No rehabilitation treatment works perfectly for everybody and in the case of dual diagnosis an individualized program of detox and psychotherapy can be the only solution. Rehab centers around the country which have been successful in treating addiction share the understanding that it takes time and patience to discern the connection between co-existing problems of mental illness and substance abuse.
Psychotherapy, which refers to the integration of psychological and medicinal support, has proven to be a particularly effective means of treating patients with a dual diagnosis. This isn’t to say that psychological counselling will always be effective: in fact, psychotherapy must continually be shaped by the patient’s needs and progress. Effective psychotherapy in a rehabilitation facility is characteristically individualized – that is, adapted to suit the emotional needs of the patient – longitudinal and flexible over time, non-confrontational and often includes an emphasis on a medicinal program alongside counselling.
When should psychotherapy begin?
The first stage of drug rehabilitation is detoxification, and this process can take a physical and mental toll on the individual. Long-term substance abuse alters the chemistry of the body and mind, and when individuals no longer have access to the substance their body undertakes the uncomfortable process of readjusting to normality. It is during this stage that medical treatment can help an individual to get through the worst of the detox. After detoxification the real ‘work’ can begin; professional psychologists will then attempt to understand the mental state of the individual, and whether their substance abuse could be related to an underlying mental disorder. This is not a quick and easy process as it takes a lot of work to encourage an individual to open up and remain honest. Similarly, the relationship between substance abuse and a mental disorder is difficult to discern: it isn’t always clear what the ‘primary’, or most potentially dangerous, problem is. Even when the primary problem has been diagnosed the psychological professional will then need to decide the best course of psychotherapy for the individual.
How does psychotherapy work?
If a patient has been given a dual diagnosis, then a psychologist will decide the best method with which to proceed. There are three variations of psychotherapy which can be chosen and undertaken by a psychologist: sequential, parallel, or integrated.
Sequential psychotherapy treats the most acute order first, before moving on to treat the less threatening problem. This model of psychotherapy is usually only used in extreme cases; for example, treating substance use may be of little value to a patient who is psychotic or mentally disturbed.
Parallel psychotherapy addresses each of the issues concurrently but in different settings; for example, the patient may attend the substance abuse program earlier in the week and visit the mental health center later on.
Integrated psychotherapy has proven to be the most effective means of treating addiction. The integrated approach treats both issues simultaneously and in the same setting. The integrated approach perceives substance abuse and mental illness as inextricable: it is not useful to separate the two or attempt to figure out which problem is causing which. A number of rehabilitation professionals claim that it’s very rare to have a patient with a substance abuse problem who does not have an underlying mental issue as well.
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