, research shows that there is a strong correlation between the disorder and SUD.  PTSD can be difficult for the health care professional to determine if the cause of the SUD is directly related to the mental illness due to the medications that treat PTSD can in turn cause a dependence on the drugs.

Treating dual- diagnosis patients can be difficult due to many of the clients do not have natural supports nor the tolerance for outside resources.  Many of the dual-diagnosis patients have a sense of denial about their illnesses known as free floating or interchangeable denial (Doweiko, 2015). The client must acknowledge their illness before it can be treated affectively.


Being a person that has a diagnosis of generalized anxiety disorder/depression and a family line of alcoholics I can say that by the grace of God I have not been the subject of a SUD.  I find myself depending on scripture for encouragement. The following scripture is one that I look to for reassurance that God loves me and that he understands my diagnosis better than me and that he looks deep in the heart of a person. Psalms 34:17-19 says, “When the righteous cry for help, the Lord hears and delivers them out of all their troubles.  The Lord is near to the brokenhearted and saves the crushed in spirit.

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