Co-Occurring disorders are a very serious situation which require extremely delicate care from the patient perspective. Counselors play a very important role in people’s life whether it’s providing a service to someone who has a dual diagnosis or someone whose primary diagnosis is a substance use disorder. It can be very difficult for a counselor who is specialized in chemical dependency to understand other mental disorders. It is also very difficult to find a counselor who understands all mental disorders including substance use disorders. People who battle both substance use disorders and mental disorders have a very hard time understanding what resources are available to them, if any. Their mental disorder may block them from comprehending their substance use disorder and they may not be consciously aware of how the two go hand in hand. Even worse, they may feel isolated and in certain situations may not have the ability to obtain what is critical to save their life (such as homelessness). It is also important for counselors to be trained on non-addictive, legal drugs that dual-diagnosed patients need to take to keep their mental disorders stable. Without these medications they have a very high chance of relapse. Counselors have a lot on their plate when it comes to helping people who battle substance use disorders as it is very important for the counselor to know when other mental illnesses need more attention than what they give. Not recognizing other mental illnesses or vice versa; creating a mental illness that may not be there, can be very detrimental to the outcome of the treatment and this is the crux of the issue with co-occurring disorders.
When counselors attempt to treat clients who have co-occurring disorders (mental disorder + substance use disorder) it is critical that they treat both equally. They must understand how the two disorders play together and must use individual techniques that work in treating both disorders. Abstinence is always practiced in treatment but there are definitely times when working with clients who are dual-diagnosed when abstinence is unrealistic. Therefore, the individual treatment must cater to the uniqueness of the client.
Counselors play a different role when providing treatment to clients who have only a substance use disorder versus patients with co-occurring disorders. First, they must rule out other mental illnesses and if they are successful then focusing on the substance use disorder fully is their primary goal. Everything will revolve around substance abuse and it is important to not use techniques and theories that are used for mental illnesses that are unrelated. This could hinder the outcome and could confuse the client into thinking that there are other things going on with them than just substance abuse problems. When working with clients who have only substance abuse disorders then it is realistic to expect them to practice complete abstinence as long as their living situation permits. If they struggle with their living environment then a primary goal should be a change to their situation in order to practice abstinence.
In the end, counselors have one goal and that is making sure the client is stabilized. Some clients will need long term counseling to keep the stabilization whereas; others may only need some counseling with a long-term life plan. Regardless, counselors should be aware of their own limitations and not be afraid to acknowledge that they are working with a client who may need something more than they can give. Continuing education is very important for counselors to practice as new thoughts and research goes underway especially with co-occurring disorders.
Center for Substance Abuse Treatment. Substance Abuse Treatment for Persons With Co-Occurring Disorders. Treatment Improvement Protocol (TIP) Series 42. DHHS Publication No. (SMA) 05-3922. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2005.