Dual diagnosis aka Co-Occurring mental health conditions and substance abuse disorders affect nearly 14 million Americans each year. Of those only 19% receive the appropriate treatment for both conditions, with the vast majority bounced among different treatment systems and facilities that treat one of the conditions but not the other. Few treatment programs specialize in treating complex co- occurring or dual diagnosis disorders. Nationally, research continues to reveal that people with co-occurring or dual diagnosis disorders need a specialized form of treatment, referred to as integrated services.

Treatment systems for mental health and addiction have historically been and will continue to be separated systems of care. While many research studies have been performed on mental health issues and addictions separately, it has only been within recent years that a few studies have emerged on people who struggle with both conditions in unison. This emerging research identifies that traditional separated systems of care not only alienate the patient from the treatment, but they also result in much poorer outcomes than those experienced by patients with single disorders.

According to researchers and ever more surprising, we are just now learning from these studies that treatment programs designed to treat a specific disorder only are actually only capable of treating the minority of those in need where, in fact, up to 65.5% of patients with a substance abuse disorder had at least one mental disorder as well and 51% of patients with a mental disorder had at least one substance abuse disorder. We are also learning that these poorer outcomes result as much from these separate and contradictory systems of care as from the diagnoses themselves with people who have co-occurring conditions comprising the majority of the 10 percent of people using over 70 percent of the country’s healthcare resources

Alcoholism and drug addiction is a family disease. It’s estimated that for every person suffering from alcoholism or drug addiction, another seven people are affected.

Trying to help a loved one get sober can be emotionally draining and lead to issues of co-dependency and control. Attempting to regulate drinking or drug usage can end up consuming large amounts of time and money with little result. Negative consequences that pull the family into continuing chaos can include tremendous emotional stress, economic strain, poor health and run-ins with the law that result in legal fees and complications. It can be a confusing and extremely disruptive environment if you live with an alcoholic or drug addict.

Family dynamics can be a major contributing factor in both addiction and recovery. For the individual to be successful in transitioning from addiction to recovery, it’s necessary for family dynamics to change as well. Drug addiction treatment centers helps to educate and assist families in making this transition. Some of the questions to consider include:

1.    What is the family history? Is there a history of alcohol or drug abuse? Is there emotional trauma or issues of abuse that may have occurred? Choose a treatment center who work with clients that have underlying issues associated with alcohol or drug abuse. Uncovering these issues and addressing them with family members will help repair issues that may be contributing to alcohol or drug abuse as well as unhealthy patterns.

2.    Denial is a major symptom of alcohol and drug abuse not only for the individual, but also family members. Sweeping it under the rug or downplaying the amount of alcohol or drugs consumed and the consequences involved can be a result of fear, an inability to want to face reality. But denial only postpones the inevitable – things can and will get worse.

3.    Denial is also a form of enabling. Enabling a family member to continue using alcohol or drugs in spite of negative consequences can sometimes look like love. Calling in sick to work for a loved one, making excuses for his or her behavior or going to the store for more alcohol to minimize withdrawal symptoms are all forms of enabling. This is a trait of co-dependent behavior and a very normal coping mechanism that family members engage. The fear that your child or loved one will die if you don’t cover for them or keep them at home where you can watch them is a valid one but nonetheless can assist in helping the alcoholic or addict continue to engage in destructive behavior. Your loved one may be safe momentarily, but until alcoholism or drug addiction has been arrested it’s only a matter of time before the bottom falls out.

The social model of alcohol and drug recovery in California has evolved through several generations to what we know as today’s model. Social model programs emphasize the process of learning through ‘‘doing’’ and ‘‘experiencing’’ and providing positive role models. Social model programs are cost effective and outcome effective because of their ability to build strong and lasting social support systems.

The roots of modern social model are in the mutual self-help concepts of Alcoholics Anonymous. Individuals
struggling with early sobriety often were temporarily homeless and in need of social support systems. members of Alcoholics Anonymous would often house newer members and act as guides by sharing their own experiences. Since Alcoholics Anonymous, according to its “Traditions,” could not be involved in support systems, it became a movement of its own. When public support began to flow into these recovery homes, they became more formalized with program standards and facility licensing.

An example of social model includes Recovery Homes, which are community-based, peer-group oriented, residential facilities that provide food, shelter, and recovery services in a supportive, non-drinking, drug-free environment. Services provided include individual and group recovery planning, alcohol and  drug recovery education, group support, recreational activities, assistance in obtaining health, social, vocational and other community services.

Typically, the home is cheerful, warm and accepting, and provides an environment in which the recovering alcoholic or addict has the opportunity to make a positive change in lifestyle with an alcohol- and drug-free environment and positive role models.

The major goal of a recovery home is to provide an environment in which men and women recovering from alcoholism and drug addiction will experience a sober, functioning lifestyle, and return to the community as a responsible drug-free individual.

A nonresidential Social Model Program is a community-based program that provides a sober supportive environment, offers services to persons with alcohol- or drug-related problems, and educates the surrounding
community concerning such problems in order to reduce alcohol- or drug-related problems including alcoholism or drug addiction.

Many people view drug abuse and addiction as strictly a social problem. Parents, teens, older adults, and other members of the community tend to characterize people who take drugs as morally weak or as having criminal tendencies. They believe that drug abusers and addicts should be able to stop taking drugs if they are willing to change their behavior.

These myths have not only stereotyped those with drug-related problems, but also their families, their communities, and the health care professionals who work with them. Drug abuse and addiction comprise a public health problem that affects many people and has wide-ranging social consequences. It is NIDA’s goal to help the public replace its myths and long-held mistaken beliefs about drug abuse and addiction with scientific evidence that addiction is a chronic, relapsing, and treatable disease.

