Dual disorders is a term used in the past to refer to clients who deal with substance abuse problems and mental disorders. Nowadays we use terms such as co-occurring or comorbid disorders. All it means is that there is one or more problems in addition to the original problem. Clients with substance abuse problems usually deal with poly-substance abuse and one or more mental disorders. Then, it is much more complex than just thinking of a client with cocaine addiction and bipolar disorder. In reality, we encounter clients abusing more than one substance and presenting symptoms for one or more mental disorders. Therefore, it is important for substance abuse counselors and therapists to be well-trained in both substance abuse assessment and mental disorders assessment. Clients are often misdiagnosed with mental disorders as the main problem, when the real case is that the client’s symptoms could be the product of the substance(s) being abused. Since several symptoms of substance abuse and mental disorders overlap, counselors and therapists need to have the skills to identify the main problem and the co-occurring problem.This is a brief outline about dual/co-occurring/comorbid disorders

1. Co-Occurring Disorders
   • Substance abuse problems combined with mental disorders
   • Counselors/therapists can treat clients with co-occurring disorders by mastering basic approaches
2. Models of Training
   • Scientific Professional Model
     1. Training of psychologists and psychiatrists
     2. Classroom teaching of “facts”

1. Traditional addictions counseling training
2. Based on personal experience and on-the-job apprentice-style training and supervision

There advantages and disadvantages of both, but can be overcome by combining them.

• First Steps
  • Learn about the disorder

1. Read available literature on the topic
2. DSM-IV

• Assess the client carefully

1. Avoid misdiagnosing clients due to overlapping of symptoms between the effects of a drug and a mental disorder
2. Is there a mental disorder, regardless of the substance abuse problem?
3. Is the substance causing the symptoms? (e.g. schizophrenia, paranoia, depression due to substance use)

• Learn what to avoid in treatment

1. Do no harm

• Learn appropriate treatment strategies

1. Help the client maintain sobriety and the mental disorder under control by providing good after-care.

1. Become familiar with the client’s medication
2. Medication should be monitored closely

Psychiatric and Psychological reports

• Impulse control
  • Client’s tendency to act on feelings, thoughts, or impulses
• Level of functioning
  • How well clients manage their impulses
• Affective expression
  • Client’s style of emotional expression
• Cognitive functioning
  • Client’s level of intelligence
• Perceptual functioning
  • Nature and frequency of client’s perceptual disturbances
• Reevaluation

• Avoid undermining treatment
• Encourage AA or NA involvement
• Supervision

• Well-trained addictions therapists/counselors can skillfully treat the psychiatric disorder and the substance abuse disorder
• Competence in the brief therapies is needed
• Cognitive Behavioral Therapy (CBT) is one of the most effective ones.

Reference: Dual Disorders – David F. O’Connel