Co-Morbid Disorder - Research Paper Example

? Treatment Plan: Co-occurring Disorder Treatment Plan: Co-occurring Disorder Introduction A co-occurring disorder whichis also referred to as co-morbid or dual diagnosis disorder is when a patient is having a mental disorder and at the same time experiencing addiction to substances of abuse (Chen & Biswas, 2012). The occurrence of this disorder would start from depression and consequent drug abuse or vice versa. Because of the coexistence of two disorders within one individual concurrently, the treatment plan which is aimed at allowing the patient to recover from both problems. Treating one condition will not help the patient because one condition influences the onset of the other (Benaiges, Prat & Adan, 2012). It is in this sense that clinicians employs a dual diagnosis approach in which a simultaneous treatment plan is employed in the management of co-occurring disorder. This research paper presents a treatment plan for a co-occuring disorder for a patient with a problem of alcohol abuse and a major depressive disorder. The treatment plan is based on research on co-morbid disorder with a view of presenting a detailed discussion and justification of the assessment, diagnosis and treatment of the patient. The strengths and weaknesses of combining individual and group therapies with pharmacological approach for major depression and alcohol abuse are also presented within the research paper. Treatment Approach A dual treatment method or approach is argued to be the most efficient, reliable and effective way through which a dual diagnosis can be treated (Austin, McKellar & Moos, 2011). This is a process through which the concurrent disorders are treated concurrently using various treatment methods and interventions within a health care setting. It is in this sense that the treatment plan for the patient with a co-occurring alcohol abuse or addiction and major depression is to be based on the dual treatment approach. It is however to be noted that the treatment of the patient will employ different stages of treatment and interventions for each of the two conditions. The treatment plan will be aimed at overcoming the two disorders at the same time rather than healing one condition before starting to treat the other. In the treatment of dual diagnosis an in-patient treatment plan is often indicated for patients especially when their symptoms are severe and unbearable. Otherwise an outpatient plan for the treatment of the patient is implemented (Brown & Melchior, 2008). In the case of a major depression that is combined with alcohol abuse, with less severe symptoms, the dual treatment approach will be employed within an outpatient treatment plan. The dual treatment approach for the patient will therefore be aimed at identifying the underlying causes of the patient’s major depression as well as alcohol addiction to the alcohol abuse. This will involve elaborate clinical processes of patient assessment, diagnosis and treatment as described in the following sections of the paper. It is notable though that the treatment of either of the disorders will be achieved through determination of whether it is the depression which led to the alcohol use and abuse or vice versa. Researchers report that in co-occurring disorder, the presence of one disorder and its symptoms significantly increases the chances of the other disorder to develop leading to the dual diagnosis condition. The use of drugs is said to cause a 16% risk for the abusers to develop major depression especially when the use of the drugs cause the patient to be dependent on them or addicted (Benaiges, Prat & Adan, 2012). On the other hand, major depression has been found to be related to a 4.2% chance or predisposition of the depressed individuals to develop a drug use and addiction problem. These statistics support the implementation of the dual treatment approach in the plan for managing the patient with drug abuse and major depression co-occurring disorders. Assessment The assessment of patient with co-occurring disorders is achieved through a comprehensive or detailed patient history as collected by the clinician during the interaction with the patient (Brewer, Bowen, Smith, Marlatt & Potenza, 2010). The taking of history for the patient with a co-occurring major depression and alcohol addiction will therefore be achieved through effective communication with the patient with an aim of tying to establish the experiences of the patient which led to the depression and motivated the use and resultant addiction to alcohol. In taking patient history, the clinician must adhere to the standards, legal and ethical framework which involves the patient-care provider interaction and the use of information or patient data (Chen & Biswas, 2012). The