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Substance Abuse/Dual Diagnosis

Drug abuse, which can include tobacco, alcohol, narcotics, and even prescription pills, is a prevalent problem in our society that can take a tremendous toll on a person’s mental and physical well-being. Addiction can happen to anyone from any background, social status, race, gender, or sexual orientation. Although some people are genetically at a higher risk for substance abuse than others, oftentimes substance use and subsequent abuse are triggered by other external factors such as family, environment, peers, etc. In addition, unresolved traumas can cause a person to self-medicate with drugs and alcohol in order to suppress unwanted feelings and/or memories. Substance abuse can also be caused by or result in mental health concerns such as anxiety and depression, resulting in a dual (or co-occurring) diagnosis.

Symptoms of Substance Abuse/Dual Diagnosis

Because there can be many combinations of dual diagnosis, symptoms vary widely. Some of these symptoms include things like withdrawing from family and friends, changes in behavior or engaging in risky behavior,  developing a high tolerance or experiencing withdrawal symptoms from a substance, as well as needing the substance to function. Other symptoms can be more related to mental health, such as mood changes, anxiety, depression, trouble with concentration or comprehension, and even suicidal ideation/behaviors.

Diagnosis of Substance Abuse/Dual Diagnosis

The symptoms of substance abuse and mental illness often closely resemble one another. This makes an accurate diagnosis a very difficult task. People with substance abuse are often misdiagnosed with bipolar disorder, anxiety, depression, and psychotic disorder dues to symptoms presentations directly caused by the substance(s) used. Although DSM-5 is clear that a diagnosis of mental disorder cannot be assigned if substance use is present and prominent, many people receive a diagnosis of mental health while under the influence of substance(s). Conversely, sometimes mental health is not diagnosed because all symptoms are contributed to the substances. In both cases, people are affected significantly as their treatment is inadequate and unsuccessful. 


For instance, too often people are being overmedicated upon achieving sobriety because they have been misdiagnosed during their substance use with a debilitating disorder that they do not have. Antipsychotic medications, heavy mood stabilizers, and sedatives are among the medications that are usually prescribed along with substitution treatment drugs such as methadone, buprenorphine, and suboxone. As a result, despite their sobriety status, many of these people cannot return to productive and fulfilling lives because of the side effects of these debilitating polypharmacological practices. On the other hand, failing to diagnose a mental illness because of substance use, it can hinder a person’s recovery and increase the risk of relapse. 


At Nelmar Health Centers, we put an enormous significance on the diagnostic process. We work diligently to uncover the root causes of all symptoms and to carefully differentiate a mental illness from substance-induced symptom presentations mimicking mental health disorders. 


We begin the process of diagnosing substance abuse/dual diagnosis by conducting a comprehensive psychological evaluation, which involves a combination of various assessments and observations and a collection of information from multiple sources, such as schools, parents, partners, coworkers, etc. Due to well-known findings that substance use significantly affects cognitive functioning, neurocognitive testing is often utilized during the assessment so that we can establish a baseline cognitive functioning before the beginning of the treatment. We also use a qEEG brain scan as a supplemental measure to examine the areas of the brain that are functionally out of balance. Understanding the underlying physiology helps us detect the factors contributing to the clinical and behavioral problems and design the most appropriate treatment. In addition, we conduct a whole-body diagnostic assessment that looks at a client’s nutrition and lifestyle habits, medications they are taking, as well as a thorough review of family and medical history, to explore all the factors that may be contributing to and exacerbating a client’s symptoms. This information is then used by our multidisciplinary team to create a treatment plan that is custom-tailored for every unique situation.


Previous Opioid agonists buprenorphine and methadone prevent opioid withdrawal symptoms and reduce craving for opioids.

Treatment of Substance Abuse/Dual Diagnosis

The best treatment for Substance Abuse/Dual Diagnosis is integrated interventions that target both issues. At Nelmar Health Centers, we tackle both issues from a holistic perspective. 


Studies have shown significant impairments in multiple cognitive domains in heroin-, morphine-, and methadone-dependent individuals. The deficits are primarily found  in memory, information processing, and problem-solving. In fact, research showed that a single dose of methadone could negatively impact on episodic memory in opiate users (Tolomeo et al 2019). It is a well-known fact among clinicians and patients alike, that cognitive symptoms occur in the opioid-dependent population because opioid-substitution treatment with the long-acting opioid agonists methadone and buprenorphine disrupts the way the brain handles cognitive processes. Moreover, based on the current practice the opioid agonists are often administered along with high level psychotropic polypharmacy (use of two or more classes of psychotropic medications). This not only increases the deficits in  cognitive functioning, slows reaction time, and diminishes alertness, but also leads to multiple metabolic issues that increase the risk of heart disease, diabetes, and early deaths.  


At Nelmar Health Centers, we take these findings very seriously and we fight against the widely accepted practice of overmedicating. A major part of our treatment plan addressing substance use/abuse is medication management. Although opioid-substitution treatment plays an enormous part in achieving sobriety by preventing opioid withdrawal symptoms and reducing craving for opioid, people do not need to be on these substitutes for longer than they need to. Our professional trained in prescription medication carefully evaluates the psychoactive medications utilized by the client. As a result, drugs that directly contribute to individuals' cognitive problems are gradually eliminated or significantly reduced. This approach also ensures a healthy brain and strong body and freedom from dependence on multiple drugs leading to debilitating side effects. At Nelmar Health Centers, we believe in the research showing that the healing and maintenance of well-being are best achieved with cognitive, behavioral, environmental, and lifestyle changes strengthened with ongoing social support.


Another essential part of the treatment plan is neurofeedback, where we work directly on the brain using neuroplasticity in order to reorganize neural networks to facilitate healing. In addition, various evidence-based psychotherapy modalities are utilized in the treatment. For instance, we integrate Cognitive Behavioral (CBT) techniques into the treatment plan  to teach you the skills you need to complete the body and mind cycle and support your efforts toward achieving your goals. Family and group therapy are excellent treatment modalities during which we provide psychoeducation about the symptom presentations and increase knowledge and immediate support. In addition, our counselors support these interventions with mindfulness and art techniques to complete the body and mind cycle and support your efforts toward achieving your goals. 


The treatment plan also includes sessions with our holistic health practitioner and exercise expert. They educate you on how diets filled with processed foods and exposure to environmental toxins can contribute to increased symptoms and make recommendations for dietary and lifestyle changes as well as massage with essential oils performed by our massage therapist, which will achieve stress reduction, and improve mood and sleep. Finally, our trauma-informed meditation and yoga classes are a great way to promote a healthier lifestyle, enhance your treatment plan, maintain the gains you have achieved, and be a part of our small community where you can meet friends and find understanding and social support. 


While undergoing treatment, each client receives continued qEEg,  psychological, and cognitive testing to monitor progress and provide psychoeducation to ensure understanding of where they are in their healing at every step of the treatment process. We regularly modify the neurofeedback protocol and the overall treatment plan based on this information. Every change in the treatment plan is made after a thorough review by each multidisciplinary team member and approved by the client. 


For clients that may need more rigorous treatment interventions, we also offer an Intensive Outpatient Program (IOP) and a Partial Hospitalization Program (PHP).

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