Dual Diagnosis

                                                                                                            Dual Diagnosis
Dual diagnosis is the coexistence of substance misuse and mental health problem. The individual with dual diagnosis meets the criteria for both substance abuse or dependency and coexisting psychiatric disorder. Substance misuse is the maladaptive pattern of use that has persisted for at least one month or has occurred repeatedly over a long period of time. Psychiatric disorder is a clinically significant behavioural or psychological syndrome or pattern that occurs in an individual and that is typically associated with present distress (Rassool, 2006).
Dual diagnosis is arguably one of the most significant problems facing health services. A significant percentage of all patients in general hospitals are thought to be there because of complication related to alcohol consumption, and many people who misuse alcohol and other substances are thought to have at least one mental illness (McKeown, 2010). A primary psychiatric illness can lead to substance misuse. Substance misuse can worsen the course of psychiatric illness. Intoxication and substance dependence can lead to psychological symptoms. Substance misuse or withdrawal can lead to psychiatric symptoms or illness. Few examples are given. A dependant drinker can experience anxiety. Recreational misuser of drugs struggles with low mood after weekend use. An individual with schizophrenia who misuses cannabis on a daily basis compensates for social isolation. An individual with bipolar disorder who occasionally binge drinks or experimentally misuses other substances destabilises his mental health. The prevalence rate of substance use disorder among individuals with mental problems ranges from thirty five percent to sixty percent (Rassool, 2006).
Under Mental Health Act 2014 Section 11 persons receiving mental health services should have their medical and other health needs, including any alcohol and other drug problems, recognised and responded to (Mental Health Act 2014). Australian policy is to Harm Minimisation by harm reduction, demand reduction and supply reduction. Harm reduction refers to the policies, programmes and practices that aim to reduce the harm associated with the use of substances in people unable or unwilling to stop. Motivational Interviewing is an evidence-based way of working with people in order to enable them to make changes in their lives. The background to Motivational Interviewing is the cycle of change. This describes change as being a six-part process, pre contemplation, contemplation, decision, action, maintenance and Relapse (Glover, 2010).
In phase one, a person is pre contemplative, not wishing to make any changes to their behaviour. This group is the largest group found in those with coexisting disorders. This group is the largest group mental health staff will be working with. Rather than working towards reduction or abstinence at this point staff needs to attempt to raise the person’s awareness of the use of a substance in relation to the current situation. Some small or large, external or internal influence may make the pre contemplative person consider change to his or her behaviour, making him or her contemplative. The role of worker at this point is to try and enable client to resolve ambivalence. Provided some ambivalence is resolved, the client moves into next phase of preparation, where he or she is committed to and planning to make change. Action is the next phase with the client making changes as planned. If all goes well, the client moves into the next phase, maintenance, with the worker helping him or her to develop new skills in order to adapt to a reduced use, or abstinent lifestyle (Glover, 2010).
The knowledge will be implemented during screening and assessment. To be non-judgemental and evidence based during assessment. Help the person by the following steps. Persuade to make the change. Advise how to change. Explain why they should change. Give specific benefits of changing. Warn of the risks of not changing. Repeat the above if there is any resistance. Listen carefully with the goal of understanding the dilemma without giving any advice. Asking why he or she want to make the change. How they can go about it. What are the best three reasons for changing? On a scale of zero to ten, how important is to make the change. Finally asking what they think they will do. Motivational Interviewing is helpful. This is a collaborative, person-centred form of guiding to elicit and strengthen motivation for change.

References:
Glover, C. (2010). In P. Phillips, O. McKeown, & T. Sandford (Ed.). Dual Diagnosis Practice in Context (pp. 58-66). Oxford, UK: Blackwell Publishing Ltd.
McKeown, O. (2010). Definition, Recognition and Assessment. In P. Phillips, O. McKeown, & T. Sandford (Ed.). Dual Diagnosis Practice in Context (pp. 3-12). Oxford, UK: Blackwell Publishing Ltd.
Mental Health Act 2014. Retrieved June 27, 2015, from www.legislation.vic.gov.au/Domino/Web_Notes/LDMS/PubStatbook.nsf/51dea49770555ea6ca256da4001b90cd/0001F48EE2422A10CA257CB4001D32FB/$FILE/14-026aa%20authorised.pdf
Rassool, G. H. (2006). Understanding Dual Diagnosis an Overview. In G. H. Rassool (Ed.). Dual Diagnosis Nursing (pp. 3-15). Oxford, UK: Blackwell Publishing Ltd.

By: Jasim Ahmed