Are you having back pain with any of the following?
We understand that you are experiencing one or more of the health issues that might be impacting your back pain.
We recommend that you discuss these health issues with your doctor before proceeding with this program.
Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.
Dual diagnosis is a term that describes the condition when a person has a mental or emotional illness and a substance abuse problem.
Substance abuse can commonly occur with mood disorders, including depression or bipolar disorder; anxiety disorders, such as panic disorder or post-traumatic stress disorder; or psychotic disorders, such as schizophrenia.
For example, someone with post-traumatic stress disorder (PTSD) who has experienced a traumatic event and has nightmares or significant anxiety reliving the event may use alcohol or other substances to cope with the emotional distress. Any emotional relief a person might feel from the substance does not last long, however, and soon the substance has the effect of only worsening a person's symptoms, emotions, and overall ability to function in life.
It is not always clear if the substance abuse or the mental illness began first. Treatment is most successful when it addresses both the mental illness and the substance abuse. Treatment typically includes psychological counseling, alcohol and drug abuse rehabilitation, and possibly medications, depending on the type and severity of mental illness the person has.
A person with a dual diagnosis will have symptoms a mental illness and substance abuse. For instance, the person may have signs of depression, including sadness, irritability, and fatigue, and also may use alcohol in excess amounts.
The symptoms of substance abuse are related to the recurrent use of alcohol or drugs despite negative consequences. Common examples include missing work, school, or neglecting to take care of other major obligations such as children, financial commitments, and important relationships. Often those that abuse substances will continue to perform activities while under the influence that could cause harm to self or others, such as driving while intoxicated. Substance abuse can often lead to the diagnosis of substance dependence, which involves an even greater disruption to life and functioning.
The symptoms of substance dependence can be loosely grouped into 3 categories:
Self-destructive behaviors often occur with substance abuse and may include neglecting important responsibilities and having legal and relationship trouble.
As part of your evaluation, we will ask you about your mental health and medical history. We may also ask you about your life growing up and how you are currently experiencing relationships, work, school, and other activities. In order to better understand your situation, we may also cover areas such as:
Substance abuse can affect organ function. For example, excessive alcohol use can damage the liver. We may order lab tests to determine if this has occurred and to help us monitor the condition.
Both the substance abuse condition and the mental illness must be treated for full recovery. Treatment of the comorbid (co-occurring) disorders should be integrated. As dual diagnosis conditions are chronic, the treatment should be viewed as long term. Relapses of substance abuse or recurrence of the mental illness may be expected. Once sobriety is achieved, treatment focuses on the mental illness and on staying free from the substance. Usually, the person receives treatment from a team of physicians and counselors.
Every substance of abuse has a well-characterized set of withdrawal symptoms. Depending on the substance, the symptoms of withdrawal may:
An evaluation will help clarify which withdrawal symptoms you are most likely to experience if you stopped using a particular substance. It may take a few days to a week or more to detoxify. During this time, the person may be given medications to ease withdrawal symptoms.
Typically, treatment includes psychological counseling and may also include medications. An individual with a dual diagnosis may be worried about taking any psychiatric medication due to a mistaken belief that all psychiatric medications are addicting. There are medications that can be addictive, especially for those with a history of substance abuse or dependence. However, there are other medications that can be used safely and with great benefit to those with dual diagnosis. Depending on the mental illness that is being treated, one of the following classes of medication may be used:
It may take several weeks for medications to become effective; however, it is important to continue taking them. Side effects may occur, which will be discussed during the office visit.
Remember that substance abuse can worsen the symptoms of the mental health illness or make treatment less effective. A person who is abusing alcohol or substances may be less likely to follow the prescribed treatment plan.
It is common to experience relationship problems with the person who has a dual diagnosis. Substance abuse can result in financial and legal problems, or in high-risk behaviors that may end in inadvertent harm to themselves or to others. In addition, many of the mental illnesses that occur in a dual diagnosis can make these problems worse.
People with a dual diagnosis often struggle with accepting that they truly have a substance use problem and can at times resist treatment or not comply fully with their treatment plan. This can be challenging not only for the clinicians treating them, but also for those who live with them or care about them. You may be able to help support the person to continue with their treatment, but you should never feel responsible if they fail to follow the treatment plan. Early in the treatment, helping transport the person to a support group meeting or medical appointment, or other types of support, may help facilitate the recovery process. However, because this is a chronic illness, relapse is common. Once again, you should not feel responsible when there are setbacks. Always remember that you are not to blame, and your behavior cannot cause someone to become addicted to a substance.
Being close to someone with a dual diagnosis can at times be exhausting or disruptive to your own life. Frequently, there may be a need to set firmer boundaries with the individual. Many families benefit from involvement in support groups, such as Al-Anon, whose focus is helping loved ones cope with a family member suffering from substance abuse issues.
During your first visit, I will ask you about what symptoms you have been experiencing and what brought you to seek treatment at our department. I will also ask you about other aspects of your life, for example, your mental health and medical history as well as how you are currently experiencing relationships, work, school, and other activities.
I will then develop a unique and individualized treatment plan in collaboration with you to help bring you greater well-being and functioning in life. I may also discuss additonal services, including individual or group psychotherapy, behavioral health education classes, and medication management visits, as appropriate and indicated. I can also familiarize you with community resources and self-care strategies.
If you need to talk with me after your visit, please feel free to call my direct office line. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.
If you have urgent concerns or issues while my office is closed, you can call our main clinic telephone number and you will be connected to the mental health call center. Our main clinic number is available to you 24 hours a day, 7 days a week.
If you are experiencing an emergency, call 911 or go to the nearest Emergency Room.
Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.
Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.
When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.
For lab tests, we use our electronic medical record system to send a requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the Radiology department. When the results are ready, we will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any any comments we may have attached to explain them.
If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.
As your provider, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I encourage you to become familiar with the many resources we offer so that you can choose the services that work best for you.
We developed the My Doctor Online website to make it easier for you to understand and manage any mental health issues you may be facing. You will find useful information regarding mental health conditions and treatment resources. From my home page you can also:
• View and compose secure e-mail messages.
• Manage your prescriptions.
• View most test results.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.
• Read about causes, symptoms, treatments, and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.
• Locate health education classes and support groups offered at every medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.
If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.
This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.