Treatment of Co-Occurring Disorders the Term Paper

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Clients attend multiple twelve-step meetings and participate in twelve-step work to gain freedom from alcohol and/or drug addiction. In addition, they participate in individual and group counseling in order to alleviate the depression and anxiety underlying the addiction ("Dual diagnosis...," 2006).

Happiness, in their opinion, is the cure for addictions. Giving and receiving love is the key to happiness. This concept is the main reason for Hope and Serenity's success in treating addiction by addressing the underlying cause of the problem. This simple word love that is as old as time itself, is so overused in today's society that it get's equated with sex, control, abuse, and so forth. Hope's dual diagnosis addiction treatment staff was hired first, for their ability to show love for others and secondly, for their qualifications as therapists (also extremely high). Love is the ability to understand and empathize with another human being and their problems.("Dual diagnosis," 2006).

Different Therapy - Detoxification

Another method of treatment at other treatment centers begins with an in-residence detoxification process that allows for stabilization under the care of a physician who specializes in addiction medicine. Whether the drug of choice is cocaine, alcohol, methamphetamines, marijuana, benzodiazepines, heroin, prescription medications, or club drugs, the process of those substances leaving your system is supervised by a physician. ("Dual diagnosis programs," n.d.).

Part of the same treatment program is a brief therapy aimed at helping individuals make significant changes in their lives and their relationships with others. By focusing on new ways of thinking, behaving and interacting with others and the world around them, clients develop the skills to live their lives differently. In Solution-Focused Therapy, personal recovery goals are identified and specific strategies for achieving those goals are developed ("Dual diagnosis programs," n.d.).

Horses...Really?

Others believe that Equine Therapy, which incorporates the use of horses, facilitates positive, long lasting behavior changes. As horses are incredibly intuitive creatures, interacting with them helps to build self-esteem and a connection with something outside ourselves. A horse's sensitivity to nonverbal stimulus gives them an amazing ability to read people and reflect our emotional states back to us. Horses have an incomparable understanding of the feelings and emotional stress that a person is going through. Therapy with the use of horses can often help individuals realize truths about themselves that they never would have found otherwise Dual Diagnosis programs," n.d.).

Review of Treatment Methods

The literature shows that, over the past several decades, treatment for co-occurring disorders has undergone a broad shift in approach, from treating substance abuse before providing mental health care to providing simultaneous treatment for each disorder, regardless of the status of the co-morbid condition. Many treatment recommendations are supported by a broad consensus.

However, despite this broad agreement, recommendations are often not specific enough to guide clinical care. Most recommendations with specificity are for acute pharmacotherapy, but even specific recommendations lag behind current clinical practice. Although the use of psychotropic medication for mental illness is encouraged, experts disagree as to whether it is necessary to wait for abstinence before beginning pharmacotherapy. (Watkins, Burnham, Pincus, & Nicholson, 2005).

In addition, most diagnosis-specific guidelines are silent as to whether the specific treatment recommendation applies to co-occurring disorders. Finally, empirical evidence is lacking for most recommendations. The authors conclude that the mental health and substance abuse treatment fields need to consider its research priorities and how to address the multitude of potential combinations of disorders (Watkins, et al., 2005).

Assumptions and General Findings of Treatments Offered

Recommendations in diagnosis specific guidelines do not specifically apply to persons with co-occurring disorders. Although most diagnosis specific guidelines contain a small section documenting the importance of co-occurring disorders, diagnosis specific guidelines are often silent as to whether the specific treatment recommendations apply to co-occurring disorders.

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Thus there is no evidence for important treatment questions such as how long psychotropic medication should continue once symptoms have remitted, whether and for how long maintenance treatment for substance use or mental disorders is recommended, and whether methadone is efficacious for individuals with opiate addiction who have co-occurring disorders.

In the absence of evidence, the presumption is that clinicians should use the same guidelines to treat persons with co-occurring disorders as they use to treat those with a single disorder (Watkins, et al., 2005).

Empirical evidence is lacking for most recommendations. Perhaps the most important issue revealed by our review is that empirical evidence is lacking for most recommendations. Of particular importance is the lack of evidence for the recommendation to treat patients with co-occurring disorders in integrated treatment settings, the need for specialist assessment, and the sequencing of substance abuse and mental health treatment (Watkins, et al., 2005).

Most recommendations are supported by expert opinion, and there are few randomized -- or even quasi-experimental -- designs. When empirical evidence exists, it is usually diagnosis and setting specific, yet the recommendations we found in conducting this review are framed in more general terms. In addition, many recommendations are not easily evaluated for efficacy, such as the recommendation that successful treatment programs be welcoming and accessible and convey an attitude of optimism and recovery (Watkins, et al., 2005).

Recommendations lag behind current practices. Most recommendations that have specificity are for acute pharmacotherapy, but even specific recommendations lag behind current clinical practice. Many studies have evaluated the use of tricyclic antidepressants for populations with co-occurring disorders; fewer studies have looked at the use of newer anti-depressants.

Yet tricyclics are rarely prescribed now that newer agents are available, so treatment recommendations concerning them are of little relevance.

Conclusions

The results of this review present several challenges and dilemmas. Patients who are seen in clinical practice commonly have multiple problems, yet the efficacy data we have almost always come from treatments of single illnesses. In the absence of data, good practice suggests that each illness should be treated with the most effective treatments for the single illness.

However, it would be useful to have more information about how standard treatment approaches should be modified for co-occurring disorders. Without efficacy data and performance measures, it is difficult for public and private payers to evaluate the appropriateness of treatments and hold agencies accountable for evidence- based care (Watkins, et al., 2005).

The enormous number of potential combinations of disorders means that it is unlikely that there will ever be efficacy data for most combinations of disorders. The mental health field needs to consider its research priorities and how to address the multitude of potential combinations. As a first step, we might consider research on treatments and illness combinations that are highly prevalent, or research on treatments with immediate clinical impact (Watkins, et (al., 2005).

Second, rather than evaluating single treatments or interventions, it may be most useful to evaluate "packages" of best practices that could be applied to a range of disorders. Finally, research related to treatment effects and the realities of implementation in community settings may have more relevance to clinicians and program administrators who are interested in informing clinical management decisions (Watkins, et al., 2005).

It is easy to see from this research that treatment for co-occurring disorders is far from simple, and is still in the "evolution" phase to discover effective and proven methods......

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