My Doctor Online The Permanente Medical Group

Symptoms

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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:

• Loss of control of how the substance is used. For example, a person makes repeated, unsuccessful attempts to reduce the amount of alcohol consumed.
• Negative consequences from the substance use. A person continues drinking alcohol despite the awareness of liver damage from excessive alcohol use.
• Physical tolerance or withdrawal. A person needs to drink increasingly greater amounts of alcohol to obtain the same "high" or "buzz."

Self-destructive behaviors often occur with substance abuse and may include neglecting important responsibilities and having legal and relationship trouble.
 

Diagnosis

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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:

• When your symptoms started.
• If you have ever been treated for any mental health issues in the past.
• Frequency and amount of alcohol or drug use.
• Negative consequences resulting from alcohol or drug use.
• Loss of control over how the substance is used.
• Increased amounts of substance used due to developing a physical tolerance.
• If other members in your family have experienced psychiatric illness or substance abuse.

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.

Treatments

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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. 

Detoxification

Every substance of abuse has a well-characterized set of withdrawal symptoms. Depending on the substance, the symptoms of withdrawal may:

• Be mild and brief.
• Primarily involve emotional symptoms, such as feelings of depression.
• Include physical symptoms that are not medically dangerous, such as nausea.
• Involve medical symptoms that can be severe or even life-threatening, such as alcohol withdrawal seizures.

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.

Treatment for the mental health disorder

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:

• Antidepressants, such as fluoxetine or sertraline, treat depression, anxiety, and obsessive-compulsive disorder.
• Mood stabilizers, such as valproic acid (Depakote), are indicated for bipolar disorder.
• Antipsychotics, such as olanzapine or risperidone, treat hallucinations and delusions.

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.

Helping Someone You Care About

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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.

Your Care with Me

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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.

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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.

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Coordinating Your Care

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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.

If you come to an office visit

• As noted above, during your first visit I will ask you questions about the symptoms you may be 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.
  

If medications are prescribed

• Your therapist and psychiatrist will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let us know which pharmacy works best for you, and we will send the prescription electronically in advance of your arrival at the pharmacy.

If refills are needed in the future, you can:

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy.If no refills remain when you place your order, the pharmacy will contact us regarding your prescription.

If lab testing or imaging is needed

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 refer you to another specialty colleague

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.

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Convenient Resources for You

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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:

Manage your care securely

• 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.

Learn more about your conditions

• 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.

Stay healthy

• 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.

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