This model, sometimes referred to as the Drake model for Dartmouth researcher Bob Drake, MD, takes the stance that both the substance abuse/dependence and psychiatric illness need to be treated at the same time and in an integrated fashion. While this makes intuitive sense, it does represent a turnaround in treatment practice. Up until very recently, and there are still many proponents of this approach, it was believed that you had to get one under control before you could start to work on the other issue.
In the dual diagnosis model, the approach to treatment is person-centered and incorporates the concepts of stages of change theory. That is, when someone is trying to change a behavior, they go through typical stages that include:
• Pre-contemplation: “I don’t have a problem.”
• Contemplation: “This could be a problem.”
• Planning: “What can I do about this?”
• Action: “I’m changing my behavior to make the problem go away, or at least be less.”
• Consolidation of gains, sometimes referred to as relapse prevention
• Termination, the problem is no longer an issue
In the DD model, having an appreciation for where someone is, related to wanting to change a behavior, guides treatment. It’s an attempt to match the person with interventions that are more likely to help. A good example of this might be someone who is currently manic and abusing cocaine and alcohol. They might not think there’s any problem whatsoever (a precontemplation stage of change), thus for this person, interventions might include hospitalization, medication, and possibly detoxification. Three months later, this same person might be in a stable mood but struggling with cocaine cravings and occasional relapses with alcohol, despite trying to be abstinent (an action stage of change). Interventions at this point might include an outpatient substance abuse program and twelve-step self help groups such as Alcoholics Anonymous (AA), Narcotics Anonymous (NA) and/or Cocaine Anonymous (CA).
DD treatment relies heavily on a therapeutic technique called motivational interviewing or motivational enhancement that keys in to the person’s stage of change and helps her move forward.