Compound Case Study

Background - In 1980, my sister had just been born when things in our family started to change. I was only five when my sister was born, but I remember her coming home from the hospital. I don’t really have any memories before that; at least, none that weren’t implanted through stories and pictures (photograph albums). Things changed that year - my father changed. One day (several years later), I asked my mother if “my father was always like this” and she explained, to me, that my father was not violent when they first married: he became violent when he started using drugs. That is he displayed “Psychopharmacological traits” (Mockery, Lecture). So, what led to the drug use? Why did his behaviors change? What crimes did he commit and what does the future hold for him?

Adolescence - Vincent Quaglietta, my father, was born on February 28, 1954. Sandy Quaglietta, his mother, had to have open heart surgery when she was pregnant for him. So, he was addicted to morphine when he was born.  He was raised by both of his biological parents: in a middle class family. He had only one sibling; which was abnormal for an Italian Family. The family went to church on a regular basis, and they participated in community activities. He was reported to be “a good kid, no trouble with the law, and smart” by his mother.

            Vincent Quaglietta started to lift weights. He was six feet four inches tall and had a “mesomorph” physique (Siegel, 2009, p.122). His cousin started to “hang out” with him, and he introduced Mr. Quaglietta to cocaine. One time was all it took – Mr. Quaglietta was hooked. Sandy Quaglietta believes it was because his body remembered the morphine. The brain is complex, and the reality is, that it is possible the morphine had a neurological impact to the structure of his brain. But one thing is certain -Vincent’s attachments to and with others changed from that point on. His moral bar was eroded/ lowered, and things he once found inappropriate were acceptable. I.e. Drug use, pornography, and prostitution became acceptable.

Crimes - According to Siegel, “Delinquent friends cause law-abiding youths to get in trouble” and Vincent changed his associations (p.201). Cocaine was the first drug that he used, but it would not be the last. The intranasal cocaine and crack caused irritability, aggression, and physical violence: Vincent started to violently assault his wife and children. Debbe, Vincent’s wife and my mother, is independent and assertive, so it is possible that in Vincent’s mind these traits triggered his violence. I.e. She argued with him about using drugs (confrontation); therefore, she deserved it. “Victim precipitation theory” suggests that she was “active” in precipitating the events, because she provoked him (p.73). On the other side, “Deny the victim” (a neutralization technique) suggests that “criminals sometimes neutralize wrongdoing by maintaining that the victim had it coming” (p.207).

              The violent behavior that was displayed by Vincent was never corrected, so it escalated. Mr. & Mrs. Quaglietta, my parents, divorced and Mrs. Quaglietta took the children to Minnesota for two years, then to Westport, N.Y. Mr. Quaglietta requested and was granted visitation privileges. Mr. Quaglietta’s children were conditioned to base their behavior on their father’s behavior. I.e. If he appeared angry, they would avoid him or give the answers he wanted to hear “Yes, I am sorry, I will take care of that” and so on so forth. But, if he was relaxed and smoking marijuana his children were able to relax a little and they could go upstairs and not stay in the basement. The basement was partly finished and there was a couch, games, and television. The children that were males were expected to go to work when they were not in school, and the female children were to clean the house, make supper, and be presentable by the time the males returned. Some household jobs were not for “Women,” so the boys took the garbage and did the yard work. Mr. Quaglietta felt that Sundays were family days and he would do things on that day with his family; however, the activities for the day might include his friends joining us and some form/type of drugs.

He worked to support his lifestyle, and when his lifestyle started to dwindled he became creative and created other ways to stay in the middle class lifestyle. He started to “underreport his income” and created a false set of books for the tax consultant (Tax Evasion/Fraud: Siegel, P. 382). Vincent started selling drugs, and selling items he owned (later he would report them stolen).

Vincent Quaglietta moved in with his aunt, in 2004. His substance dependence had impacted all aspects of his life to the point where he wasn’t able to function. He applied for and received SSI; however, after a short while he realized that the income he was receiving was insufficient to cover his expenses. As a “problem solver”, he came up with a way to get some money. He pretended to be his father and ordered a credit card in his father’s name. Then, he persuaded his aunt into putting him on her credit card account. He misrepresented the reasons for which he would use the card, and he hid the credit card statements for an extended period of time. His father passed away in December of 2007, and he moved in with his mother. She was left with enough money to live out her life and not want for anything. It took less than a year for Vincent to be in charge of all of the financial transactions and estate. He committed property crimes – he started out committing “Fraud” and progresses to “Embezzlement” (Siegel, p.359-360). The money taken from his mother and aunt depleted their savings. 

As of 2010, he has never been arrested for anything other than failure to pay child support. Mr. Quaglietta participated in activities with people that held positions, within the legal field, which provided him with knowledge of criminal techniques and information (Differential Association Theory, p.203). The information that he gathered was for his own personal use, so it could be argued that he was “high risk” to violate the law, and he used his “criminality traits” to decide which crimes he was going to commit, and how he could get away with the crime (p.94).

