One Size Does Not Fit All
Diagnosis: The Key To Finding The Right Rehab
Diagnosis Must Match The Rehab’s Licensure
By Walter Wolf
How often do we hear someone remarking, “You oughta send him to that place…I hear they do a great job,” upon finding out about someone’s son or daughter needing addiction or mental health treatment? “They” do a great job at what? The first question to ask is if its licensure matches the individual’s diagnosis.
Recently, I accompanied my wife to one of her business-related banquets where I was introduced to one of my dining companions. And it happened again. Upon her questioning of what I do, Karina’s look of polite interest morphed into one that’s become familiar to me, “Oh my God, someone who understands what my family is going through.”
Like the other 74 million families in our nation wrestling with addiction and/or mental disorder, Karina is climbing the Mt. Everest of learning curves in getting the right help for her son’s psychosis. The question is, what is the right treatment for him, where can he get it and how can we pay for it?
Diagnosis > Substance Use Disorder (SUD)
Karina’s situation is something all too common: what is his exact diagnosis? Is it substance use disorder that’s driving a mental disorder or a mental disorder that driving the substance use? A tool professionals use as a guide in formulating an SUD diagnosis is the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The DSM-5 lists eleven diagnostic symptoms that define whether there is a disorder and, if so, the severity of it:
● Using in larger amounts or for longer than intended.
● Wanting to cut down or stop using, but not managing to do it.
● Spending a lot of time to get, use, or recover from use.
● Craving for the substance.
● Inability to manage commitments due to use.
● Continuing to use, even when it causes problems in relationships.
● Giving up important activities because of use.
● Continuing to use, even when it puts the user in danger.
● Continuing to use, even when physical or psychological problems may be made worse by use.
● Increasing tolerance to the substance.
● Withdrawal symptoms.
Fewer than 2 symptoms = no disorder; 2-to-3 symptoms = mild disorder; 4-to-5 symptoms = moderate disorder; 6 or more symptoms = severe disorder.¹
Diagnosis > Mental Disorders
Since addiction is a disease of the brain, it frequently occurs with other mental disorders. The Substance Abuse and Mental Health Services Administration (SAMHSA), states that 40–60 percent of all those suffering from a substance use disorder also have an accompanying mental disorder — 80% in my experience. Either way, today’s research indicates that both illnesses should be treated in an integrated fashion.
But what do treatment professionals mean by the term mental disorder? Generic mental illness is broken down into one broad category : any mental illness (AMI) and serious mental illness (SMI). Both categories are not mutually exclusive — AMI includes all mental disorders while SMI is a more severe subset of AMI.
An adult having any mental, behavioral, or emotional disorder in the past year that ranges from none to mild impairment for two weeks or less, all the way up to full-blown schizophrenia, has an AMI. Adults with AMI are defined as having SMI if they have any mental, behavioral, or emotional disorder that substantially interferes with or limits one or more major life activities. Symptoms of SMI include the inability to work, function in school, interact with family, and fulfill other major life activities. The most common mental disorders treated include depression, anxiety and PTSD due to trauma (physical, mental, sexual, experiential).
Diagnosis > Process Addiction
Although drug and alcohol addiction suck up most of the oxygen, there are other addictions that are no less serious and are treated as chronic brain diseases. Process addiction is an addictive behavior that does not necessarily involve substance misuse but is obsessive conduct that compels the individual to engage compulsively and repeatedly in behavior detrimental to the individual. Examples of obsessive behaviors include eating disorder, gambling, pornography, sex & intimacy, gaming and codependency to name a few.
Process addiction treatment is highly specialized and only a few select facilities know what they’re doing. Do not go near one that says they treat “everything,” and when asked about process addiction they say “Oh yeah, we treat that too.”
Diagnosis > Assessment
In lieu of an upfront, in-person diagnosis by a healthcare professional — frequently due to criminal justice issues, the individual is in urgent detox/stabilization at the moment or he must be taken to treatment NOW before he changes his mind — an over-the-phone assessment of the individual by a facility is often the starting point for the treatment process. In those cases, the integrity of the facility doing the assessment is of vital importance since they need to confirm that they and the individual are the right clinical fit. If the treatment is insurance-driven, the assessment must also match the insurance company’s guidelines for medical necessity.
Additionally, the individual must be alone during that call in order to be completely honest and truthful about his drug use and/or mental disorder behavior — I mean everything. Confessing those details in the presence of a parent or family member often constrains his truthfulness. Intake is the thorough assessment at the facility which begins the process of detox, if necessary, and then evidence-based treatment during residential (inpatient) stage.
The Right Diagnosis = The Right Treatment Plan
Like other chronic diseases, addiction and mental disorder can be managed through the right treatment plan that includes lifelong mutual support, and a self-management system that is customized to fit the individual and his or her resources.
The key in finding the right treatment for the right individual is to determine the individual’s diagnosis, his personal and resource-related factors then matching them with the facility that best fits that individual’s profile and a one-year customized treatment plan.
By the way, I arranged treatment for Karina’s son at a facility that fits his profile. He was admitted and is now in treatment.
Next: What is Treatment?
Walter Wolf is the pen name of a 30-year veteran of the movie and television industry who produced studio and independent films and television throughout the United States, Australia, and South Africa. That all changed in 2010 with one 3 A.M. call that a family member was in crisis due to addiction. Today, he is an interventionist who matches adults and adolescents with the optimum treatment program and facility for their particular diagnosis, demographics, financial and personal needs. In order to demystify and explain in layman terms what treatment is and how to get it, Wolf wrote The Right Rehab which became the only step-by-step guide for vulnerable families navigating the confusing world of addiction and mental disorder treatment, health insurance and recovery.
To know more about interventions and finding the right treatment for you or a loved one, read The Right Rehab or go to www.therightrehab.com or call Walter Wolf at 1–310–210–4334.
Footnotes
[1] Diagnostic and Statistical Manual of Mental Disorders (DSM-5 (R)), American Psychiatric Association, https://www.amazon.com/Diagnostic-Statistical-Manual-Disorders-Hardcover/dp/B08GSNT6G2/ref=sr_1_3?crid=2URKKJSRVC3Y3&keywords=dsm-5+diagnostic+and+statistical+manual+of+mental+disorders&qid=1652799976&sprefix=dsm%2Caps%2C93&sr=8-3
