A wise Mind Presented by Sabino Recovery S1 EP 10

In this episode of A wise mind presented by Sabino Recovery, host Sam Zimmer sits down with the Chief Medical Officer at Sabino Recovery, Dr. Aaron Wilson M.D. Sam and Dr Wilson discuss exactly what dual diagnosis or a co-occurring disorder is, the importance of treating the individual when they have a dual diagnosis and how Sabino Recovery treats those suffering with a dual diagnosis. View Dr. Wilson’s full bio on our staff page.

Sam Zimmer: [00:00:00] Welcome back to a Wise Mind podcast presented by Sabino Recovery. I am joined once again by Dr. Aaron Wilson. How’s it going, Dr. Wilson?

Aaron Wilson: It’s going well. Pleasure to be back.

Sam Zimmer: Yeah, happy to have you back. Uh, today what I wanted to talk about was dual diagnosis as, as long as we have the medical professional here. Might as well have you explain that not everyone knows what dual diagnosis is, and I was hoping you could maybe kind of inform us on, you know, what it is and what does.

Aaron Wilson: Yeah, no, absolutely. So, dual diagnosis has been around since the eighties. It really, the gist of it is it’s, you know, having both a mental health diagnosis as well as, uh, substance use diagnosis.
And, you know, some of the, some of the, probably more recent terminology has been like co-occurring disorders. And so whether that means you have, you know, depression in addition to having alcohol use disorder, um, it’s just they, they have to both be present and they can’t be directly caused by the other.

Sam Zimmer: Gotcha. Yeah, no, I think that’s definitely something that kind of, [00:01:00] you know, you read dual diagnosis, the layperson may not really fully understand what it means. Um, so, and then beyond that, you know, beyond not even knowing what it means, how can someone identify that they have a dual diagnosis?

Aaron Wilson: Yeah. I think, you know, working with, with your, whether it’s your therapist or a, a mental health professional in general or, or in a treatment center, you know, such as Sabino Recovery, as a, as a treatment community, we’ve gotten a lot more sophisticated, we’ve gotten a lot better at looking for those things, you know, really if somebody presents with, you know, uh, abusing alcohol for, for example, you know, I think as a, as a team and a community, we’ve done a better job of figuring out the, the treatment of course, for that, but also looking for any other, any other issues that are going on.
Right? So we’ll do a lot of screenings for, you know, as you were growing up, did you struggle with depression? Did you struggle with anxiety? And then, you know, really the, probably the most common would be, you know, if you, if you had suffered any abuse, have you been through some pretty traumatic experiences?
And, and I think that we’ve become more [00:02:00] savvy at that, you know, here at Sabino Recovery, we really are looking at things through that lens and really looking at, and really, we, we say that we’re, we’re looking at things through a trauma lens just to see if we’re missing any of those things. It could be, it could be a pre-curser.

Sam Zimmer: Right. Absolutely. And you know, that’s one thing that’s so great about Sabino recovery is how well positioned we are with how small we are and how many eyes on we have, how many professionals like yourself we have in, you know, as part of the clinical team. Top to bottom is how we’re able to kind of individualize things and pivot. Right. So, you know, dual diagnosis, there are any number of combinations, right? Of somebody who comes to our treatment. Whether it’s, you know, anxiety, depression, eating disorder, um, aspects of trauma. So another thing I kind of wanted to talk about, you know, we are a trauma facility. Like you said, we see things through a trauma lens. What kind of role can trauma play in causing dual diagnosis or maybe the way that we treat somebody with a dual [00:03:00] diagnosis?

Aaron Wilson: Right. You know, I think trauma, trauma manifests whether it’s, you know, fully diagnosed PTSD or just traumatic experiences that people have been through. Really manifests in a, in a number of different ways for a lot of people.
And, and it’s drastically different in a lot of people, you know, men and women even manifest some of those symptoms differently. And so I think it’s having a team of people that can look at it. Like you mentioned, there’s a, a team of professionals looking from multiple different angles. Getting that three-dimensional view of what’s going on with someone is, is really, really important.
You know, symptoms of, of trauma, of course, can, can manifested in multiple ways. You can see depressive symptoms, you can see anxiety, you can see a lot of people self-medicating with, with substances and of, and again in treatment centers, you know, like Sabino Recovery. It’s, it’s, it’s probably the rule rather than the exception that somebody has been through some traumatic experiences and what, what I find is really interesting is, You know, a lot of folks will say that, you know, my experiences weren’t traumatic because I just [00:04:00] heard this other, this other resident share their story, and mine is nothing like that.
And so one of the, one of the big areas of emphasis for us is helping people realize that their experiences are unique to them, and it was traumatic for them and helping them process that it is not, you know, trying to compare yourself and saying, well, they have it worse than I do somewhere else. It’s just helping people understand that those experiences shaped who you are.
And they, they shape how you try to manage and cope with that, with that stress.