Mr. Quaglietta has been married seven times (is currently going through a divorce), and he has eleven children (only two whom speak to him). The subordinate/degrading viewpoint, and the substance abuse, held by Mr. Quaglietta lead to spousal abuse with his wives (my mother fought at first, but after a few visits to the hospital she was conditioned to submit to his authority). The child abuse was both physical and verbal. The effects on the children have varied (I can only attest to the first five). The oldest, David, received the most of the physical beatings, and he mimicked his father’s physical aggression towards women for several years, until he went to see a psychiatrist. He was arrested for substance use and forced into treatment. The second oldest, this writer, didn’t tolerate the drugs and the people that did them, so there were many verbal altercations. There was physical violence, but not while I was around after I found my voice, because I told him that, “I would call the police and show them every mark and everything I knew.” Our visits were far and few between, unlike the other siblings I never went to live with my father when I was disagreeing with my mother. The fourth child, Greg, doesn’t remember his childhood, but has nightmares that make him wake up screaming. Up until a year ago, he drank* so that he didn’t have to remember. The youngest, Sondra, hasn’t spoken to him in ten years, and she has no intention of making any effort to see him. (Side note* Mr. Quaglietta never discouraged the use of drugs, but he would not tolerate smoking cigarettes in his home and drinking to intoxication. He didn’t care if people had a drink, but they needed to know their limits.)

            Conclusion - There are multiple reasons for the criminal behavior that Vincent Quaglietta displayed. His behaviors were deviant and some were illegal, but “not all deviant acts are illegal” (Siegel, p.5). The criminal justice system did not catch him, thus he was not deterred and he progressed/evolved as a criminal. Social Reaction theory points to his “interactions and interpretations” to either encouraging or discouraging behaviors: behaviors can be either effective or ineffective in our lives (Siegel, p. 214). Modern trait theorists would say that there are multiple biological and psychological reasons for his behavior (Siegel, p.123) This writer doesn’t know if Mr. Quaglietta’s  mental health was within “normal” parameters before he began his drug use, but it is reasonable to assume that being born addicted to morphine impacted his neurological functioning in some way. After thirty-one years of using and abusing drugs, both his physical and mental health has been impacted. He would be labeled “Dual Diagnosis/co-occurring disorders:” meaning that he would be hard to treat and the chance to reuse would be high.

            Could anything have prevented this? In my opinion, substance abuse is a disease. Yes, Mr. Quaglietta made the choice to use, but the interactions it created within his neurological system triggered a response, and that response caused an exceedingly complex relationship. That relationship grew – the first use- a snort of cocaine progressed into 10 grams, because that’s what it took to get the original high; the first use of marijuana- a hit here and there turned into 5-6 joints a day. The relationship intertwined in such a way that when Mr. Quaglietta did try to stop his body reacted: physiological symptoms presented making him believe he needed to continue with use, and each time he used and stopped the physiological symptoms appeared. His future is grim, because his body can’t take the substance abuse anymore and he doesn’t believe treatment will help.

 

References

Siegel, L. (2009). Criminology (10^th ed.). Belmont, CA: Thomson Wadsworth.

 

Dual Diagnosis among African Americans

A Review of the Literature

Often times, when we look at an individual we will have a certain interpretation (judgment or thought) of that person based on their race, culture, age, sex, and so on. What happens when you look at an individual that has a mental health diagnosis, a substance abuse issue, has been, or is, incarcerated? Now, what if that individual has all three qualities and the individual has a different race than your own? What will you think of them? What judgments are rushing through your mind - right now? Will that person be treated differently by you? By society? Are you even aware of the despairing thoughts you have about another person. What will the consequences be for that individual? African Americans are suspiciously, and excessively “undiagnosed, minimally treated, and untreated…” which in turn, leads to “serious practice and policy implications that may mitigate or exasperate the inequalities in health that blacks experience” ( Hatcher, S., Toldson, I., Godette, D., & Richardson, J.., 2009, p.1).

“By the mid-year 2007, Blacks were almost three times more likely than Hispanics and five times more likely than whites to be jailed,” and currently 1.1 million of 2.6 million incarcerated individuals are African Americans in the United States (Hatcher, S., Toldson, 

I., Godette, D., & Richardson, J.., 2009, p.1). The study looked at individuals that had been detained, arrested, incarcerated, paroled, and/or released; so throughout this review, the term incarcerated will be used in place of the latter.  So, what does this say about our court system? Let’s look at the issues.

