With over 30 years experience in behavioral health, Clinton Weyand, Psy.D., CAADAC, gives us deep insight on dual diagnosis and co-occurring disorders and how they are treated properly.
You can fix a broken arm, but addiction you can not fix in the same way. You have to think of time and commitment and keep your program fresh. You always have to keep things interesting.
Dual diagnosis would be like somebody that has both the severe depression and alcohol dependence or alcohol abuse … there might be like 40 different co-occurring disorders or even more so you have to treat both. There’s been some debate in the field, do you treat the psychological disorder first or do you treat the addiction first and, you know, the current consensus is you really have to treat both simultaneously and then both have to be fine tuned and I tried to explain that to clients that both treatments have to be fine tuned.
It’s extremely important that you’re identifying everything the client is dealing with and I say don’t string them along to fit a system which some people do. You can’t impose something on yourself and some of the programs just do … they might just treat the addiction and say, “Well you’ve learned … we’re going to unlearn the addiction that you taught yourself,” and then they skip over or miss a lot of the personality issues like with narcism, its entitlement, grandiosity
If somebody cuts you off on the freeway, most people have a really quick thought, that’s an asshole or he did that deliberately. Now, I’m going to do something to him. I’m going to tailgate him or I’m going to try to run him off the road and they ought to have an aggressive thought about it so CBT would say, “Wait a minute, you really don’t know that. He could be in a medical emergency. He could be having a kidney stone.” A lot of things could have … like he could have dropped his glasses or something. He might be having some other difficulty. The first step is just to be aware of the thoughts. Then the second step might be to either substitute a healthier thought or put in another thought. Sometimes, the awareness is enough.
We found it’s pretty much effective with everybody as long as the therapist connects with their client and if they feel understood and they feel hurt, it just got a very wide range of applications so we use CBT with the personality disorders, social phobias, severe depression, almost everything, there are even some new things of people using what they call narrative to the CBT with psychotics, they use some things like that because it is dealing with thoughts. It’s a very powerful therapy.
Not really that we know of. There are some clients who might say, “Oh it’s too mechanical for me” or some clients that are very intellectual and you have to connect with them emotionally because they sometimes see, “Oh this is just another theory” or this is just another intellectual thought. “Gee, if I could read … I read a million books, if I could read a book to help myself, I would be cured. I wouldn’t have to talk to you.”
Sometimes, they think that it’s a intellectual exercise when it’s really not. So sometimes if that’s the case we’ll modify it a little bit or we’ll do like I say narrative therapy with him where they tell the different story of their life. We would probably use some other techniques if they really had an aversion to the CBT. Then sometimes they do better and because we also use psycho drama and smart recovery.
That’s the big deal is that if you don’t have an eye to recovery, you’re in trouble and then we also try to educate the family. The biggest myth of the family is I’m sending my son or daughter to Malibu. We’re paying some money and insurance and are you going to fix them? We want them fixed in 30 days and send them back to us fixed and then we can go on to some other deal. We have to educate the family. “No, please don’t sabotage your son or daughter and please support them.” Recovery takes time. Maybe they developed this addiction over 4 or 5 years. It takes more than 30 days to have an impact on it.