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  • Subject Name : Mental health

Dual Diagnosis of Mental Health and Misuse of Drugs and Alcohol Abuse

Introduction to Mental Health

Mental illness has been defined by the World Health Organization (2019) as the “psychological wellbeing of an individual”. The psychological wellbeing of an individual is a multi-dimensional asset that is impacted by the physical health, environmental conditions and the social influences for an individual (Deas and Clark 2009). Psychological illness has been long considered as a taboo keeping them devoid of scientific applications and interventions through the timescale of history. However, this is not the only problem associated with the treatment and management of mental illnesses in contemporary times (Jenkins et al. 2017). Treatment of patients with mental illness becomes even more difficult when the patient presents with comorbid health conditions. Illicit drug and alcohol abuse have been closely interlinked with the psychological health of an individual in a reciprocal relationship where one may be a cause to others (Barnett et al. 2012). This essay aims to explore the challenges associated with the treatment of mental health patients with drug and alcohol addiction in a clinical setting. This essay will also analyze the impact of the treatment on healthcare professionals, patients, and allies. Further, this paper will also throw some light on the health models that are often applied in such situations to promote the health and beneficence of the patient.

Relationship Between AOD and Mental Health and Etiology

The concept of “dual diagnosis” has been critically evaluated by Roberts (2010) who defined that the term is an embodiment of a medical model of mental health along with substance abuse and in turn, tends to consider them independent identities. However, that is not the case, it has been found that common mental disorders like anxiety and depression often occur in concordance with substance abuse (Teesson et al. 2009). Therefore, it can be effectively deduced that substance abuse is comorbidity in mental health illnesses. According to the NSW Mental Health Guide, alcohol and other drugs (AOD) disorder could occur as a consequence to repeated alcohol and drug use to cope with the symptoms of mental illness (NSW 2007a).

For instance, people with cognitive impairments may struggle with social cues and thereby leading to increased consumption of alcohol and drug leading to addiction. This relationship between mental health and the comorbidity has been explained by the direct casual, indirect casual and the common factors hypothesis that asserts that the two domains can be linked directly, linked via intermediary factors, and by the common factors respectively (NSW 2007b). The intricate association between alcohol and drug use, therefore, is often hindering the treatment and management of the patients that possess the condition as there is an inevitable loop of dependency that hinders the overall process of medical treatment. A patient with comorbidities of AOD may not be able to comprehend the need for clinical interventions for psychological wellbeing (McWhirter 2008).

Impact on Patient, Healthcare Professionals and Family

Coping with mental illnesses can be tough as, unlike physical disorders, its signs and symptoms are evidently visible in all the cases. This may push the patient towards AOD abuse and generate dependency. In situations where mental illness originates through substance abuse, it is known to arise from physiological and chemical changes in the brain triggered by the psychoactive compounds (Cohen et al. 2008). Addiction to alcohol and drug-based consumables has been associated with various social, cultural and demographic factors like peer pressure, social structure, and age (Holt 2005). Mental illness in association with comorbid health conditions has a severe impact on the patient, healthcare professionals, and the carers. The patient may develop a sense of distortion and emotional distance from its allies due to the clinical manifestations of the mental illness. In the presence of alcohol and drug addiction, withdrawal may trigger the symptoms and can make the treatment and management extremely difficult.

This also severely affects the healthcare professional-patient relationship and therefore impacts the overall course of treatment. Further, dependence on drugs and alcohol generates physical needs that may cause exaggerated symptoms in the patient at the time of withdrawal. This makes the treatment and management of the mental illness of the patient a herculean task. As a consequence, in extreme situations, clinicians are forced to apply non-therapeutic interventions like restraints that may further worsen the health condition of the patient. The patient may develop mistrust against the professional and resort to non-compliance towards treatment. Being associated with an individual with a mental illness also requires empathy, patience, and courage. The clinical manifestations of the mental disorder may severely affect the emotions of the patient along with his interaction and relationship with his carers. As the patient is asked to avoid the alcohol and drugs and is provided with the interventions for the mental health management, the family and the carers may experience distancing and often guilt in the entire process affecting their personal and social lives significantly.

Assessment Considerations

It is crucial for healthcare professionals to develop a comprehensive assessment strategy when dealing with mental health patients with AOD abuse. It is of prime consideration that assessment of mental health is not a single step procedure as the psychological needs and manifestations of the patient are continuously evolving. It is important to develop focus and assertion on engaging the client with treatment, this can be done by developing a therapeutic alliance with the patient. This can be tough as the individual may possess a history and bias due to their association with AOD (NSW 2007a). For dealing with individuals that possess comorbid mental health conditions, the care principles must be taken into an essential consideration. These principles include, “ do no harm, work within your capacity, engage in ongoing professional development, recognize that the management of comorbidity is part of AOD workers’ core business, provide equity in access to care, adopt a ‘no wrong door’ policy, and recognize that comorbidity is common and that all clients should be routinely screened for comorbid conditions” (NSW, 2007a).

