In the process of diagnosing a patient at dual diagnosis treatment centers should be evaluated for the possibility of a mental disorder and substance dependence disorders. In addition, it is necessary for an interview and periodic inspection in connection with psychiatric symptoms or symptoms of substance dependence to complete diagnostic evaluation. There are some principles in the diagnosis and treatment of patients with dual disorders, namely:
– Stabilisation of acute psychiatric symptoms or symptoms of substance dependence and acute
– It should be observed in patients with substance dependence to be free of substances for 3-6 weeks before making a psychiatric diagnosis and plan for long-term therapy
– Treat the disease effectively, because if not then it will not bring significant improvement. Treatment should be supportive and non-judgmental.
– Counselling addiction and or Alcohol / Narcotics Anonymous itself is not an effective therapy for patients with dual disorders when done alone.
– The attitude of confrontation and stiffness in patients with dual disorders should be avoided to make patients stop taking the drug/substance at the start of therapy.
– The frequency of treatment should be done 2-3 times a week until the stabilisation phase for both diseases is achieved.
– Provide therapy to a clinician or with one program, because when treated with two different therapists, will be needed discussions between the therapist and patient can manipulate the therapist.
– Relapse is more apt to occur in patients with dual disorders, but it does not mean previous treatment failed.
– Be careful of reaction transferences and countertransferences. Patients usually want a cure or treatment given ultimately failed.
– Give the full encouragement to the patient.
After the determination of diagnosis, the clinician needs to think about the relationship aetiology of psychiatric symptoms and substance dependence. There are three hypotheses:
– The existence of a psychiatric disorder causing substance dependence disorders.
– The presence of a substance dependence disorder that causes mental disorders.
– Symptoms of psychiatric and substance dependence occur together