The court system has based its decisions (rulings) on the moral model: to treat individuals. They believe that the deficiencies found in people are due to a spiritual or character deficit. That the individual chooses to do something bad; in turn, they deserve the consequences that result in their actions. By using this type of model, they create a stigma and contribute to the improper treatment of individuals that are incarcerated. This can be seen through the policies that “Play a role in the criminalization of mental disordered persons. Many people with mental illness may be arrested for minor acts that are in fact manifestations of their illness and their lack of treatment” (Hatcher, S., Toldson, I., Godette, D., & Richardson, J.., 2009, p.2). The same can be said of individuals with a substance abuse diagnosis.

As long as individuals cannot receive adequate treatment, they will be unable to function in society in an acceptable manner.

“A 2001 report of the surgeon general discussed disparities in access, treatment, and quality of mental health care form minorities. Contributing factors associated with mental health in the African American community include: 1. Historical adversity; 2. Impeded access to insurance; and 3. The help-seeking traits of African American, whose traditional attitudes toward mental illness are considered a barrier in that they include stigmatization” (Hatcher, S., Toldson, I., Godette, D., & Richardson, J.., 2009, p.2).

Over the last few years, some courts have started using mental health court and drug court to make a difference. There has been some progress, but there needs to be more changes made within the court system. The laws need to be changed to treat a person using a combination of models rather than one model which just incarcerates the person. Incarcerating them does not treat the underlining condition.

In fact, the changes need to be made and implemented to help individuals before they are incarcerated. Treating one diagnosable condition in itself posses’ problems, treating two conditions just exasperates the problems, and when you add racial disparity to the mix… there doesn’t seem to be a great deal of hope.  

“A vast body of literature indicates that African Americans are disproportionately affected by a myriad of socioeconomic problems (including poverty, structural inequality, family disruption, inadequate schools) that increase the likelihood of mental health and behavior disorders, substance abuse…” despite all of this knowledge and information the progress towards improvement are minimal at best (Hatcher, S., Toldson, I., Godette, D., & Richardson, J.., 2009, p.5). Organizations, health care providers, and health care professionals know that the needs of African Americans can be met if a “multidisciplinary approach” is used.

References

Hatcher, S., Toldson, I., Godette, D., & Richardson, J.. (2009). Mental Health, Substance Abuse, and HIV Disparities in Correctional Settings: Practice and Policy Implications for African Americans. Journal of Health Care for the Poor and Underserved: Special Issue: Health Disparity Critical Issues, 20(2A), 6-16.  Retrieved October 15, 2010, from Research Library. (Document ID: 1777631601).

Dual Diagnosis among Adolescent

A Review of the Literature

            Research on child and adolescent mental illness is available; research on child and adolescent drug use is available, but research on dual diagnosis among children and adolescents is limited. However, you would think that this would be a time when we would want to know all of the facts. That way we can intervene in a young ones life and help them, because they are at a crucial stage where learning is important. So, how do children and adolescent with a mental illness and substance use problem impact our educational System? What does the future hold for children and adolescents with a dual diagnosis?

            Children and adolescents with a mental illness and substance abuse problem impact our educational System – through lower grades, lower attendance rates, and a higher probability to drop-out of school. The American Academy of Child Adolescent Psychiatry (2007) published statistics that showed some children 12 and older were using illicit drugs, tobacco, marijuana, and vicodin (p. 2). According to Substance Use and Academic Outcomes, substance use “impairs cognitive development which, in turn, reduces academic achievement and disrupts academic progression” (King, 2006, p. 1) Substance use has an effect on an individual’s cognitive development. The effect can be likened to having a brain problem; “Addicts can articulate very well the consequences of their behavior. But they fail to act accordingly. That’s because of a brain problem… (likened to) damage in the ventromedial area which causes a disconnect between what you know and what you do” (Gladwell, 2005, p. 60).

            Mental illness is thought to be a brain disorder as well; although, not all people are willing to accept a mental health diagnosis due to the stigma that surrounds it. Children that have an ADHD diagnosis have an inability to “control their behavior and/or pay attention;” whereas, children that are depressed have a problem with their “ability to think, feel, and behave in a normal manner” (NIDA, 2007, p. 1); are you seeing similarities? Substance use and mental illness impair a child’s ability; this in turn, can have an effect on their social life, the desire to achieve, and their behaviors displayed. These impairments will have an impact on their ability to learn, and the educational systems ability to help them; without appropriate supports.  

What does the future hold for children and adolescents with a dual diagnosis? The future looks grim; without appropriate supports their worlds will continue to spiral downhill. Their academic outcomes will likely be met with failure and/or extremely challenging. This will cause a lack of desire to try – educationally. Socially and behaviorally the individually will not be “normal,” and thus they will be shunned by the majority of society. Chances are all of this will lead to a high probability of being incarcerated in the future. So, what are appropriate supports?

