Effective Dual Diagnosis Treatment Approaches

This Article Discusses the Following:

• Definition of dual diagnosis and trauma-informed care
• Common types of trauma and how they impact recovery
• Effective dual diagnosis treatment approaches
• Different treatment settings for dual diagnosis
• Members and importance of a dual diagnosis treatment team
• How to address trauma in dual diagnosis treatment
• Educational support for teens undergoing dual-diagnosis treatment

Teen addiction and mental health relationship is closely intertwined and can have a significant impact on each other. Adolescence is a crucial stage of development, and during this time, teens are more susceptible to addiction and mental health issues due to various biological, psychological, and social factors. When you visit any good mental health professionals, psychiatrists, and addiction experts, for teenage behavioral problems, they will support effective dual diagnosis treatment approaches. This means they will consider both mental health disorders and substance abuse disorders when treating teens to ensure long-term recovery and improved mental health. They also use teen mental illness treatment approaches that enhance recovery outcomes, offer comprehensive care, and promote long-term well-being.

Key Healthcare, a US-trusted teen rehab center, discusses a few common strategies and interventions used in the dual-diagnosis treatment and how it has helped teens overcome co-occurring disorders for a long, healthy, and productive life.

Understanding Dual Diagnosis and Trauma-Informed Care

Teenagers with dual diagnosis have co-occurring disorders, i.e., a mental health disorder such as PTSD and a substance use disorder. It is estimated that roughly 50% of people with mental health disorders are likely to develop a substance use disorder and vice versa, a potentially lethal interaction. In treating dual disorder cases, mental health professionals mostly use a trauma-informed approach which we will discuss in detail as the article progresses. It is a treatment approach that assumes a high probability of trauma history in individuals and runs on the following core principles: choice, safety, collaboration, empowerment, and trustworthiness.

Co-Occurring Disorders and Their Treatment Approaches

Co-occurring disorders, also known as comorbidities, are mental health and teen substance use disorders with strong correlations. They require a dual diagnosis treatment approach for complete recovery. Some common combinations include:

Teen Substance Use Disorder (SUD) and Depression: Teen depression often coexists with substance abuse, as teens may turn to drugs or alcohol to cope with their depressive symptoms. Conversely, substance abuse can worsen depressive episodes, creating a harmful cycle.

SUD and Teen Anxiety Disorders: Teen anxiety disorders, such as generalized anxiety disorder, teen social anxiety disorder, or teen panic disorder, can be linked with substance use as a means of self-medicating to alleviate anxiety symptoms.

SUD and Post-Traumatic Stress Disorder (PTSD): PTSD in teens may resort to drugs or alcohol to numb the distressing memories and emotions associated with past traumatic experiences.

SUD and Bipolar Disorder: Teen bipolar disorder, characterized by mood swings between manic and depressive states, can be intertwined with substance abuse as adolescents may misuse substances during manic episodes or use them to cope with depressive episodes.

SUD and Schizophrenia: Substance abuse is common among individuals with schizophrenia, which can complicate the management of their mental health symptoms and affect their overall functioning.

SUD and Borderline Personality Disorder (BPD): Borderline personality disorder in teens is associated with emotional instability and impulsivity, making individuals more susceptible to substance misuse as a way to cope with intense emotions and self-destructive behaviors.

SUD and Attention-Deficit Hyperactivity Disorder (ADHD): ADHD in teens can lead to difficulties in attention and impulse control teens, increasing the risk of substance use as individuals may seek stimulant drugs to self-regulate.

SUD and Eating Disorders: Substance abuse can be linked with eating disorders in teens like anorexia nervosa, bulimia nervosa, or binge-eating disorder, with individuals using substances to manage body image issues or suppress appetite.

SUD and Obsessive-Compulsive Disorder (OCD): OCD in teenagers may co-occur with substance abuse as individuals may use drugs or alcohol to alleviate anxiety related to their obsessive thoughts and compulsive behaviors.

