Getting Both Barrels

Dual Diagnosis of Mental Illness and Substance Abuse

Drugs & booze are deadly

Dual diagnosis services are treatments for people who suffer from co-occurring disorders — mental illness and substance abuse. Research has strongly indicated that to recover fully, a consumer with co-occurring disorder needs treatment for both problems — focusing on one does not ensure the other will go away. Dual diagnosis services integrate assistance for each condition, helping people recover from both in one setting, at the same time.

Dual diagnosis services include different types of assistance that go beyond standard therapy or medication: assertive outreach, job and housing assistance, family counseling, even money and relationship management. The personalized treatment is viewed as long-term and can be begun at whatever stage of recovery the consumer is in. Positivity, hope and optimism are at the foundation of integrated treatment.

How often do people with severe mental illnesses also experience a co-occurring substance abuse problem?

There is a lack of information on the numbers of people with co-occurring disorders, but research has shown the disorders are very common. According to reports published in the Journal of the American Medical Association (JAMA):

  • Roughly 50 percent of individuals with severe mental disorders are affected by substance abuse.
  • Thirty-seven percent of alcohol abusers and 53 percent of drug abusers also have at least one serious mental illness.
  • Of all people diagnosed as mentally ill, 29 percent abuse either alcohol or drugs.

The best data available on the prevalence of co-occurring disorders are derived from two major surveys: the Epidemiologic Catchment Area (ECA) Survey (administered 1980-1984), and the National Comorbidity Survey (NCS), administered between 1990 and 1992.

Results of the NCS and the ECA Survey indicate high prevalence rates for co-occurring substance abuse disorders and mental disorders, as well as the increased risk for people with either a substance abuse disorder or mental disorder for developing a co-occurring disorder. For example, the NCS found that:

  • 42.7 percent of individuals with a 12-month addictive disorder had at least one 12-month mental disorder.
  • 14.7 percent of individuals with a 12-month mental disorder had at least one 12-month addictive disorder.

The ECA Survey found that individuals with severe mental disorders were at significant risk for developing a substance use disorder during their lifetime. Specifically:

  • 47 percent of individuals with schizophrenia also had a substance abuse disorder (more than four times as likely as the general population).
  • 61 percent of individuals with bipolar disorder also had a substance abuse disorder (more than five times as likely as the general population).

For the rest of this article, go to NAMIhttp://www.nami.org/Template.cfm?Section=By_Illness&Template=/TaggedPage/TaggedPageDisplay.cfm&TPLID=54&ContentID=23049

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Some Simple Facts

•The World Health Organization predicts that by 2020, mental illness will be the second leading cause of disability worldwide, after heart disease.

•Major mental disorders cost the nation at least $193 billion annually in lost earnings alone, according to a new study funded by the National Institutes of Health‘s National Institute of Mental Health (NIMH).

•When workers with depression were treated with prescription medicines medical costs declined by $882 per employee per year and absenteeism dropped by 9 days (Health Economics).

•Half of all lifetime cases of mental illness begin by age 14, three-quarters by age 24. Treating cases early could reduce enormous disability, before mental illnesses become more severe.

•One in four adults experiences a diagnosable mental disorder in any given year, including our returning troops. One in ten children has a serious mental or emotional disorder.

•Suicide is the third leading cause of death for America’s youth ages 15-24. More youth and young adults die from suicide than from cancer, heart disease, AIDS, birth defects, stroke, pneumonia, influenza, and chronic lung disease combined. The vast majority of those who die by suicide have a mental illness-often undiagnosed or untreated.

•Our jails and prisons are now the largest psychiatric wards in the nation, housing well over 350,000 inmates with serious mental illness compared to approximately 70,000 patients with serious mental illness in hospitals.

•One out of every five community hospital stays involves a primary or secondary diagnosis of mental illness.

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Source: NAMI.org

Tourette Syndrome: Know The Basics

“Dropping F Bombs”

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Tourette’s disorder, or Tourette syndrome

(TS) as it is frequently called, is a neurologic syndrome. The essential feature of Tourette’s are multiple tics that are sudden, rapid, recurrent, non-rhythmic, stereotypical, purposeless movements or vocalizations.