First, it is important for the interview to include “A consensus approach… combining self-report and interview data, along with collateral reports and longitudinal data accumulated by case managers through repeated contacts over time”(164) the authors go on to explain that we must provide interventions that benefit both types of disorders, “For example: provide training in social skills and effective communication, problem solving, stress management, increasing pleasant activities, vocational rehabilitation, and cognitive-behavioral techniques and coping skills”  (Monti, 2002, p.174-176). Children and adolescents might have a hard time expressing all of their thoughts and ideas, so it might be beneficial if they can write in a journal/diary or have materials that are age appropriate.

There are five general principles that people need when interviewing individuals with a mental illness and substance abuse problem. They are:

(1) it is nonconfrontational; (2) it views motivation for change as a dynamic state rather than a static state; (3) readiness to change can be influenced by major life crisis and by therapeutic interventions; (4) building readiness to change may be a long-term process; and (5) key elements include discrepancies, altering the perceived cost-benefit ratio, and enhancing self-efficacy (White, 1998, p.48).

Thoughts and Feelings

            It is vital that we intervene in a young ones life, because they are at a crucial stage where learning is important. The developmental stages that they are endeavoring to succeed in are being hindered by a mental illness and a substance use problem (dual diagnosis). These issues impact their learning and set them up to fail, because both mental illness and substance abuse have an effect on children and an adolescent’s cognitive ability. It is hard for them to perceive events and information in a way that will bring about success within society, and for them to make judgments that are successful. This is not to say that they are unable to solve problems. There is no doubt in my mind that they can figure out how to manipulate a situation or person; or how to solve a problem and/or get the drugs that they need; or to make decisions that will get them what they want. The problem is that the choices they are making are not helping them to stay in school, get an education, and to learn how to behave socially, so that they can live within society “norms”. It is hard for children (and adults) to know that they are not “normal” and that they do not belong for some reason or another; therefore, it is vital that they learn what is acceptable and techniques that will help them to fit into society.

            Children that have been identified as having a need are entitled to services within the educational system: if the school receives funding from the government. Identified as having a need means that their education is being effected due to a condition that will not likely change within the next few days: substance use and mental diagnosis would fit into this category. The child or adolescent can receive services through an Independent Educational Plan (IEP). However, these are only successful if the parent, school, and community work together for the benefit of the child or adolescent.

I can see how it is easy for an individual to fall through the cracks in our society; hopefully, as more data is compiled we will be better able to serve children and adolescents. The most important thing is to treat not just the child or adolescent, but to include their entire homeostasis (Everything that surrounds the child/adolescent: family, friends, school, environment, etc).

References

Child and Adolescent Mental Illness and Drug Abuse Statistics. (2009, March 18). American Academy of Child & Adolescent Psychiatry. Retrieved from http://www.aacap.org/cs/root/resources_for_families/child_and_adolescent_mental_illness_statistics

Gladwell, M. (2005). Blink. New York, NewYork: Back Bay Books.

King, K., Meehan, B., Trim, R., Chassin, L. (2006). Substance Use and Academic Outcomes: Synthesizing Findings and Future Directions. Addictions, December; 101(12): 1688-1689. doi: 10.1111/j.1360-0443.2006.01695.x.

Monti, P., Kadden, R., Rohsenow, D., Cooney, N., Abrahs, D. (2002). Treating Alcohol Dependance : A Coping Skills Training Guide. (2^nd ed.). New York, New York: The Gilford Press.

White, R., & Wright, D. (1998). Addiction Intervention. Binghamton, New York: Hayworth Press.

13 Principles of Effective Drug Addiction Treatment

"Thirteen Principles of Effective Drug Addiction Treatment"

