The diagnosis of depression follows two (2) years of persistent symptoms of hopelessness, irritability, fatigue and ennui, possibly including suicidal thoughts or attempts. “Major depressive disorder is one of the most common mental disorders in the United States.” After other possibilities are controlled (thyroid, heart conditions, substance abuse, etc.), treatment for depression likely includes medication and psychotherapy; most prescriptions require 4-6 weeks to reach the effective dose. (For unresponsive severe depression, ECT has shown to be highly effective, with few long term side effects.)
The Mayo Clinic lists numerous post-considerations in combating alcoholism (and other addictions), after the substance is no longer accessible and detoxification has safely completed. These other considerations include individual and family-systems training, a spiritual practice, medical and psychological treatments. Detoxification often requires medical supervision, related to length of use and the dependence of the body on the substance; alcohol and opioids are particularly dangerous during withdrawal. In all situations re: detox, seek professional medical advice.
Many families wanting a clinician, pediatrician, or psychiatrist for a particular diagnosis starts with the medical professional known to them. The family doctor or family therapist may refer to professionals (such as endocrinologists, neurologists, psychologists) able to perform formal testing to confirm or clarify a particular diagnosis. If investigating possible therapeutic disorders, (neuro)psychologists can perform tests to assess a differential diagnosis (ie mental or behavioral changes, depression, etc.), to provide a baseline of information against a particular treatment, reveal daily functioning (i.e., to understanding cognitive or behavioral treatment or types of therapy that could be needed)
Caveat: if a teen is seeing a clinician for assessment and diagnosis or having formal testing, the assumption is that the student is healthy (i.e., not intoxicated or on recreational drugs, is well rested), is somewhat interested and engaged in the 2-5 hours of testing.
For the purposes of this website, many treatment facilities which specialize in Diagnosis and Assessment provide clinical oversight and many have formal assessment pieces too, but the key difference is that the participant is not experiencing success in a home environment and is in an intentional residential or wilderness therapy setting, because the participant is not interested or engaged in their process. These settings allow for stabilization of the client to ensure the participant is psychiatrically and behaviorally stable before valid assessment and diagnosis can occur.
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The first of 4 pillars of Dialectical Behavioral Therapy focuses on skills training, to help the client practice acceptance and to become familiar with living with cognitive dissonance through the behavioral skills of Zen Buddhism mindfulness. These skills promote Mindfulness, Distress Tolerance, Interpersonal Effectiveness and Emotion Regulation.
“dialectical” means the synthesis of opposites and helps describe the skill and the mission of this therapy - the practice and goal is to simultaneously accept the current situation while acknowledging that it must change. DBT was initially created to work with chronically suicidal borderline clients, and entails 4 major aspects: behavioral skills training, phone coaching and individual therapy and lastly, therapist support through ongoing consultation. While DBT has been shown to be effective in drug dependence, depression, PTSD and eating disorders, it is commonly the first and foremost milieu for borderline treatment. DBT has been designed for outpatient therapy, but some residential treatment facilities have used it and have significant training and are listed in the Behavioral Tech Directory. Some of the programs on this site are listed.
Overcoming a drug addiction requires will power, possibly requires medical support (see Detox), individual and group addiction-specific therapeutic support, extensive practice with coping skills and relapse prevention. Self-help support groups, often using the 12 Step model or other group support, help decrease the sense of shame and isolation that can trigger a relapse. The need and acceptance (not to mention the economic expansion) of sobriety residential programs underlines the value for structure, experience and community for the most-difficult early cravings. Because almost ⅔ of clients diagnosed with substance dependence disorder have a co-occurring mental disorder, programs must include integrated treatment with different types of therapy woven into the treatment process. “We are also increasingly learning that these poorer outcomes result as much from these separate and contradictory systems of care as from the diagnoses themselves…”
Any psychological difficulty combined with drug or alcohol addiction is qualified as “dual diagnosis”, as both disorders combine to create a sum very different from the individual parts and treatment of dual diagnosis is more complicated. Many people with mental illness “self medicate” with drugs or alcohol, and are therefore very susceptible to develop dependence.
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