Comorbidity
What is comorbidity?
A relatively new concept in mental health care, the problems relating to comorbidity have recently become the centre of attention among mental health care practitioners. People who suffering from comorbidity have the misfortune to struggle with a psychiatric disorder and with a form of addiction at the same time. The dependency on certain substances and the psychiatric disorder are correlated: one feeds and deteriorates the other and both hamper the treatment or at least render it much more difficult. In some cases, the psychiatric disorder is in itself an incentive to use alcohol or drugs. The (ab)use of certain substances leads to a marked turn for the worse of the symptoms of the psychiatric disorder. Many comorbid clients encounter problems on all levels of life: work and leisure activities, social relations and family; add to this financial problems and the prospects are bleak indeed if they want to break through this circle.
Causes
The causes that lie at the root of the combined psychiatric disorder and addiction are very difficult to establish. Some studies indicate that the combination of a psychiatric disorder and some form of addiction is much more frequent than was always assumed. Furthermore, it is a given that the symptoms mutually reinforce each other.
Addiction can also be the prime cause of certain psychiatric disorders. Some drugs cause confusion and psychoses. An excessive intake of alcohol often leads to feelings of sombreness, moral decay and loneliness.
There is also the possibility that the psychiatric disorder makes one more sensitive to the effects of an addiction. For example, people can feel angry or lonely or can become suffused with shame because of their depression and because of these feelings they may want to take refuge in alcohol or drugs. Taken in moderation, these may help them to feel stronger, for a while that is, but in the end it can only lead to more loneliness and anger.
Treatment of double diagnosis clients
Many clients facing this problem already have a long therapy history. For the treatment to have a chance to succeed it is essential that the psychiatric disorder and the addiction are tackled conjointly and as a matter of priority. Addiction must not be regarded as an isolated problem. It is important to offer one integrated treatment ,that pays attention to medical/psychiatric and psychological problems. In practice, an intense clinical stay will nearly always be necessary and the stay in the clinic should be immediately followed by an aftercare programme, on an outpatient basis. The simultaneous treatment of both the disorder and the addiction will bring a significant alleviation of the psychiatric symptoms and put a stop to the active addiction behaviour.