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More than two decades of scientific research have yielded a set of fundamental principles that characterize effective drug abuse treatment. These 13 principles, which are detailed in NIDA's new research-based guide, Principles of Drug Addiction Treatment: A Research-based Guide, are: 1.   " No single treatment is appropriate for all individuals. Matching treatment settings, interventions, and services to each patient's problems and needs is critical. 2.    Treatment needs to be readily available. Treatment applicants can be lost if treatment is not immediately available or readily accessible. 3.    Effective treatment attends to multiple needs of the individual, not just his or her drug use. Treatment must address the individual's drug use and associated medical, psychological, social, vocational, and legal problems. 4.    Treatment needs to be flexible and to provide ongoing assessments of patient needs, which may change during the course of treatment. 5.    Remaining in treatment for an adequate period of time is critical for treatment effectiveness. The time depends on an individual's needs. For most patients, the threshold of significant improvement is reached at about 3 months in treatment. Additional treatment can produce further progress. Programs should include strategies to prevent patients from leaving treatment prematurely. 6.    Individual and/or group counseling and other behavioral therapies are critical components of effective treatment for addiction. In therapy, patients address motivation, build skills to resist drug use, replace drug-using activities with constructive and rewarding nondrug-using activities, and improve problem-solving abilities. Behavioral therapy also facilitates interpersonal relationships. 7.    Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies. Methadone and levo-alpha-acetylmethadol (LAAM) help persons addicted to opiates stabilize their lives and reduce their drug use. Naltrexone is effective for some opiate addicts and some patients with co-occurring alcohol dependence. Nicotine patches or gum, or an oral medication, such as bupropion, can help persons addicted to nicotine. 8.    Addicted or drug-abusing individuals with coexisting mental disorders should have both disorders treated in an integrated way. Because these disorders often occur in the same individual, patients presenting for one condition should be assessed and treated for the other. 9.    Medical detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug use. Medical detoxification manages the acute physical symptoms of withdrawal. For some individuals it is a precursor to effective drug addiction treatment. 10. Treatment does not need to be voluntary to be effective. Sanctions or enticements in the family, employment setting, or criminal justice system can significantly increase treatment entry, retention, and success. 11. Possible drug use during treatment must be monitored continuously. Monitoring a patient's drug and alcohol use during treatment, such as through urinalysis, can help the patient withstand urges to use drugs. Such monitoring also can provide early evidence of drug use so that treatment can be adjusted. 12. Treatment programs should provide assessment for HIV/AIDS, hepatitis B and C, tuberculosis and other infectious diseases, and counseling to help patients modify or change behaviors that place them or others at risk of infection. Counseling can help patients avoid high-risk behavior and help people who are already infected manage their illness. 13. Recovery from drug addiction can be a long-term process and frequently requires multiple episodes of treatment. As with other chronic illnesses, relapses to drug use can occur during or after successful treatment episodes. Participation in self-help support programs during and following treatment often helps maintain abstinence. " Principles of Drug Addiction Treatment: A Research-based Guide (NCADI publication BKD347) has been mailed to NIDA NOTES subscribers in the U.S. Copies of the booklet can be obtained from the National Clearinghouse for Alcohol and Drug Information, P.O. Box 2345, Rockville, MD 20847, 1-800-729-6686.

A Review of the Literature

A Review of the Literature

            There is no “One” intervention and treatment for individuals with co-occurring disorders that is the “Cure”. In fact, it appears that when you look at the interventions and treatments that are utilized among co-occurring disorders there is one similarity – multiple interventions and treatments are used. According to NIDA, there are thirteen principles of effective drug addiction treatment. Alcoholics Anonymous (AA) feels that there are twelve steps to the road to recovery. Then, there are others that believe in a sixteen step program. However, the Frequency of Prayer, Meditation, and Holistic Interventions in Addictions Treatment shows how some programs are “Endorsing the twelve step approach and the use of prayer, meditation, and holistic techniques” (p.1). What are prayer, meditation, and holistic approaches? How powerful are prayer, meditation, and holistic approaches?

            Let’s take a look at prayer, meditation, and holistic approaches, as applicable in the article. Prayer is a common technique that is used by individuals with a mental health diagnosis and a substance abuse diagnosis. “Spirituality is recognized as a potential important part of treatment” (p.1), as such it is encouraged if an individual has a spiritual belief. Meditation varies across the intervention and treatment practices. The three categories that were found in use were: “(1) Devotional meditation…; (2) other spiritual approaches that eschew thinking and contemplation…; (3) secular modification … secular meditation, relaxed awareness and focus of attention are used in a manner similar to that of Eastern spiritual meditation traditions” (p. 3). The article discussed the holistic techniques that were used, and it placed them in four categories: “(1) nutrition, exercise, relaxation and physical health; (2) recreation and adventure-based activities; (3) religious and spiritual practices; and (4) the use of specific modalities” (p.4).

Is there power in prayer, meditation, and holistic approaches? First, it should be noted that not all professionals use a prayer, meditation, or holistic approach. Some feel that it is not beneficial for their clients to pursue this direction. But, the results of the study showed that, “Of all treatment centers surveyed, 91% indicated that they include a twelve step orientation treatment…and are willing to use an overtly spiritual approach” (p. 6). Obviously, some people are influenced by prayer, meditation, and holistic approaches.

The study expressed that there were limitations to the study and that additional research needed to be done.

Thoughts and Feelings

            Dual diagnosis (co-occurring diagnosis) is not a uncommon occurrence, so it is important to be familiar with many interventions and treatments to best help ones client. There is no easy way of providing one intervention or treatment due to the variety of diagnosis combinations. For example, an individual might have an anxiety disorder and an alcohol addiction or depression and a gambling addiction. The possibilities are endless, and the interventions and treatments are going to vary based on the diagnosis. Granted, there are some interventions and treatments that can be used for multiple diagnoses’ there are also some forms of interventions and treatments that could hinder the client’s progress. Another problem with individuals that have a co-occurring disorder is that the symptoms being displayed could be either from the mental diagnosis and/or the substance diagnosis.