However, the development of a strong interpersonal relationship with the patient is essential to provide the necessary care and also to develop the compliance of patients towards treatment. Assessment considerations for the ongoing treatments and the assessment of expected outcomes can be achieved by expression of empathy, provision of individualized care, adoption of a holistic approach, protection of confidentiality and privacy of the patient, and promotion of self-efficacy. The primary assessment consideration of the adoption of a holistic approach is extremely essential as the primary goal of AOD treatment services is to address the AOD use in the patient. The condition of the individual must be perceived holistically with the inclusion of social, environmental and personal needs. The care provider must possess a non-judgmental attitude and a non-confrontal approach in the treatment. With the consent of the patient, in the process of assessment, it is beneficial to also incorporate the family and friends to develop essential insights (National Institute on Drug Abuse 2003).

This also aids in the facilitation of the treatment and helps in the collection of regular feedback. It is also crucial to develop realistic expectations for improvements to keep the patient and family motivated and takes the necessary steps toward health promotion and beneficence gradually. The caregivers must develop competence and work towards the beneficence of the patient. The development of competence helps in the building of strong interpersonal relationships with the patient and is therefore essential for providing person-centered care (Lee et al. 2016). A person-centered approach is highly important in the treatment and management of patients with mental health problems and alcohol and drug abuse. The psychological needs of every individual are different and therefore, possession of a person-centered approach helps in designing and implementing suitable interventions that cover the entire spectrum of the psychological, social and clinical needs of the patient (Branstetter 2011).

Duty of Care

For effective treatment and management of different patients that require mental health support in association with comorbid conditions and use of AOD, various care models have been developed (Barnett et al. 2012). These models of health not only address the physical and psychological needs of the patients but also include services that can help towards the broader needs of the patients, like housing, employment, education, etc. through coordinated care. An example of the same is the recovery star presented by Roberts (2010). The recovery star provides a holistic care model that is inclusive and asserts on the essential components like identity and self-esteem, self-care, living skills, addictive behavior assessment, relationships, trust and hope, work, social network, and responsibilities. The holistic care model is considered to be extremely appropriate for the treatment and management considerations in individuals that seek mental health in association with comorbidities (Marel et al. 2016).

Individuals with comorbid AOD and mental health problems are found to present with increased risk of developing physical health problems (NSW 2007b). Multiple factors are associated with this comorbidity and poor health in individuals. Therefore, it is crucial to assert significance on the overall wellbeing of the individuals through a holistic care model. The four essential behavioral risk factors associated with AOD must be incorporated into the care plan. These include smoking, diet, physical activity, and sleep. Smoking rates have been found to be enormously high in individuals who undergo AOD treatment. It has been reported that “people with AOD and mental health conditions also smoke substantially more cigarettes per day, and are more likely to be nicotine dependent, than the general population” (NSW 2007a). Further, poor diet and nutritional habits have also been closely interlinked with individuals with AOD and mental illnesses. Mental illnesses like anxiety and depression have been linked with relapse on drug and alcohol consumption, this is of crucial consideration as people who actively exercise show improvement in their mental health status (Marel et al. 2016).

The holistic model provides complete care for the “recovery” of patients with mental illnesses and AOD. Therefore, this model serves as a crucial for the treatment and management of patients with mental illnesses (Roberts 2010). The interventions and management plans that aim to improve the psychological well being of an individual cannot be applied individually on a patient that presents with comorbid health conditions. In consideration of alcohol and drug abuse in patients, it thereby becomes crucial to have a holistic approach and a person-centered application so that addictions of the individuals are essentially managed with the mental care needs and there are higher chances of recovery and minimal relapse is observed (Deas and Clark 2009). Patients with mental health and AOD are also associated with self-harm and other toxic habits (Jenkins et al. 2017). Development and provision of holistic care plans ensure that the patient develops an optimistic approach towards healing and coordinates with the treatment. The holistic plan also ensures that the essential requirements of the patient are met in association with the overall development of his or her circumferential needs as well.