Dual Diagnosis Treatment Approaches

To treat patients with dual disorders, the treatment team develops a tailored addiction treatment plan consisting of behavioral and pharmacological therapies that can address both conditions. At Key Healthcare, we screen for co-occurring disorders to ensure teenagers get full and correct diagnoses. Screening also helps us develop the correct treatment regimens for teenagers admitted to our facilities. Three main approaches are used in dual diagnosis, i.e., integrated, parallel, and sequential treatment. Let’s explore them further.

Integrated Treatment

Integrated dual disorder treatment, popularly known as IDDT in medical circles, is the most common type of dual diagnosis treatment. It is an evidence-based approach combining mental health and substance abuse services to improve patients’ quality of life with co-occurring disorders.

In this type of treatment, a treatment service or provider uses different interventions (psychological, pharmacological, social, and educational) to meet the needs of patients and their families. Our integrated dual disorder treatment at Key Healthcare helps teenagers attain sobriety, manage symptoms and become more independent through several small, overlapping incremental changes.

Core Components

The main components of the integrated treatment approach include motivational interventions, a multidisciplinary team, stage-wise interventions, family psychoeducation, time-unlimited services, access to comprehensive services, assertive outreach, pharmacological treatment, group treatment, teenager drug rehab counseling, health promotion interventions, and secondary interventions targeting non-responders.

Effectiveness and Benefits

Studies have found that integrated treatment effectively increases motivation among patients with co-occurring disorders treatment. It can also reduce mental illness/ substance abuse relapse, incarcerations, arrests, high-cost services utilization, and service duplication.

Parallel Treatment

Unlike integrated treatment, the parallel treatment approach utilizes different providers to treat co-occurring disorders simultaneously. This means that one team treats the patient’s substance use disorder while another treats their mental health condition. Owing to this arrangement, treatment generally happens in different settings or service systems.

Benefits and Shortcomings of Parallel Treatment

Parallel treatment encourages a higher degree of thoroughness since treatment is conducted by different teams well-versed in their areas of expertise. However, the different teen treatment programs ( one for the mental health condition and another for substance use disorder) used in this approach may have different philosophies, confusing patients. Patients are also likely to receive different experiences depending on the engaged setting.

Sequential Treatment

As the name suggests, one disorder must first be resolved before a patient is treated for the other in sequential treatment—the healthcare team checks for the more acute condition when determining the disorder to be treated first. For example, a manic teenager with a prescription pill disorder must be stabilized before treatment, meaning the mania will be addressed first.

Benefits and Shortcomings of Sequential Treatment

Unlike the other treatment approaches, the more acute condition enjoys more thoroughness and attention in sequential treatment. However, patients are generally referred to a different team to address the second disorder, potentially reducing the chances of fully addressing the interrelationships between the co-occurring disorders.

Dual Diagnosis Treatment Settings

Dual-diagnosis treatment can be administered in inpatient or outpatient settings, bringing us to intensive outpatient, inpatient, and teen partial hospitalization programs.

Teen Residential Treatment

Teen residential treatment is an immersive approach requiring hospital or healthcare facility admission. Teenagers spend their day focusing on recovery without worrying about any external distractions. However, it is the most expensive dual diagnosis treatment setting (Worry not! You can pay via insurance) and offers less privacy to teenagers as they are monitored round-the-clock. They are also separated from their families.

Key Healthcare has a secured teen residential treatment program where adolescents with mental health and drug abuse disorders get round-the-clock support and care. It offers group and residential therapy, holistic recreation therapies (such as yoga and surf therapy), family-centered treatment, regular exercise/healthy diets, and academic support. We also have a teen extended care program where teenagers with co-occurring mental health and drug abuse disorders attend dual diagnosis treatment during the day and retire to sober facilities for the night.