            The best type of treatment for these individuals is integrated treatment. That is treatment that comes from both a mental health provider and as substance abuse provider. The prayer, meditation, and holistic techniques provide an individual with insight into their mind, body, and soul. These techniques can help an individual in different ways. For example, when meditating the individual will become in tune to the environment around them and their body - this can be useful in helping them to understand what messages the body is sending when they are upset. Do they start to sweat? Does their shoulder’s tighten? Does their voice level change? This insight can help them to know when to leave, walk away, or use a coping skill that will help them to endure the moment.

            I don’t believe that all interventions and techniques work for all people. I think that it is a good idea to go over several things with the client and to get their feedback on likes and dislikes. The more techniques the individual learns the bigger their resources will be to get them through the situation at hand. Sometimes, teaching people to eat healthy, exercise, and participate in spiritual activities helps them to meet new people and change their old lifestyle.

 

References

Introduction: Recovery from addictions using Transcendental Meditation and Maharishi Ayur-Veda; O'Connell, D. F.; Alexander, C. N. Alcoholism Treatment Quarterly; 1994 Vol. 11, p1-10, 10p. Document Type: article; DOI: 10.1300/J020v11n01; (AN ATQ.AA.A.OCONNELL.IRFAUT) [Citation Record] Database: EBSCO Publishing Citations

Co-occurring Disorders

“I really want to make changes in my drinking and use of drugs.” “I am constantly bombarded by thoughts… I can’t explain them - they won’t stop.” I don’t mean to do the things that I do, but I am always getting in trouble.” “I know I want to stop, and I have tried, but it’s not working.” Make no mistake individuals with a substance diagnosis and a mental health diagnosis know that something is not right and that they need help. However, getting help is another story, because society as a whole does not agree with what needs to be done.

In 2005, the literature showed that in co-occurring disorders treatment plans, they “Lacked specificity; lag behind current practices, sometimes reflect a disagreement about important details; may not apply specifically to co-occurring disorders; lacked empirical support” (Reedy & Hall, 2008, p.50). By 2008, the National Association of State Alcohol and Drug Abuse Directors, created a four quadrant model to help caretakers, therapist, counselors, and others to place individuals with a co-occurring diagnosis in either one of four quadrants. Why? Because it is hard to create a standard of care that is universal among individuals with co-occurring disorders due to the variety of diagnoses. For example, an individual might have an anxiety disorder and an alcohol addiction or depression and a gambling addiction. The possibilities are endless, and the interventions and treatments are going to vary based on the diagnosis.  So, some people might say, “Service providers need to collaborate;” “Case management is suggested;” “Fully integrated care” is needed, but others saw a need to integrate services, and they are moving to a more united front.  The four quadrants allow treatment providers to place an individual in a quadrant, and then the provider can prepare a treatment plan for the individual.

According to Reedy and Hall (2008), “… agencies need to implement careful and thorough screening and assessment procedure” (p. 45). While it appears there are improvements being made in this area, some providers are not trained to do thorough assessments/screenings. Providers need to be effectively trained to screen for co-occurring disorders. Providers need to “View co-occurring disorders as the norm rather than the exception” (p.48). Assessment and screening forms in the mental health field and the substance abuse field should include questions regarding both fields. The article implies that if information is not shared about the client between agencies, then the client is not receiving adequate care and the chances of having some type of improvement are minimized and less effective. So, “ideally” treatment plants for individuals with co-occurring disorders would include a “fully integrated” treatment plan (Reedy & Hall, 2008, p.50).  Perhaps, a reason for the inadequate care is the lack of “dully” credentialed individuals, but that does not mean that the individuals that are taking care of the patients can’t be creative in the treatment plans and referrals that they make.

While researchers are trying to decide what the standard of care is, we are lacking empirical studies that could help providers treat the younger generation. Children and adolescents with a mental illness and substance abuse problem impact our educational System – through lower grades, lower attendance rates, and a higher probability to drop-out of school. The American Academy of Child Adolescent Psychiatry (2007) published statistics that showed some children 12 and older were using illicit drugs, tobacco, marijuana, and vicodin (p. 2). According to Substance Use and Academic Outcomes, substance use “impairs cognitive development which, in turn, reduces academic achievement and disrupts academic progression” (King, 2006, p. 1) Substance use has an effect on an individual’s cognitive development. The effect can be likened to having a brain problem; “Addicts can articulate very well the consequences of their behavior. But they fail to act accordingly. That’s because of a brain problem… (likened to) damage in the ventromedial area which causes a disconnect between what you know and what you do” (Gladwell, 2005, p. 60).