assessment of the patient will therefore be carried through collection and use of patient data for the sole purpose of overcoming the challenges experienced and healing the two co-occurring conditions. In addition, the patient will be guaranteed that the information that will be provided in the process of taking history will only be used to improve the health condition. Therefore details concerning the use of alcohol by the patient such as the frequency will be determined through the process of history taking. In addition, the age at which the patient started to use and abuse alcohol will be gathered. The mode of intake such as with company or alone could also be ascertained during the history taking and assessment. This is aimed at determining if it is depression that led to the abuse of alcohol or vice versa. The assessment of the psychological and psychiatric state of the patient will also be achieved through gathering data on the past experiences, whether at home or at work. The family history for depression or abuse of alcohol involves important details within the patient history upon which the assessment of the patient will be achieved accurately by the clinician. The duration of the major depression and the coping mechanisms that the patient has employed to overcome the problem are also important in the assessment of the patient. The assessment of the patient will be the basis on which a differential and conclusive diagnosis for the co-occurring disorder would be made possible. The assessment of patients with co-occurring disorders is aimed basically at determining how the dual conditions interact to lead to their simultaneous occurrence within the patient (Matthews, Kelly & Deane, 2011). It is through this that an accurate diagnosis for the patient will be achieved to confirm the major depression and the abuse of alcohol. Diagnosis The diagnosis of the patient will be achieved through the implementation of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-IV). This is because DSM-IV is the standard for the diagnosis of mental illnesses which presents with criteria for determining how mental conditions are related to the abuse of drugs such as alcohol (Tiet & Schutte, 2012). Through this model of diagnosis, the clinician will use the information that was gathered during history taking and the assessment process to determine how the major depression and abuse of alcohol by the patient are related and the mechanisms upon which they interact. The symptoms of the patient and the detailed history will therefore be the basis for the diagnosis. This implies that the differential diagnosis for various mental illnesses and substances of abuse will be achieved before a conclusive diagnosis for major depression and alcohol use or abuse is reached. DSM-IV will provide the clinician with the most appropriate criteria through which the etiological factors for major depression and the abuse of alcohol lead to a resultant co-occurrence of these two conditions within the patient. DSM-IV is illustrated to be the most effective standard within which a clinician can be able to differentiate the causal factors for mental illness and substance use and abuse (Matthews, Kelly & Deane, 2011). This is a process which aids achieving an accurate diagnosis for the co-occurrence of alcohol abuse and major depression. The diagnosis of con-occurring disorders also involved close observation of the behaviour of a patient (Cridland, Deane, Hsu & Kelly, 2012). This is necessary at determining the differences between symptoms of mental illness and those of substance use or abuse (Perron, Bunger, Bender, Vaughn & Howard, 2010). About 2-4 interviews will be arranged between the clinician and the patient during the assessment and diagnosis processes for the con-occurring disorders. Therefore the diagnosis of the patient will consider the approach or criteria for diagnosis, the patient history, patient behaviour and symptoms as described above as the most important factors for an accurate diagnosis which will pave way for the process of therapy or treatment. Treatment The treatment of the patient with co-occurring major depression and alcohol abuse is the major part of the management of the patient. This is because the outcome of the clinical management process as guided by the assessment and diagnosis is measured through the effectiveness of the treatment or therapy in helping the patient to overcome both of the co-existing disorders (Schulte, Meier & Stirling, 2011). Detoxification if the first phase or stage in the treatment of a dual diagnosis or co-occurring conditions (Tiet & Schutte, 2012). This process is important because it relieves the dependence of the patient on drugs so that readiness for the other treatment interventions and processes is