Intensive Outpatient Program

A teen IOP program can help individuals struggling with mental health and addiction challenges. It offers more flexibility (for the teen and facility), personal responsibility (for teens), privacy, and access to community support networks. It may also be less expensive than inpatient treatment, granting teenagers more opportunities to practice what they learn. However, unlike inpatient treatment, your child will still be exposed to triggers as we cannot eliminate distractions once they are out of the treatment center and back home.

Our Key Healthcare intensive outpatient program offers teenagers a safe and supportive environment to help them advance their self-awareness, respect, and coping skills. They should expect at least nine hours of treatment for 4-12 weeks, depending on the gravity of the condition and their response to treatment.

Partial Hospitalization

This is one of the best options for teenagers with a dual diagnosis. It is more rigorous than the intensive outpatient program as, more often than not, it involves a multidisciplinary team. Teenagers can also live at home with their parents or make their own living arrangements. Adolescent partial hospitalization program at Key Healthcare offers teenagers a structured therapeutic environment where they can learn healthy coping skills. We also help adolescents with co-occurring disorders reintegrate into their families, society, and schools.

The Dual Diagnosis Treatment Team

Effective dual diagnosis treatment requires a multidisciplinary team, defined as a group of healthcare professionals from different professions/ departments working together to make the best treatment decisions and provide optimal support and care to a patient. Common dual diagnosis multidisciplinary team members include:

• Psychologists: These professionals study human behavior and processes related to how people think and feel. They administer therapy and counseling to teenagers with co-occurring disorders to reduce distress and help them manage psychological problems.
• Psychiatrists: Psychiatrists are medical doctors specializing in emotional and mental health. Their role in a multidisciplinary team is to diagnose and treat mental health issues. They may prescribe medications after diagnosis or administer talk-based therapies such as dialectical behavior or cognitive behavioral therapy for teenagers.
• Mental Health Nurses: The main role of a mental health nurse in a dual diagnosis treatment team is to liaise with psychiatrists and other team members to offer support and care to the patient. Other duties include assessing the mental health status of patients, administering medications (subject to doctor instructions), and participating in behavior modification programs and related activities.
• Social Workers: Social workers help people manage or cope with everyday problems. Common social worker roles in multidisciplinary teams include offering sound professional advice and direction, identifying teenagers’ goals, and creating plans to help reach them. For example, they can help patients in addiction recovery identify and manage triggers to prevent relapse or help teenagers with an anxiety disorder understand what causes their anxiety and how to manage uncomfortable situations.
• Counselors: Counselors help people manage personal problems through talk therapy and other non-medical interventions. They normally explain options, administer talk therapy and help teenagers set goals and take action.
• Peer Workers: Peer workers are trained mental health professionals with a history of mental health problems and recovery. They are included in dual disorder treatment groups because their work is based on shared responsibility, respect, and mutual agreement on the most helpful approach. They generally share their experience to let teenagers understand they are not alone. It’s been proven that peer work can improve independence, hope, and a sense of empowerment.
• Occupational Therapists: Occupational therapists help teenagers with co-occurring disorders participate in everyday life through behavioral modification and ability enhancement. They also help patients develop coping strategies, increase independence, and build confidence.

Importance of a Multidisciplinary Team

A multidisciplinary team comprises diverse professionals working together to benefit a particular patient. It ensures that teenagers receive comprehensive care and support tailored to their needs during dual diagnosis treatment. It also helps prevent errors in care delivery, keeping patients and their families relatively safe. Lastly, such teams promote efficient use of resources through preventative care approaches and increased productivity.

Tips for Working Effectively With the Treatment Team

You should advise your teenager to be as open as possible with the treatment team to obtain services tailored to their needs and preferences. Remind them that the treatment team’s members are interested in helping them recover from drug use and improve their mental health; therefore, they should not feel intimidated. They should also heed the team’s instructions and actively participate in treatment for better results.

Addressing Trauma in Dual Diagnosis Treatment

Common traumas most individuals experience include childhood, sexual, and combat trauma.