 
 What are the symptoms of Tourette syndrome?
 
  • Both multiple motor and one or more vocal tics are present at some time during the illness, although not necessarily simultaneously
  • Occurrence many times a day nearly every day or intermittently throughout a span of more than one year
  • Significant impairment or marked distress in social, occupational, or other important areas of functioning.
  • Onset before the age of 18.

 Symptoms can disappear for weeks or months at a time and severity waxes and wanes.

  

What are the first tics that may be characteristic of Tourette’s syndrome?

Usually, the facial tic, such as rapid blinking of the eyes or twitches of the mouth, may be the first indication a parent has that their child may have Tourette’s syndrome. Involuntary sounds, such as throat clearing and sniffing, or tics of the limbs may be an initial sign in other children.

  

Are any other symptoms associated with Tourette’s syndrome?

Approximately 50 percent of patients meet criteria for attention deficit hyperactivity disorder (ADHD) and this may be the more impairing problem. Approximately one-third of patients meet criteria for obsessive-compulsive disorder (OCD) or have other forms of anxiety. Learning disabilities are common as well as developmental stuttering. Social discomfort, self-consciousness and depressed mood frequently occur, especially as children reach adolescence.

 

Yelling and irrational

What causes these symptoms?

Although the cause has not been definitely established, there is considerable evidence that Tourette’s syndrome arises from abnormal metabolism of dopamine, a neurotransmitter. Other neurotransmitters may be involved.

 

Can Tourette’s syndrome be inherited?

Genetic studies indicate that Tourette’s syndrome is inherited as an autosomal dominant gene but different family members may have dissimilar symptoms. A parent has a 50 percent chance of passing the gene to one of his or her children. The range of symptomatology varies from multiple severe tics to very minor tics with varying degrees of attention deficit-disorder and OCD.

  

Are boys or girls more likely to have Tourette’s syndrome?

The sex of the child can influence the expression of the Tourette’s syndrome gene. Girls with the gene have a 70 percent chance of displaying symptoms, boys with the gene have a 99 percent chance of displaying symptoms. Ratios of boys with Tourette’s syndrome to girls with Tourette’s syndrome are 3:1. 

  

How is Tourette’s syndrome diagnosed?

No blood analysis, x-ray or other medical test exists to identify Tourette’s syndrome. Diagnosis is made by observing the signs or symptoms as described above. A doctor may wish to use a CAT scan, EEG, or other tests to rule out other ailments that could be confused with TS. Some medications cause tics, so it is important to inform the professional doing the assessment of any prescribed, over-the-counter, or street drugs to which the patient may have been exposed.

  

What are the benefits of seeking early treatment of Tourette syndrome symptoms?

When a child’s behavior is viewed as disruptive, frightening, or bizarre by peers, family, teachers, or friends, it provokes ridicule and rejection. Teachers and other children can feel threatened and exclude the child from activities or interpersonal relationships. A child’s socialization difficulties will increase as he reaches adolescence. Therefore, it is very important for the child’s self-esteem and emotional well-being that treatment be sought as early as possible.

  

What treatments are available for Tourette syndrome?

Not everyone is disabled by his or her symptoms, so medication may not be necessary. When symptoms interfere with functioning, medication can effectively improve attention span, decrease impulsivity, hyperactivity, tics, and obsessive-compulsive symptomatology. Relaxation techniques and behavior therapy may also be useful for tics, ADD symptoms, and OCD symptoms. 

  

How does Tourette syndrome affect the education of a child or adolescent with Tourette syndrome?

Tourette syndrome alone does not affect the IQ of a child. Many children who have Tourette syndrome, however, also have learning disabilities or attention deficits. Frequently, therefore, special education may be needed for a child with Tourette syndrome. Teachers should be given factual information about the disorder and, if learning difficulties appear, the child should be referred to the school system for assessment of other learning problems.

  

What is the course of Tourette syndrome?

Some people with Tourette syndrome show a marked improvement in their late teens or early twenties. However, tics as well as ADD and OCD behavior, may wax and wane over the course of the life span.   

  

Reviewed by Charles T. Gordon, III, M.D., 2003

 

For more help go to: http://www.nami.org/   and  http://www.tsa-usa.org/

 

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