            Mental illness is thought to be a brain disorder as well; although, not all people are willing to accept a mental health diagnosis due to the stigma that surrounds it. Children that have an ADHD diagnosis have an inability to “control their behavior and/or pay attention;” whereas, children that are depressed have a problem with their “ability to think, feel, and behave in a normal manner” (NIDA, 2007, p. 1); are you seeing similarities? Substance use and mental illness impair a child’s ability; this in turn, can have an effect on their social life, the desire to achieve, and their behaviors displayed. These impairments will have an impact on their ability to learn, and the educational systems ability to help them; without appropriate supports. 

What does the future hold for children and adolescents with a dual diagnosis? The future looks grim; without appropriate supports their worlds will continue to spiral downhill. Their academic outcomes will likely be met with failure and/or extremely challenging. This will cause a lack of desire to try – educationally. Socially and behaviorally the individually will not be “normal,” and thus they will be shunned by the majority of society. Chances are all of this will lead to a high probability of being incarcerated in the future. So, what are appropriate supports for adolescents?

First, it is important for the interview to include “A consensus approach… combining self-report and interview data, along with collateral reports and longitudinal data accumulated by case managers through repeated contacts over time”(164) the authors go on to explain that we must provide interventions that benefit both types of disorders, “For example: provide training in social skills and effective communication, problem solving, stress management, increasing pleasant activities, vocational rehabilitation, and cognitive-behavioral techniques and coping skills”  (Monti, 2002, p.174-176). Children and adolescents might have a hard time expressing all of their thoughts and ideas, so it might be beneficial if they can write in a journal/diary or have materials that are age appropriate.

There are five general principles that people need when interviewing individuals with a mental illness and substance abuse problem. They are: “it is nonconfrontational; (2) it views motivation for change as a dynamic state rather than a static state; (3) readiness to change can be influenced by major life crisis and by therapeutic interventions; (4) building readiness to change may be a long-term process; and (5) key elements include discrepancies, altering the perceived cost-benefit ratio, and enhancing self-efficacy” (White, 1998, p.48).

Children are not the only ones that need help. African Americans are suspiciously, and excessively “undiagnosed, minimally treated, and untreated…” which in turn, leads to “serious practice and policy implications that may mitigate or exasperate the inequalities in health that blacks experience” ( Hatcher, S., Toldson, I., Godette, D., & Richardson, J.., 2009, p.1).

“By the mid-year 2007, Blacks were almost three times more likely than Hispanics and five times more likely than whites to be jailed,” and currently 1.1 million of 2.6 million incarcerated individuals are African Americans in the United States (Hatcher, S., Toldson, 

I., Godette, D., & Richardson, J.., 2009, p.1). This means that the court system has incarcerated some individuals that would fall into the category of having a co-occurring disorder, and that they  based their decisions (rulings) on the moral model: to treat individuals. The deficiencies found in these people are due to a spiritual or character deficit: The individual chooses to do something bad; in turn, they deserve the consequences that result in their actions. By using this type of model, they create a stigma and contribute to the improper treatment of individuals that are incarcerated. This can be seen through the policies that “Play a role in the criminalization of mental disordered persons. Many people with mental illness may be arrested for minor acts that are in fact manifestations of their illness and their lack of treatment” (Hatcher, S., Toldson, I.,  Godette, D., & Richardson, J.., 2009, p.2). The same can be said of individuals with a substance abuse diagnosis.

As long as individuals cannot receive adequate treatment, they will be unable to function in society in an acceptable manner. “A 2001 report of the surgeon general discussed disparities in access, treatment, and quality of mental health care form minorities. Contributing factors associated with mental health in the African American community include: 1. Historical adversity; 2. Impeded access to insurance; and 3. The help-seeking traits of African American, whose traditional attitudes toward mental illness are considered a barrier in that they include stigmatization” (Hatcher, S., Toldson, I., Godette, D., & Richardson, J.., 2009, p.2).

Over the last few years, some courts have started using mental health court and drug court to make a difference. There has been some progress, but there needs to be more changes made within the court system. The laws need to be changed to treat a person using a combination of models rather than one model which just incarcerates the person. Incarcerating them does not treat the underlining condition.

In fact, the changes need to be made and implemented to help individuals before they are incarcerated. That is why it is imperative that these issues be addressed during childhood. The United States stresses physical check-ups for children, but they do not stress mental health check-ups. I would argue that mental health check-ups are just as important as physical check-ups.

There is no “One” intervention and treatment for individuals with co-occurring disorders that is the “Cure”. In fact, it appears that when you look at the interventions and treatments that are utilized among co-occurring disorders there is one similarity – multiple interventions and treatments are used. According to NIDA, there are thirteen principles of effective drug addiction treatment. Alcoholics Anonymous (AA) feels that there are twelve steps to the road to recovery. Then, there are others that believe in a sixteen step program. However, the Frequency of Prayer, Meditation, and Holistic Interventions in Addictions Treatment shows how some programs are “Endorsing the twelve step approach and the use of prayer, meditation, and holistic techniques” (Maharishi, 1994, p.1). What are prayer, meditation, and holistic approaches? How powerful are prayer, meditation, and holistic approaches?