Sam Zimmer: Yeah. And one thing you said is like, you know, the exception or it’s more the rule, not the exception, that somebody has some kind of trauma. And I, I would think that it’s the same way for a dual diagnosis. Right. Probably pretty uncommon for somebody to come in here with just one issue. I mean, there might be one issue that’s more prevalent, but there are gonna be a couple other things that we would like to address while they’re here. And you know, I know that when I went to treatment, um, Having one thing that was wrong with me was enough was, you know, enough for me to try to admit Right.
I probably didn’t want to admit that [00:05:00] I had a number of things wrong with me. Which was definitely the case. So I think there is kind of a stigma around dual diagnosis, which means, you know, there’s kind of, we need to talk about it more. Right. How is, how important is that to kind of normalize it and, and tell somebody that, you know, it’s okay. It’s something that everyone goes through,

Aaron Wilson: right? Yeah. I think, I think it’s critical. I think, you know, normalizing it for people, having them feel heard and you know, also sharing their experiences, learning how to share their experiences. You know, step one, it’s, it’s being able to open up and talk about that.
And I think our clinical team does a tremendous job of really making it a safe environment, right? People are not gonna bring open up about that if they don’t feel like the container they’re in is gonna, is gonna hold them and, and get ’em through it. And so providing that safe, that safe environment surrounding them with people who maybe have shared experiences or, or similar experiences enough that they can process through that who can actually empathize and, and feel that and, and help them, you know, navigate it.

Sam Zimmer: So, [00:06:00] absolutely, and I think that’s one thing about our treatment center and, and just, you know, residential treatment in general is that community aspect and knowing that you’re not alone, because you know, if you’re just going to see your therapist once or twice a week, you know, you’re not getting the experience from your peers that can kind of put your mind at ease that, okay, I’m not alone. I don’t have to go through this alone. So I think that’s really important to definitely touch on too. You know, the community aspect here, while there is a ton of individualized therapy, you also have, you know, 20, 25 other people with you at the same time that are gonna have your back and hold you accountable, making sure you’re doing the right things, and definitely fosters an environment where somebody can really get better.

Aaron Wilson: Oh yeah. The sense of community is, you know, it’s tremendous. I think you just, you see groups out there supporting each other, talking through things and going on outings and experiences and just building those bonds.
And I think that’s also just, you know, the alumni that, that have been through here and, and continue to, to stay [00:07:00] in contact with each other. They come back for alumni events. I think that just really speaks to the connections of bonds that are built while people are here, and then they just maintain those as they, as they move forward.

Sam Zimmer: So obviously with dual diagnosis, there are two or more, in some cases, things going on simultaneously. So as a medical professional and the person who’s in a lot of cases treating these folks, How do you treat all those things at the same time when they’re kind of blended together and, you know, riffing off each other? I’m sure it can be pretty confusing and, um, yeah. Can you speak to that a little bit?

Aaron Wilson: Yeah, no, it’s, it’s definitely a, it’s a clouded picture, you know, especially if, if somebody’s coming in, whether they come here to detox or they have, you know, done that somewhere else and they come here fresh out of a detox. You know, that’s a, it’s a, it’s a difficult time. There’s, it’s a cloudy picture.
There’s, I mean, in general, people are not feeling well physically or mentally when they, when they first get out. You know, there is, there is something that we would call substance induced, right? So [00:08:00] whether it’s while they’re intoxicated with a substance or immediately during the withdrawal. It’s not a great time to be trying to diagnose somebody with depression, anxiety. It’s just because generally speaking, they probably would light up criteria for all of the, during that acute phase. So it’s really important to us that we have diagnostic clarity.
Part of how we accomplish that is giving people time to settle in. Let’s really try to get a good idea of what your baseline is. In addition to that, let’s get some historic data. Let’s talk to you about life before you, you came into treatment. What it was like for you growing up? You know, did you have depression? Did you have anxiety? Early adulthood, or honestly even into adolescence.
And so getting that perspective is very helpful. Giving them time to settle in and establish a baseline here is effective. I think that’s one of the advantages of being in a slightly longer program is we, as the clinical team and the medical team, have more data, we have more touchpoints of, every time I meet with you, I’m gonna [00:09:00] ask a few questions specific to that to see if as, as your treatment progresses, Am I picking up on some major depressive disorder undertones or what, what’s going on?
And so I think it’s really important, you know, I, I do see some clinicians that will, will say, Hey, you’re, you’re detoxing, but, oh, I think you have schizophrenia as well, but oh, by the way, they were using stimulants or methamphetamine. So it’s just, it’s so cloudy that you just have to let people settle in and, and get a better, better view.