achieved (Lyne, O''Donoghue, Clancy & O''Gara, 2011). The patient will therefore be subject to the clinical process of cleansing or removing alcohol from the body systems of the patient. This is achieved through the use of various drugs as prescribed by the clinician (Thylstrup & Johansen, 2009). The detoxification of the patient will be aimed at allowing the ability of overcoming dependence to alcohol. The detoxification will be achieved within a period of 6-10 days depending on the severity of the addiction. The detoxification of the patient will then be followed by the actual dual treatment approach. In dual diagnosis, the dual diagnosis process is employed with an aim of rehabilitating the patient and instilling the ability to overcome the symptoms and behaviours which lead to the two co-occurring disorders (Horsfall, Cleary, Hunt & Walter, 2009). The rehabilitative process for the patient will therefore be focussed at treating the major depressive disorder while allowing the patient to overcome the drug use behaviour and the related addiction. Different approaches are employed in the treatment of co-occurring disorders. These approaches are employed in the rehabilitative phase and include group and individual psychotherapy sessions within a larger psychopharmacological approach (Perron, Bunger, Bender, Vaughn & Howard, 2010). This means that in addition to the group and individual sessions, the patient will be provided with various drugs as prescribed by the clinician in overcoming the underlying dual disorders of the patient’s problem. In the group and individual sessions, the patient will be educated on alcohol abuse and the related effects and consequences. The importance or benefits of not using drugs will be also being learned during these sessions. This will be the most appropriate way through which the patient will be discouraged from the abuse of alcohol. It is however necessary to keep note that the ethical and legal frameworks and standards for psychotherapy will be adhered to in the treatment of the patient. This includes voluntary participation of the patient in group activities and processes. In addition to the processes of psychopharmacological rehabilitative approach, various activities will be subscribed to the patient. These include exercises and adherence to a specific healthy diet. Behavioural therapies for the treatment of co-occurring disorders have been researched and reported by investigators with psychopharmacological rehabilitative approach being argued to be the most effective way through which the objectives and goals of the treatment plan can be achieved (Thylstrup & Johansen, 2009). This forms the justification for the implementation of the various approaches of behaviour therapy in the treatment of the patient with a co-occurring alcohol abuse and major depression. Strengths And Weaknesses Of Combined Treatment Approaches The advantages of combining the group and individual therapies with psychopharmacological rehabilitative approaches include the usefulness of a combined therapeutic process in focusing on the dynamics that cause the use of drugs and mental illnesses (Lyne, O''Donoghue, Clancy & O''Gara, 2011). The combined approach in this case will be effective in determining the issues within the patient’s home, work environment or behaviours such as violence, aggression and defiance which are related to major depression and the related abuse of alcohol. In addition, the combined approach is effective in deterring the external forces such as economic and social cultural issues which are related to the depression of the patient and the associated co-occurrence with substance abuse (Schulte, Meier & Stirling, 2011). Regardless of these benefits of combined therapy, its processes are often complex and as a result some patients may not comply with all rehabilitative processes such as group sessions and activities (Horsfall, Cleary, Hunt & Walter, 2009). Adequate expertise is required by professionals or clinicians in the combined approaches or modes of rehabilitation. This means that the number of clinicians in the management of a co-morbid disorder within patient may not be adequate in meeting the demands of patient within the rehabilitative program (Cridland, Deane, Hsu & Kelly, 2012). The application of group and individual sessions in rehabilitative phase of co-occurring disorders is also faced with the challenge of managing patients because of their diverse behaviours which limit their team work processes. In this sense, other patient may be discouraged from full participation in rehabilitative activities such as exercising. Differences In-Patient Care The treatment of the patient in the above treatment plan is based on an outpatient approach because of the less severity of the symptoms of