Why research is not about your problems – co-occurring diagnoses


By David Joel Miller.

Feeling left out? You probably have been.

Have you had difficulty finding information that applies to the problems you are facing? You are not alone. The latest research usually doesn’t apply to your condition and should you find a relevant article it may end with the statement, this treatment has not been studied in patients with X, Y or Z.  In the mental health field this issues is especially acute, “acute” meaning sharp and painful not “a cute” as in nice to look at.

Most people don’t have only one problem. We have many, many problems. So when we look for treatment we want something that might help us. When people have multiple problems we call that dual diagnosis or co-occurring disorders. You may have two mental health diagnoses, maybe more. Sometimes this is called multi-occurring or even “complex.”

Most people with a mental illness will meet the criteria for two or more conditions. Overlap between substance abuse and mental illness is the rule not the exception. People with mental illnesses are more likely to develop an addiction or substance abuse disorder than those without mental illness.

People with a mental illness often have physical illness. People with an earlier physical illness are more likely to develop a mental illness. If you are seriously and chronically ill you might be a little depressed and anxious wouldn’t you?

As a therapist and a blog writer I am always looking for the latest in research, things that might help my client. There are some new things, but frankly there are a lot of studies that are not very helpful.

Most studies exclude from their population anyone who had a substance abuse problem until they are clean and sober for at least 6 months or more. They also exclude from studies those who have had a psychosis such as schizophrenia.

Most of my career has been spent in substance abuse facilities, crisis units and psychiatric hospitals. Clients there have the greatest need for new effective treatments. They also have the most co-occurring disorders.  The newest treatments have not been tested on the people who need the help the most.

Drug companies would love to play this game. Many psychiatric meds cause weight gain. This excess weight gain can result in obesity and diabetes. So if I am a drug manufacture and want to minimize side effects which I need to report to the government I would want to exclude a person who had diabetes, better yet let’s leave out anyone who is overweight. When it comes to drug companies there are regulatory agencies that keep an eye out for this sort of thing, with psychotherapy not so much.

Recently I have been doing some reading on the problems relation to treating people with PTSD. We need to find better ways to help people with this condition. Right now there are lots of possible treatments but even the big names in therapy don’t seem to agree on the best approach. If therapists don’t agree on the best treatment how is the client to know if the treatment will help or harm them?

Most of the clients I see who have PTSD also have other problems. Substance Abuse is common. With those recurring intrusive memories that keep you from a good nights sleep for years on end would you be tempted to drink?  Most of the “controlled” studies on PTSD exclude anyone with a substance use disorder or psychosis. These are the clients for whom we most need to find better treatments.

People who have a combination of PTSD and depression or substance abuse are at greater risk. Does it make sense to exclude high risk clients from efforts to evaluate treatment for high risk clients?

Recently I came across a study on a new treatment for PTSD. I won’t spoil the fun by telling you whose study this was.

The introduction sounded good, till I read further. They excluded from their study anyone with Bipolar Disorder, Psychosis or a history of addiction. By the time they got done excluding they were down to less than ten subjects. They had excluded more people than they included. To me this means they should have gone the other way and tried this new treatment on the people with the most problems, the larger group. When they did their study they found out that all but one of their subjects had a history of alcohol abuse. While they had screened out current alcoholics they missed that all the people they serve had at some time or other had an alcohol problem.

A further concern should be mentioned here. Treatment should not make a client worse. Some of the current treatments for PTSD seem to make clients worse off, the treatment can retraumatize them.  Treatments that are too painful result in clients dropping out of treatment. I continue to believe that people do not benefit from treatment they do not receive, no matter how great the treatment looked in a research study.

I will post more about treatments for PTSD as I wade through the newer studies.

For more blog posts on PTSD, substance abuse or Co-occurring disorders see the newly revised list by categories to the right.

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For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books

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One thought on “Why research is not about your problems – co-occurring diagnoses

  1. Pingback: Types of Mania and Dual Mania | counselorssoapbox

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