Our focus on recovery-oriented therapy for the dual disorders of depression or bipolar illness combined with a substance use disorder begins with a brief discussion of an integrated dual disorders model of treatment, the concept of recovery, factors mediating recovery, the continuum of care for dual disorders, and stages of change and phases of recovery. The major thrust of this chapter is discussing the biopsychosocial issues in recovery associated with mood and substance use disorders, substance use lapse and relapse, mood disorder relapse, and the ongoing use of recovery tools. Numerous clinical issues and strategies face patients and families experiencing dual disorders. Our model of integrated dual disorders recovery therapy (DDRT) draws on clinical strategies used in addiction counseling (Daley and Marlatt, 1997a, 1997b), cognitive therapy (Beck, 1995), behavioral skills training (Liberman, DeRisi, and Mueser, 1989), interpersonal psychotherapies (Frank and Kupfer, 1994; Weissman, Markowitz, and Klerman, 2000), motivational interviewing (Miller and Rollnick, 2002), and relapse prevention (Daley and Marlatt, 1997c). DDRT assumes that there are several possible relationships between substance use and mood disorders: (1) mood disorders are a risk factor for substance use disorders, (2) substance use disorders are a risk factor for mood disorders, (3) a mood disorder can complicate recovery from addiction or contribute to a substance use lapse or relapse, (4) a substance use disorder can complicate recovery from a mood disorder and contribute to relapse or recurrence, and (5) these disorders can develop at different points in time and not be meaningfully linked. Our recovery-oriented model posits that there are different phases of treatment for dual disorders, and each phase has therapeutic issues and interventions associated with it as well as criteria with which clinicians can determine the progress of a patient. DDRT uses both individual and group modalities to educate patients, teach coping skills, and help resolve personal problems contributing to or resulting from the disorders. More background information leading to the development of this recovery-oriented treatment model and the description of clinical applications can be found in other publications (Daley and Moss, 2002; Daley and Thase, 2000). In addition, given that many dual disordered patients, especially those with persistent and chronic forms of mental illness, have severe levels of psychopathology with numerous psychosocial problems (e.g., homelessness, unemployment, and limited income) and deficits (e.g., lack of vocational skills), they often benefit from referral to ancillary or social services such as vocational training, public assistance, food banks, or shelters.
|Original language||English (US)|
|Title of host publication||Integrated Treatment for Mood and Substance use Disorders|
|Publisher||Johns Hopkins University Press|
|Number of pages||22|
|State||Published - Jan 1 2003|
ASJC Scopus subject areas
- Social Sciences(all)