the co-morbid disorders. However, it is notable that the treatment process will significantly change if the patient was to be managed as an inpatient. This means that the symptoms of major depression such as irritation and aggression and other psychotic symptoms would be aggravated. In this sense the monitoring of the patient in all activities of the rehabilitative process would be more intense. This is due to the need to protect both clinicians and fellow patients from possible harm by the patients which would emanate from the mental illness. For example, the inpatient patient with co-occurrence of major depression and alcohol abuse would be enclosed and separated from other patient within the various stages or phases of the treatment. Conclusion It is in line with the above treatment plan and justification of the recommended approaches that it becomes conclusive that co-occurring disorders within a patient can be managed effectively through the application of appropriate patient management strategies. The management of the patient with co-occurrence of major depression and abuse of alcohol is effectively achieved through an adequate assessment process. This includes collection of all details on the patient history upon which the clinician will reach a diagnosis. This is followed by the establishment of the diagnosis of the patient. The assessment of the patient and diagnosis process should adhere to the legal and ethical requirements which pertain to care and particularly the use of patient data or information for the purpose of care alone. A dual treatment approach is employed in this case because of its effectiveness in achieving a simultaneous treatment of both the drug problem and mental illness. The drug addiction is treated through a detoxification process which forms the initial phase of treatment for co-morbid conditions. This is then followed by rehabilitative processes in which group and individual therapies or sessions are combined with psychopharmacological rehabilitative approaches because of the effectiveness of these processes in determining the dynamics surrounding the co-occurring conditions. References Austin, J., McKellar, J. D., & Moos, R. (2011). The influence of co-occurring axis I disorders on treatment utilization and outcome in homeless patients with substance use disorders. Addictive Behaviors, 36(9), 941-944 Benaiges, I., Prat, G., & Adan, A. (2012). Health-related quality of life in patients with dual diagnosis: clinical correlates. Health & Quality Of Life Outcomes, 10(1), 106-116 Brewer, J. A., Bowen, S., Smith, J. T., Marlatt, G., & Potenza, M. N. (2010). Mindfulness-based treatments for co-occurring depression and substance use disorders: what can we learn from the brain?. Addiction, 105(10), 1698-1706. Brown, V. B., & Melchior, L. A. (2008). Women with Co-Occurring Disorders (COD): Treatment Settings and Service Needs. Journal Of Psychoactive Drugs, 365-376 Chen, S., & Biswas, B. (2012). Behavioural correlates of dual diagnosis among women in treatment for substance abuse. Mental Health & Substance Use: Dual Diagnosis, 5(3), 217-227 Cridland, E., Deane, F., Hsu, C., & Kelly, P. (2012). A Comparison of Treatment Outcomes for Individuals with Substance Use Disorder Alone and Individuals with Probable Dual Diagnosis. International Journal Of Mental Health & Addiction, 10(5), 670-683 Horsfall, J., Cleary, M., Hunt, G. E., & Walter, G. (2009). Psychosocial Treatments for People with Co-occurring Severe Mental Illnesses and Substance Use Disorders (Dual Diagnosis): A Review of Empirical Evidence. Harvard Review Of Psychiatry, 17(1), 24-34 Lyne, J., O''Donoghue, B., Clancy, M., & O''Gara, C. (2011). Comorbid Psychiatric Diagnoses Among Individuals Presenting to an Addiction Treatment Program for Alcohol Dependence. Substance Use & Misuse, 46(4), 351-358 Matthews, H., Kelly, P. J., & Deane, F. P. (2011). The dual diagnosis capability of residential addiction treatment centres: Priorities and confidence to improve capability following a review process. Drug & Alcohol Review, 30(2), 195-199 Perron, B. E., Bunger, A., Bender, K., Vaughn, M. G., & Howard, M. O. (2010). Treatment Guidelines for Substance Use Disorders and Serious Mental Illnesses: Do They Address Co-Occurring Disorders?. Substance Use & Misuse, 45(7/8), 1262-1278 Schulte, S. J., Meier, P. S., & Stirling, J. (2011). Dual diagnosis clients' treatment satisfaction - a systematic review. BMC Psychiatry, 11(1), 64-75. Thylstrup, B., & Johansen, K. (2009). Dual diagnosis and psychosocial interventions—Introduction and commentary. Nordic Journal Of Psychiatry, 63(3), 202-208. Tiet, Q. Q., & Schutte, K. K. (2012). Treatment Setting and Outcomes of Patients With Co-Occurring Disorders. Journal Of Groups In Addiction & Recovery, 7(1), 53-76 Read More