Childhood Trauma

Childhood trauma occurs when children experience overwhelming negative events such as abuse, neglect, violence, assault, bullying, or exploitation in their early years. Teenagers affected by this type of trauma generally show signs such as anxiety, anger, trust problems, flashbacks, nightmares, anger, and depressive symptoms. They may also be avoidant and engage in risky behaviors.

Severe cases of childhood trauma can alter a teenager’s brain structure and specific gene expressions. They may also numb themselves as a defense, making it difficult to access healing-related emotions later. Lastly, teenagers who use drugs to cope with childhood trauma mostly end up more disturbed by their addiction than what causes it.

Sexual Trauma

Sexual trauma results from forced or coerced subjection/exposure to inappropriate sexual behaviors, resulting in severe stress. Such behaviors can be verbal (e.g., threats of sexual acts and humiliation), physical (e.g., being sexually touched or grabbed without consent), or visual (forceful viewing of sexual acts or images). Common signs and symptoms of sexual trauma include changes in hygiene, sleep patterns, social behavior, school/work performance, and mood. It may also lead to poor concentration, substance experimentation, and risky behaviors.

If left untreated, this type of trauma can cause lasting negative effects on people’s health and general well-being. Teenagers with a sexual trauma history (who do not seek treatment) will likely develop mental health disorders, health problems, and chronic substance abuse in adulthood, heavily impacting recovery.

Combat Trauma

Combat PTSD occurs when people are exposed to traumatic events such as dreadful combat situations, handling human remains, and witnessing death and injury during a war. Common symptoms include anger outbursts, irritability, sleeping problems, depression, apathy, excessive worry, fear, fatigue, headaches, behavioral and personality changes, and loss of appetite. These symptoms may last 1-3 months for normal combat PTSD or more for chronic PTSD. Such traumatic memories generally dominate the victim’s minds, influencing their thoughts and behavioral patterns. They may also lead to other mental health conditions, such as anxiety, suicidality, and depression later in life.

Therefore learning about treatment for ptsd in teens is the first step in supporting teenagers through their trauma recovery process.

How Trauma Impacts Recovery

Trauma can make teenagers feel unsafe in their bodies and relationships with others, taking them longer to regain a sense of safety, especially in acute cases. The hippocampus, responsible for emotion and memory, also shrinks when someone experiences a traumatic event, leading to poor emotion processing needed for healing.

Incorporating Trauma-Informed Care in Dual Diagnosis Treatment

A trauma-informed care approach tries to understand what happened to the patient instead of fully focusing on what’s wrong with them. When treating a teenager with a trauma-related substance use disorder, the multidisciplinary team will try to picture their past and present lives to find ways of providing effective care and support.

This type of care aims to avoid re-traumatization actively, recognize the signs and symptoms of trauma, realize the trauma’s widespread impact, integrate trauma knowledge into policies, practices, and procedures, and understand recovery paths. It can help reduce high treatment-related costs and avoidable care and improve health outcomes, treatment adherence, and patient engagement.

Trauma-Informed Screening and Assessment in Dual Diagnosis Treatment

Trauma-informed screening and assessment are important tools in dual diagnosis treatment as they help providers identify treatment needs early enough and tailor their services to meet them. In trauma-based screening, the team determines the number of traumatic events witnessed by the teenager, their reactions to them, specific mental or behavioral health requirements, and whether the patient should undergo a detailed trauma-based mental health assessment.

A trauma-informed assessment seeks an in-depth understanding of the traumatic event’s timing, nature, effects, and severity. It also looks into possible functional impairment and existing trauma-related symptoms. The treatment team uses standardized measures, clinical interviews, and behavioral observations to understand the teenager’s symptom profile and trauma history.

Evidence-Based Trauma Therapies Used in Dual-Diagnosis Treatment

Cognitive Behavioral Therapy (CBT)

CBT allows teenagers with post-traumatic stress disorder to learn more about their condition, normalize their experience, and acquire coping skills for momentary distress relief. Our teen CBT at Key Healthcare incorporates several activities and techniques, such as journaling, behavioral experiments, cognitive restructuring, guided discovery, problem-solving, relaxation, and stress management, to help teenagers heal from traumatic events and experiences.