Addiction does begin with drug abuse when an individual makes a conscious choice to use drugs, but addiction is not just “a lot of drug use.” Recent scientific research provides overwhelming evidence that not only do drugs interfere with normal brain functioning creating powerful feelings of pleasure, but they also have long-term effects on brain metabolism and activity. At some point, changes occur in the brain that can turn drug abuse into addiction, a chronic, relapsing illness. Those addicted to drugs suffer from a compulsive drug craving and usage and cannot quit by themselves. Treatment is necessary to end this compulsive behavior.

A variety of approaches are used in treatment programs to help patients deal with these cravings and possibly avoid drug relapse. NIDA research shows that addiction is clearly treatable. Through treatment that is tailored to individual needs, patients can learn to control their condition and live relatively normal lives.

drug rehab treatment can have a profound effect not only on drug abusers, but on society as a whole by significantly improving social and psychological functioning, decreasing related criminality and violence, and reducing the spread of AIDS. It can also dramatically reduce the costs to society of drug abuse.

Understanding drug abuse also helps in understanding how to prevent use in the first place. Results from NIDA-funded prevention research have shown that comprehensive prevention programs that involve the family, schools, communities, and the media are effective in reducing drug abuse. It is necessary to keep sending the message that it is better to not start at all than to enter rehabilitation if addiction occurs.

A tremendous opportunity exists to effectively change the ways in which the public understands drug abuse and addiction because of the wealth of scientific data. Overcoming misconceptions and replacing ideology with scientific knowledge is the best hope for bridging the “great disconnect” - the gap between the public perception of drug abuse and addiction and the scientific facts.

Some of children had mental issues and they were shunned, ignored. There was another general threat that dashed through the lives of Cho, Klebold and Harris. They were “outsiders”. They were quiet. They kept to themselves. They were “different” by the way they dressed and acted.

So why can’t people learn when such behavior might be the sign of simmering anger, resentment and a penchant for violence? We’ve already learned that many violent people begin by torturing and killing animals.

Near the end of his life, Cho only seemed to have one friend, and when he began acting in a way that made her nervous, she dropped him fast. Warnings about him from fellow students helped in her decision. It was just another negative event in his life.

Yet, his fellow dorm members seemed to accept him into their midst, despite his oddness. Cho, on the other hand, was content to isolate himself from the crowd – to be alone. This was his social anxiety disorder at work. It was his way of protecting himself from humiliation, embarrassment and stress. At this point, we don’t know what other mental illness he might have had, but schizophrenia has been tossed around lately.

Klebold and Harris had each other, to feed off each other’s anger and resentment, to plan their revenge on those who they believed had wronged them in some way. Together, they steered clear of their fellow students, opted out of team events and social gatherings.

Their peers saw them as odd, a duo who liked to dress in black, who avoided any close encounters with other students. They were loners who were isolated from the rest.

Mental Illness and Education

Could the other students have done more? Would it have helped if they better understood mental illness? Could they have made a difference by taking more interest in or an alternate approach to Cho, Klebold and Harris?

It’s understandable that the other students would not get close to them because their actions did not encourage friendship. It is also understandable why students would fear Cho and warn others about him.

It’s now revealed that Cho had several issues in his background that contributed to his mental illness. His parents believed he was autistic, yet he proved to be intelligent. He did not speak well. He was “different” because of his race. He was bullied. And who knows what else he had to deal with during his short life. What demons occupied his mind and where did they come from?

What home life did the three have? Was it a loving environment? Was it a negative or a positive one? Did it encourage open communication where the boys could discuss their concerns, their worries, their issues without fear of retribution or misunderstanding?

For decades, mental illness was a condition people avoided. If they had family members with a mental illness, they were shunned, hidden from society. They were an embarrassment.

Fortunately, much of that stigma has been removed, but there lingers a general fear of people with mental illness. The fear is mostly based on the lack of understanding and knowledge.

When we don’t grasp why a person is acting a certain way, they make us uncomfortable. We can’t help but wonder what’s going on in their minds. We ask ourselves whether that person just prefers to be alone or are they dangerous.

As teens who are looking to enjoy life, we tend to avoid situations that make us uncomfortable or nervous. We avoid people who ‘bring us down’, who are negative, sad, depressed, angry.

Mental illness is a convoluted subject with many theories. Even therapists and mental health researchers don’t know everything. They can’t tell whether a person will become violent, although they might have some inclination as to which conditions are more prone to it.

Despite all that we now know about mental illness, it’s hard to believe that we still know so little. Therapists study and practice for years before they fully understand all the ins and outs, how to differentiate one condition from another, and how to predict their actions. Clearly, the general public can’t be expected to understand as much as the professionals, but there is a level that they can reach.

In light of the increasing incidents of violence, schools are now working hard to figure out how to protect their students from another outbreak, but no one seems able to agree on the proper solution. They’re discussing such things as putting locks on classrooms and dorm buildings.

They’re implementing a better emergency alert system so they can let everyone know when there’s a problem. Part of that will include teaching the students what to do when it does happen.

But these are just Band-Aid solutions. The real solutions lie in spotting the problems before they escalate into violent behavior.

How do we do that?

We make people more aware of signs and symptoms that can indicate a student might need help. Set in place a confidential system for reporting concerns. Put together an investigation team (nurses, therapists and counselors) who have a thorough knowledge of such matters and can do a proper examination and take appropriate steps to find solutions for the individual.

Educate parents in teen behavior patterns so they can spot when their child is not acting normally. Teach them how to approach and respond to their children in a proactive way that does not alienate the teen.

Parents need to understand the development of teen growth – what they go through as they adapt to their new world as adults and leave behind their childhoods. In this method, they will be better able to identify when things have gone twisted and intervention is essential. There’s much to be educated about parenting, and mental illness and mental health is a large part that seems to be omitted.