Sam Zimmer: Yeah, totally. And I think, you know, that process starts on the first time somebody calls us. Right? I. If there is any cloudiness, which there usually is, we’re getting medical records, we’re talking to family. We’re talking to past providers like the psychiatrists and the therapists to really get that clear picture so that we can hit the ground running with somebody before they get here. Cause we don’t want to waste any time. We are a longer length of stay program, but, or we can be, but you know, as much of a head start we can get that. that person’s treatment.

Aaron Wilson: Well, I think every minute [00:10:00] counts. Yeah, exactly like you said, I think you, you hit it right on the head. It’s that you don’t wanna waste anybody’s time and, and if they’ve committed to taking time away from their life and their loved ones and they are here, we want to have all that information ready, as much as we can get, and then we’re gonna need to gather more.
But just on day one, when I sit down with a patient, do their evaluation, or a team is doing their evaluations, I don’t want to meet a patient and say, Hey, Tell me everything. I wanna say, Hey, I’ve, I’ve done my homework, I’ve gathered this information, does this seem accurate? Let’s walk through this.

Sam Zimmer: So once we do get a little bit more clarity in situations like that, what’s the next step after that? What do you do?

Aaron Wilson: You know, I think diagnostic clarity is, is the foundation that all of the treatment is built on, right? If you don’t know what you’re treating, how do you, how do you treat it, you know, properly. And so I think once our team has a better idea of, of what you might be struggling with it, it really helps us to hone in on those treatment options. So we do, we do a psychiatric evaluation, we do neuropsychological testing, and again, it’s just [00:11:00] all gathering data so that we have that, that three-dimensional view of what might be going on for somebody.
Part of our philosophy here, you know, we are a, a very clean prescribing, uh, clean treatment center from the standpoint of, you know, we get a lot of patients who will come in and they’re like, Hey, I, they bring out a duffle bag of medications and they say, Hey doc, these are my 16 diagnoses and these are my 32 medications.
We start going through that and looking at. You know, do you know why you take all these, do you and sub-therapeutic doses of different meds that potentially interact with each other? So that diagnostic clarity helps us to know what, what we should continue out of there. Our vision is always just to make sure every, if there is a medication, which again, not everybody even takes a medication here, but if, if there was the necessity for something, every medication links up directly with, with an indication, right?
We wanna make sure your diagnosis matches up with your meds. We want that to be the cleanest, most precise [00:12:00] combination we can have. Our goal is when people leave here, if they did take medications, I want them to know exactly what it’s for, what to anticipate, what, how long you’re gonna take that, and I want it to be a dose that’s therapeutic for you.
And so we’re probably our, our biggest vision as far as that is clean prescribing and making sure that everybody understands what we’re treating so that they’re, they have that buy-in and they’re, they’re on board with it.

Sam Zimmer: Yeah, no, I think that’s awesome. I mean, nobody wants to be on any unnecessary medication, and a lot of times they’ve been through a number of psychiatrists for whatever reason, and they come in here with, like you said, you know, a long a laundry list of medications. So, Doing what we can to kind of like streamline that and, you know, make sure that they’re not taking anything that they shouldn’t or need and be taking. It’s just gonna make it a lot more stress free for them and obviously probably make them feel better too.

Aaron Wilson: Yeah, yeah. Well, and we, and we do that in partnership with their, you know, the community providers.
So let’s say you’ve been working with a psychiatrist back home. We will communicate with them, you know, my, [00:13:00] my biggest kind of push on that front is just that if you’ve been working with somebody for years and years back home, they know you well, they know what you’ve been on. They know what you’ve tried.
We don’t want you to come here and feel like a Guinea pig, and we all of a sudden are like, oh, that’s great, but here we do this. So we wanna make sure it’s a warm handoff from your outpatient team. Any decisions or any treatment decisions we make here, we do that in collaboration with your outpatient team so that everybody’s on the same page.
Because then when you’re leaving here and you have, whether it’s just pure therapeutic approaches or, or medications are involved, we want that to be a warm handoff right back to your provider, and we need them to be on that same page.