Prolonged Exposure Therapy (PET)

PET is a unique cognitive behavioral therapy that guides patients in gradually approaching trauma-related situations, feelings, and memories. It teaches them that such memories are not as dangerous as their minds make of them and do not have to be avoided.

Cognitive Processing Therapy (CPT)

CPT is a commonly used cognitive behavior therapy approach for trauma treatment. It teaches patients how to modify and challenge unhelpful trauma-related beliefs.

Self-Care and Coping Strategies for Trauma in Dual Diagnosis Treatment

Teenagers with substance use and trauma-related disorders should work on acquiring problem and emotion-based coping skills. Problem-based coping skills help manage stressful situations. They include better time management, problem-solving, and healthy boundaries establishment. Emotion-based coping skills offer a distraction when dealing with stressful situations. Examples include mindful meditation, journaling, forgiveness, and acceptance.

Effective Trauma-Informed Approaches for Teens in Dual Diagnosis Treatment

Teenagers with co-occurring substance abuse and post-traumatic stress disorders are more likely to self-medicate to “fix” their traumatic past and deal with the associated symptoms. Most justify their addiction, claiming it helps them achieve emotional and psychological stability, while in truth, it’s impossible to treat underlying psychological issues using drugs such as marijuana. Here are a few approaches that may help:

Eye Movement Desensitization and Reprocessing (EMDR)

EMDR is a unique type of psychotherapy that uses eye movements and bilateral stimulations to help patients safely and controllably process and reprocess traumatic memories and events. This treatment approach can weaken the negative emotions associated with a traumatic event, making disturbing memories less disabling.

Dialectical Behavioral Therapy(DBT)

DBT for teens was originally meant for suicidal mental health patients. However, it has become a major treatment approach for several mental health disorders. It can help minimize the symptoms of post-traumatic stress disorder by helping teenagers stay in the present moment through mindfulness.

Common DBT skills, such as distress tolerance and emotion regulation, can also improve adolescents’ responses to intrusive thoughts. At Key Healthcare, we administer this evidence-based therapy approach to help teenagers deal with difficult situations, manage their emotions and develop healthier coping skills.

Role of Family Therapy in Dual Diagnosis Treatment

Family therapy for teens is administered to family members to help them understand and resolve underlying problems within the family setting. Families get to explore the reasons behind teen distress, work on their communication skills and build healthier relationships. Here are a few ways it helps in dual diagnosis treatment:

• It helps families become more educated on dual diagnosis
• Families learn how to support and care for teenagers undergoing dual-diagnosis treatment
• It can keep teenagers in dual diagnosis treatment engaged and motivated throughout the entire process
• Families get to understand how dual diagnosis treatment works and what to expect afterward
• It eases feelings of stress, fear, anger, and confusion among family members, making them more supportive of teenagers in dual-diagnosis treatment
• Family members get to identify any undiagnosed mental health issues that may hinder effective family communication.

Dual Diagnosis Treatment and Educational Support for Teens

Let’s see how being diagnosed with co–occurring substance abuse and mental health disorders can affect a teenager’s education before discussing how to support them.

Impacts of Dual Diagnosis on a Teenager’s Education

Cognitive Issues

Most students with dual diagnosis develop an intellectual/developmental disability, popularly known as IDD. Common characteristics of IDD are adaptive behavior deficits and significant intellectual functioning impairment.

Behavioral Challenges

The existence of co-occurring mental health and substance abuse disorders can significantly affect a teenager’s behaviors, negatively impacting how they function across different settings.

Impaired executive functioning

Teenagers with co-occurring mental health and substance abuse disorders may struggle to focus, concentrate or regulate their emotions and behaviors. They may also get frustrated easily or overburdened by information.

