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Comorbidity occurs when people have two or more illnesses or disorders at the same time. Individuals who have co-occurring disorders (sometimes still referred to as dual diagnoses) have at least one substance use disorder and at least one comorbid non-substance-related mental health disorder, such as depression, a personality disorder, bipolar disorder, a trauma- and stressor-related disorder, an eating disorder, etc. These cases can often be more challenging for treatment providers despite their prevalence.
In a residential treatment program, the client lives in and gets treatment in the same facility. Typically, residential treatment programs are not hospital units or inpatient psychiatric units. Those treatment programs are typically reserved for individuals with very acute issues who require 24-hour medical supervision or psychiatric care, whereas individuals in residential treatment facilities require intensive treatment but do not need the intensive level of monitoring around the clock that occurs in a more acute setting.
Because residential treatment programs do offer a lower level of 24-hour monitoring and access to care, they are designed for individuals who need intensive treatment, may be coming out of an inpatient psychiatric or substance use disorder treatment unit, or have certain types of conditions/disabilities that result in it being very difficult for them to function without supervision.
Individuals with co-occurring disorders often require intensive treatment. These individuals need to have concurrent treatment for both (or all) of their mental health disorders, including their substance use issues and other psychological disorders, at the same time. Because these individuals need multiple interventions from different mental health specialists, individuals with co-occurring disorders are often treated by a multidisciplinary team of healthcare providers who specialize in different disorders.
According to the book Integrated Treatment for Dual Disorders: A Guide to Effective Practice, this is often referred to as an integrated treatment approach because the treatment for individuals with co-occurring disorders integrates specialists from different fields. The multidisciplinary team will most often consist of:
The team will typically work together to assess the functioning of the individual, make the specific diagnoses in the person, and develop a treatment plan for the individual. Each individual specialist will address their area of expertise. The team will communicate through the use of progress notes and team meetings.
The American Society of Addiction Medicine categorizes treatment levels for substance use disorders according to their intensity. These treatment levels can also apply to integrated treatment.
Level IV: Medically Managed Intensive Inpatient Treatment
Residential treatment (Level III) for the treatment of substance use disorders can occur in numerous different settings, including short-term residential abilities, long-term residential facilities, halfway houses, and even in institutions involved in the criminal justice system. There are no hard and fast rules to decide which type of individual should be placed in a residential treatment program. Most often, individuals entering residential treatment programs are in subacute crisis situations, such that their needs are too intense to be fully addressed in an outpatient treatment program, but the situation is not severe enough to warrant hospitalization. This can include individuals who are being transitioned to a lower level of care from inpatient treatment, individuals with cognitive or physical disabilities, or individuals with severe substance abuse issues or psychiatric issues that do not require 24-hour medical supervision but do require close monitoring and intense treatment.
Additional circumstances may benefit from residential treatment.
For some individuals with co-occurring diagnoses, a lower level of care such as outpatient treatment may be more appropriate than residential treatment, whereas for others, residential treatment may be a more appropriate starting point than outpatient treatment.
Individuals with severe issues may need inpatient treatment (Level IV). There are some other advantages to placing individuals with co-occurring diagnoses in residential treatment facilities if the facility meets the needs of the individual.
There are several general advantages to using residential treatment facilities to address issues with individuals who have co-occurring diagnoses. These advantages are only present if the facility has the resources to address the specific types of substance use disorder and co-occurring psychological/psychiatric diagnosis that the individual presents with. According to the principles of treating co-occurring disorders described in the book Treating Co-Occurring Disorders: A Handbook for Mental Health and Substance Abuse Professionals, these advantages are:
Thus , while it is always important to remember that treatment should be personalized for the individual needs of each client, residential treatment facilities offer specific advantages in the early stages of treatment of those with co-occurring disorders. They help these individuals transition to more independent living with significant progress regarding their treatment goals already under their belt. This fosters a more successful prognosis in the long-term.
It should be understood that the residential treatment portion of an individual’s overall treatment program is only one step in their recovery from a substance use disorder and any other co-occurring diagnosis. Once they are discharged from the residential treatment facility these individuals should be transitioned to some form of aftercare program, most often some type of outpatient aftercare program in order to ensure long-term success. Individuals who do not transition to a structured aftercare program run the risk of relapsing. An individual who relapses back into their old substance abuse habits will most likely begin to experience other issues that led to their co-occurring diagnosis, such as depression, anxiety, etc., or they are more likely to no longer engage in treatment for their co-occurring psychological disorder. While residential treatment can be an extremely crucial component of overall recovery, it is only one step in the process of recovery from co-occurring disorders.