Conclusion on Mental Health Problems

Patients with mental health problems require critical care and essential support. However, mental health issues in an individual may not present themselves independently but manifest in conjunction with other comorbidities. This essay summarizes the impact of alcohol and drug abuse in patients with mental health issues. This essay provides critical insights into the problems of individuals with AOD in terms of their psychological care and assessment. This paper discusses how the existence of comorbidity like AOD affects the health and wellbeing of the patient and the family along with its impact on the healthcare professionals. This paper also provides a critical analysis of the assessment considerations of patients with comorbidities who must be treated in a care setting and establishes a care model for their beneficence. The paper argues that patients with comorbid conditions with mental health problems must be treated with a holistic approach that is inclusive of all the essential needs of the patients. The paper also presents how holistic care for these individuals is essential as it not only caters to both, clinical and psychological needs. Through a comprehensive evaluation, this paper asserts that comorbidities are of essential consideration while providing care to patients and therefore, patients with AOD must be treated effectively so that their mental health needs can be successfully assessed and met through healthcare models and coordinated care programs.

References for the Assignment

Barnett, E, Sussman, S, Smith, C, Rohrbach, LA and Spruijt-Metz. 2012, ‘Motivational interviewing for adolescent substance use: A review of the literature', Addictive Behaviors, vol. 37, no. 12, pp. 1325-1334.

Branstetter, SA, Low, S and Furman, W. 2011, ‘The influence of parents and friends on adolescent substance use: A multidimensional approach', Journal of Substance Use, vol. 16, no. 2, pp. 150-160

Cohen, M, Solowij, N and Carr, VJ. 2008, 'Cannabis, cannabinoids and schizophrenia: Integration of the evidence', Australian and New Zealand Journal of Psychiatry, vol. 42, no. 5, pp. 357-368.

Deas, D and Clark, A. 2009, ‘Current state of treatment for alcohol and other drug use disorders in adolescents', Alcohol Research and Health, vol. 32, no. 1, pp. 76-82

Holt, M. 2005, Young people and illicit drug use in Australia. Social Research Issue Paper 3, National Centre in HIV Social Research, University of NSW, Sydney. 

Jenkins, E.K., Slemon, A. and Haines-Saah, R.J. 2017. ‘Developing harm reduction in the context of youth substance use: insights from a multi-site qualitative analysis of young people’s harm minimization strategies’. Harm Reduction Journal, vol. 14, no.1, pp.53.

Lee, JY, Brook, JS, Nezia, N and Brook, DW 2016, 'Adolescent predictors of alcohol use in adulthood: A 22 year longitudinal study', The American Journal of Addictions, vol.25, no.7, pp. 549-556

Marel, C, Mills, KL, Kingston, R, Gournay, K, Deady, M, Kay-Lambkin, F, Baker, A and Teeson, M 2016, Guidelines on the management of co-occurring alcohol and other drug and mental health conditions in alcohol and other drug treatment settings, 2nd edn, National Drug and Alcohol Research Centre, University of New South Wales, Sydney. Available at: https://extranet.who.int/ncdccs/Data/AUS_B9_Comorbidity-Guidelines-2016.pdf [ Accessed on 7/04/2020]

McWhirter, PT. 2008, ‘Enhancing adolescent substance abuse treatment engagement', Journal of Psychoactive Drugs, vol. 40, no. 2, pp. 173-182

National Institute on Drug Abuse (NIDA) 2003, Preventing drug use among children and adolescents: A research-based guide for parents, educators and community leaders, 2nd edn, US Department of Health and Human Services, Maryland. Available at: http://www.drugabuse.gov/sites/default/files/redbook_0.pdf. [Accessed on 20/04/2020]

NSW Health 2007a, 'IMAT (Integrated motivational assessment tool)', in Psychiatry and substance use interactive DVD-ROM. NSW Health and The University of Newcastle, Australia

NSW Health 2007b, 'Conducting a functional analysis', in Psychiatry and substance use interactive DVD-ROM. NSW Health and The University of Newcastle, Australia.

Roberts, M. 2010, 'Should we be recovering from 'dual diagnosis'? Some thoughts on language, expertise and empowerment', Advances in Dual Diagnosis, vol. 3, no. 1, pp. 8-14

Teesson, M, Slade, T and Mills, K. 2009, 'Comorbidity in Australia: Findings of the 2007 National survey of mental health and wellbeing', Australian and New Zealand Journal of Psychiatry, vol. 43, no. 7, pp. 606-614

World Health Organisation 2019. Mental health. Available at: https://www.who.int/mental_health/en/ [ Accessed on 20/04/2020]

Remember, at the center of any academic work, lies clarity and evidence. Should you need further assistance, do look up to our Mental Health Assignment Help

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