            Let’s take a look at prayer, meditation, and holistic approaches, as applicable in the article. Prayer is a common technique that is used by individuals with a mental health diagnosis and a substance abuse diagnosis. “Spirituality is recognized as a potential important part of treatment” (Maharishi, 1994, p.1), as such it is encouraged if an individual has a spiritual belief. Meditation varies across the intervention and treatment practices. The three categories that were found in use were: “(1) Devotional meditation…; (2) other spiritual approaches that eschew thinking and contemplation…; (3) secular modification … secular meditation, relaxed awareness and focus of attention are used in a manner similar to that of Eastern spiritual meditation traditions” (Maharishi, 1994, p. 3). The article discussed the holistic techniques that were used, and it placed them in four categories: “(1) nutrition, exercise, relaxation and physical health; (2) recreation and adventure-based activities; (3) religious and spiritual practices; and (4) the use of specific modalities” (Maharishi, 1994, p.4). Is there power in prayer, meditation, and holistic approaches? Obviously, some people are influenced by prayer, meditation, and holistic approaches and others are not.

In order for a person to benefit from the treatment that they receive, they need to receive knowledge in regards to the Alcohol and other drug dependencies, along with information about their mental health diagnosis. The individual will have to work through the “Stages of change: pre-contemplation, contemplation, preparation, action, and maintenance” (White, (1998), p. 38-40). The individual should be given a diary to move between the stages. According to Addiction Intervention, it promotes moving between the stages by “(1) consciousness raising (increasing information about self and problems); (2) dramatic relief (experiencing and expressing feelings about one’s problems and solutions) and; (3) environmental re-evaluation (assessing how ones problem affects the environment and others)” (p. 43). It’s not easy to examine oneself; to look at the flaws and imperfections with an open mind and a willingness to change. It is even harder for a person with a co-occurring disorder.

When an individual takes action to stop the addiction, they are plagued with the symptoms of their mental illness diagnosis or vice versa.  Individuals with a co-occurring disorder have to fight the stigma society places upon them, and they have to fight the addiction and mental illness. That is a lot to place on anyone’s plate. Statistically, the chances of recovery for an individual with a co-occurring disorder are low. But, as time goes on and improvements are made (technology advances); the hope is that we will be able to help more individuals with a co-occurring disorder.

I have enjoyed the research and information that I have gathered this semester for this class (and the lectures). I look forward to the classes that I will take next semester and the knowledge that I will gather. I plan on putting the knowledge to good use within the mental health field and addiction field.

 

References

Child and Adolescent Mental Illness and Drug Abuse Statistics. (2009, March 18). American Academy of Child & Adolescent Psychiatry. Retrieved from http://www.aacap.org/cs/root/resources_for_families/child_and_adolescent_mental_illness_statistics

Gladwell, M. (2005). Blink. New York, NewYork: Back Bay Books.

Hatcher, S., Toldson, I., Godette, D., & Richardson, J.. (2009). Mental Health, Substance Abuse, and HIV Disparities in Correctional Settings: Practice and Policy Implications for African Americans. Journal of Health Care for the Poor and Underserved: Special Issue: Health Disparity Critical Issues, 20(2A), 6-16.  Retrieved October 15, 2010, from Research Library. (Document ID: 1777631601).

Maharishi Ayur-Veda; O'Connell, D. F.; Alexander, C. N., (1994). Introduction: Recovery from addictions using Transcendental Meditation. Alcoholism Treatment Quarterly; 1994 Vol. 11, p1-10, 10p. Document Type: article; DOI: 10.1300/J020v11n01; (AN ATQ.AA.A.OCONNELL.IRFAUT) Database: EBSCO Publishing Citations

King, K., Meehan, B., Trim, R., Chassin, L. (2006). Substance Use and Academic Outcomes: Synthesizing Findings and Future Directions. Addictions, December; 101(12): 1688-1689. doi: 10.1111/j.1360-0443.2006.01695.x.

Monti, P., Kadden, R., Rohsenow, D., Cooney, N., Abrahs, D. (2002). Treating Alcohol Dependance : A Coping Skills Training Guide. (2^nd ed.). New York, New York: The Gilford Press.

Reedy, A., & Hall, J. (2008). Treatment issues with substance use disorder clients who have mood or anxiety disorders. Mental Health & Substance Use: Dual Diagnosis, 1(1), 44-53. doi: 10.1080/17523280701741738.

White, R., & Wright, D. (1998). Addiction Intervention. Binghamton, New York: Hayworth Press.