Addiction Counseling – Dual Disorders Recovery Counseling (DDRC)
Dual disorders recovery counseling (DDRC) is an integrated approach to treatment of patients with co-morbid psychiatric disorders and chemical, marijuana, alcohol, methamphetamine, cocaine and other drug use disorders. The DDRC model, which integrates individual and group drug addiction counseling approaches with psychiatric interventions, attempts to balance the focus of dual treatment so both the patient’s addiction and psychiatric issues are addressed.
The DDRC model is based on the assumption there are several treatment phases patients go through. These phases are rough guidelines delineating some typical issues patients deal with and include:
Phase 1 —Engagement and Stabilization. In this phase, patients are persuaded, motivated, or involuntarily committed to addiction treatment. The main goal of this phase is to help stabilize the acute symptoms of the psychiatric illness and/or the drug or substance abuse disorder. Another important goal is to motivate patients to continue in treatment once the acute addiction crisis is stabilized or the involuntary commitment expires. Dealing with ambivalence regarding recovery, working through denial of either or both illnesses, and becoming motivated for continued care are other important goals during this phase.
This phase usually takes several weeks, but for some patients it takes longer to become engaged in recovery and to stabilize from the acute effects of dual disorders.
Phase 2 —Early Drug Addiction Recovery. This phase involves learning to cope with desires to use chemicals, alcohol, cocaine, meth or other drugs; avoiding or coping with people, places, and things that represent high-risk addiction relapse factors; learning to cope with psychiatric symptoms; getting involved in support groups, such as Alcoholics Anonymous (AA), Narcotics Anonymous (NA), Cocaine Anonymous (CA), Rational Recovery (RR), Dual Recovery Anonymous, or mental health support groups; getting the family involved (if indicated); beginning to build structure into life; and identifying problems to work on in recovery.
This phase roughly involves the first 3 months following stabilization. However, some patients take much longer in this phase because they do not comply with addiction rehab treatment, continue to abuse drugs, experience exacerbations of psychiatric symptomology, or experience serious psychosocial problems or crises.
Phase 3 —Middle Addiction Recovery. In this phase, patients continue working on issues from the previous phase as needed. In addition, patients learn to develop or improve coping skills to deal with intrapersonal and interpersonal issues. Examples of intrapersonal skills include coping with negative affect (anger, depression, emptiness, anxiety) and coping with maladaptive beliefs or thinking. Interpersonal issues that may be addressed during this phase include making amends, improving communication or relationship skills, and further developing social and recovery support systems. This phase also focuses on helping patients cope with persistent symptoms of psychiatric illness; drug use lapses, relapses, or setbacks; and crises related to the psychiatric disorder. It also focuses on helping identify and manage relapse warning signs and high-risk relapse factors related to either illness.
The middle recovery phase involves months 4 through 12, although some patients never get much beyond early recovery even after a long time in treatment. Patients who are treated for an initial acute episode of psychiatric illness with pharmacotherapy in addition to DDRC and who do not have a recurrent or persistent mental illness may be tapered off medications during this phase. Patients are usually not tapered off medications until they have several months or longer of significant improvement in psychiatric symptomology.
Phase 4 —Late Recovery. This phase, also referred to as the “maintenance phase” of recovery, involves continued work on issues addressed in the middle phase of recovery and work on other clinical issues that emerge. Important intrapersonal or interpersonal issues may be explored in greater depth during this phase for patients who have continued abstinence and remained relatively free of major psychiatric symptoms.
This phase continues beyond year 1. Many patients with chronic or persistent forms of psychiatric illness (e.g., schizophrenia, bipolar disease, recurrent major depression), or severe personality disorders such as borderline personality disorder, often continue active involvement in treatment. Treatment during this phase may involve maintenance pharmacotherapy, supportive DDRC counseling, or some specific form of psychotherapy (e.g., interpersonal psychotherapy). Involvement in support groups continues during this phase of recovery as well.
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