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Complex Issues Require Complex Treatment

November 11, 2009
by Lynn Sucher
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I was recently giving a talk about identifying eating disorders in chemically dependent clients and received feedback from members of the audience that made a lot of sense. One woman mentioned she had been in inpatient treatment for alcoholism but remained active in her eating disorder, binging and purging the entire time she was in treatment. She underplayed her eating disorder and her counselors didn’t tackle the problem, as a matter of fact, she felt they avoided it. She quickly relapsed.

She entered another treatment center and the clinical team realized they had to treat both the eating disorder and her substance abuse issues concurrently. Fortunately for her, the team was well trained and developed a complex, individualized treatment plan. She said they were tenacious as far the eating disorder was concerned and she did the work she needed to do. She has been in recovery ever since.

So how do we treat clients who are diagnosed with more than one disorder? For example, someone who is diagnosed as chemically dependent, depressed, a gambling addict and is struggling with significant trauma? Where do you, as a clinician begin after detox? What do you tackle first?

It takes a highly skilled team to work with these issues as a whole and not place clients in “tracks”. I have seen the “non track” approach work very well at several facilities due to the fact that they developed integrated individualized treatment conducted by experienced clinicians.

So many treatment centers claim to work with “dual diagnosis”, but often, their programs do little to address all of their client’s issues or their clinicians are not trained in specific therapeutic modalities that are required for complex clients. If centers claim to treat dual diagnosis, I believe their program schedule and clinicians should reflect a high level of clinical sophistication.

It’s important treatment management understand the need to provide training for clinicians in order to offer a high standard of care. It’s also crucial for Clinical Directors to construct a program that is updated on regular basis, in order to best serve their client population.



Well said! Many clients really need individualized treatment in order to address all of those issues that are impacting them. How often does one go to residential treatment for only one major issue! As a clinician, ALL of my clients who have done inpatient treatment have done so due to the need to address more than one disorder or addiction.

I was employed by an organization that claimed to treat co-occurring disorders. What they did do, was to make sure that those diagnosed with mental disorders were taking their prescribed medications. What they did not do, was treat the disorder(s), along with the substance abuse disorder. There was not even a mere mention of mental illness during the duration of treatment. I had a client that had little- to no- self-esteem, evidenced by numerous sexual partners, physical abuse, and mental abuse. She was a beautiful 21-year old woman, who learned from a very young age that she could manipulate any man, at any time. She used her beauty and her body to keep them close to her. She had no relationship with her mother, and she abused the relationship she had with her father. She was a master of manipulation, thinking that the world owed her something because she has been victimized by the entire world because she was pretty, and everyone abused her. She even claimed that men physically fought over her, and actually had bidding forums, and the highest bidder was blessed with being seen on her arm. I began digging a bit deeper into her past records, and the same information was found, in all FIVE of her treatment episodes, treatment for heroin and alcohol addiction, all FIVE of them at this same facility. There is something terribly wrong with this picture, and she is the victim. She is victimized because she is insured and the bill is always paid, and no one says a word. Until I did!! I was told in no uncertain terms that I was never to bring up her 'other' problem, and I was to never offer her any therapy for her 'other' problem, even though I could. I am so happy that the field is going in a different direction, the evidence-based direction. I really wonder what will happen to the facility that I am referring to, as the dinosaurs there are firmly planted, none of whom have anything that even remotely looks like a degree, one that is compatible with addictions. This facility will continue to operate just under the radar, just as they have done for years. I am just thrilled that they will continue to do so, without me, because I believe we have to treat the whole person, not just the parts that guarantee payment.

So many times treatment centers still tailor their programs to what is covered by insurance. This decides what is treated. Many have what they call a "management protocol" to "manage" the other condition and just provide acute care for the primary condition. Traditional medically managed mental health care units do not provide the style or depth of care that addictions treatment routinely includes, not do they do justice to a basic addiction model of treatment. Clinicians often keep patients with multiple disorders even though their facility cannot address the full range rather than refer them to a style of facility that not only does not provide holistic care, but does not provide addictions treatment either. It is a shame.

Lynn Sucher

Lynn Sucher, MC,...

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