Social Problems

Dual diagnosis can affect a student’s social functioning. Most students in this category have social skill deficits, making it hard for them to make friends. They also report feeling lonely and isolated.

Balancing Dual Diagnosis Treatment and School

Here is how you can help your teenager balance dual diagnosis treatment and school:

Taking them to a Treatment Centre With an Accredited Academic Program

Most treatment centers offer academic support to teenagers to help them stay on top of their schoolwork. We provide curriculum and credit recovery in our facilities through Mission Academy School. Our trained staff will also help your child navigate their studies.

Encouraging Them to Adopt Healthy Coping Mechanisms

Balancing schoolwork and dual diagnosis treatment can be extremely stressful. Encourage your child to find healthier ways of managing stress, such as meditation, exercise, yoga, talking to friends, bonding with a pet, getting enough sleep, and eating healthy balanced diets. We have included holistic therapies, exercise, and regular balanced diets in our teen residential treatment program, which offers dual diagnosis treatment too.

Help them Pick Their Friends Well and Learn to Be Firm With Their Boundaries

It’s easier for teenagers to get lost in peer pressure. Help your child choose new friends who will understand that their ‘no’ means ‘no’ and not influence them to try activities that may harm their treatment or recovery. Remind them that long-term recovery and improved mental health go hand in hand with excellent performance.

Importance of Support for Continuing Education and Career Goals Support in Dual Diagnosis Treatment

• Continued education and career support can help keep teenagers in dual diagnosis treatment and recovery distracted. Productive teenagers are less likely to pick up harmful habits.
• It allows teenagers to develop new skills and understand the world better, which can boost their mental and physical health.
• Teenagers who receive ongoing career goals and education support are often interested in recovery

Conclusion

Adolescents with co-occurring mental health and substance use disorders need tailored treatment approaches to address their needs. At Key Healthcare, we offer holistic care to teenagers through comprehensive and integrated treatment models that simultaneously target their mental health and drug use disorders. Feel free to contact us and let us help your child work towards long-term recovery and improved mental health.

 Frequently Asked Questions (FAQs)

What Are Alternative Therapies, and How Do They Help in Dual Diagnosis Treatment?

Alternative therapies, such as meditation, teen yoga therapy, ayurveda, reiki, hypnotherapy, and acupuncture, are non-medical treatment approaches. They offer a holistic approach to dual diagnosis treatment.

How Does Trauma-Informed Care Benefit Adolescent Development?

Trauma-informed care supports teenagers’ capacity to cope with different responses and trauma, positively impacting their development. It also leads to a reduction in adolescent behavioral problems and post-traumatic stress.

What Are the Warning Signs of Dual Diagnosis in Teenagers?

Common warning signs of co-occurring disorders in teenagers include taking drugs to feel normal, difficulty performing in school or participating in school-related activities, drug use to escape emotional distress, severe emotional highs and lows, sudden changes in friend groups, constant lying or stealing and regular engagement in risky behaviors.

How Can Families Support Their Teenagers in Dual-Diagnosis Treatment?

Families members can support teenagers in dual-diagnosis treatment by fully participating in their treatment (e.g., attending family therapy sessions with them), joining support groups such as Al-Anon and Ala Teen to learn more about care and support, helping them take up healthy coping habits and engaging in self-care (family members should not be engrossed in their teen’s treatment to the point of neglecting their well-being).

What is the Importance of a Holistic Approach in Dual Diagnosis Treatment?

A holistic approach treats the symptoms of co-occurring disorders and looks into their root causes through individualized treatment options. It considers vital elements in mental health and substance abuse recovery, such as environmental factors, the patient’s physical and mental health, spiritual views, and social relationships.

What is the Role of Nutrition in Dual Diagnosis Treatment?

Nutrition can help reduce certain mental health disorder symptoms. According to studies, regular consumption of diets containing whole, unprocessed foods can help reduce symptoms of anxiety and depression. Nutritional therapy can also help teenagers in dual diagnosis treatment understand their health condition better and learn practical self-care.