Sam Zimmer: Okay. So we’ve talked about dual diagnosis, we’ve talked about how we treat it here at Sabino Recovery, but just taking a step back, I wanted to ask you, is there like a combination of diagnoses, um, as far as the dual diagnosis goes that we see that’s more common. Um, maybe one that we just see more than the others.

Aaron Wilson: Yeah. You know, I think [00:14:00] just in general, probably the most common or most common combinations would be trauma in addition to a, a substance, right? So you’ll see trauma with alcohol use or, or things that people typically use to try to numb that out or just suppress the nervous system.
Um, you also will just see people that have a history of depression. Or a history of significant anxiety that, again, they may have started to lean towards self-medicating at some point. Um, we’ll see people that had started using benzodiazepines, which progressed as it, as it stopped being able to manage that anxiety and so that it will kind of be a slippery slope into some sort of addictive process.
Um, the, the, the challenge of course, is, Almost all, if not all, substances that people are using, which initially they were using to self-medicate or to, to quiet their nervous system. The unintended consequences that the almost all of them will cause worsening depression will cause rebound anxiety that you would not believe, and then you, of course you have [00:15:00] to up the dose or up the frequency of, of whatever you’re using. Um, and the same holds true for trauma plus the, the substance as well.

Sam Zimmer: Yeah, definitely. I mean that’s, I think that’s something that most people who are new in recovery kind of feel the effects of and it’s why it’s so hard for someone to break that cycle. Cuz like you said, it, it kind of is a pretty quick downward spiral when you’re having depression and anxiety.
You’re treating it with whatever, fill in the blank drug. You’re using to get rid of those feelings, but those drugs actually make those feelings come back with a vengeance. So it’s just back and forth until eventually it becomes unbearable. Yeah. So that’s definitely something that we see here quite a bit.

Aaron Wilson: No, absolutely. And, and I think providing a, a safe environment for people to recalibrate and learn how to, to sit with some of those feelings. You know, I think that that is where there is a lot of utility in a residential treatment center is just being in a, in a safe space. Having medical professionals and therapists on [00:16:00] board to, to provide that psychoeducation and say, Hey, listen, what you’re experiencing is miserable. We have some solutions for you. This is what we can do.
Being able to lean on your peers who have probably had similar experiences so that you don’t feel. That you’re the, you’re the only person that this effort has ever happened to, and what has everybody else done to, to help.

Sam Zimmer: Yeah. I like that. We, we educate people on kind of like the science behind exactly that process.
And then in addition to that, like you said, they hear other experiences and how maybe this person has gotten some relief and maybe I’ll try what they tried.
What’s great about Sabino, as you know, is that we have so many different modalities and so many different recovery models that we subscribe to. It’s really just about finding what works for that person, because obviously the main goal is to break that cycle and give somebody some long-term relief from those issues and feelings of anxiety and depression and all that stuff.

Aaron Wilson: Yeah, no, I think the integrative approach and what we do here is that, you know, as you mentioned, we don’t, it’s not one size fits all.
It’s, there’s multiple different, you know, [00:17:00] viewpoints and different, you know, approaches to medicine, whether it’s east or west or which, whichever, wherever you prescribe or wherever you kind of believe. Um, we also have naturopaths that work with us. We, we do lots of different therapeutic modalities that help you regulate your nervous system and reconnect with your body and, and all those types of things.
So, It’s great because you’ll find what you need. You may not know what that is, but you’ll find what it, what it is that resonates with you. It helps you heal. We don’t ultimately tell you what that is. We just give you a lot of different tools, expose you to a lot of different treatment modalities and what sticks for you and what really hits home. Of course, we then will set you up with those services where, where you’re from, you know? I think that’s, that’s the key.

Sam Zimmer: Well, we’re very lucky to have you. I really appreciate you coming on our podcast and telling us a little bit about these more medical issues and how your team goes about treating them. I think, uh, I definitely have learned a lot more sitting here with you and I hope our listeners have too.

Aaron Wilson: Yeah. Thanks so much for having me.

Sam Zimmer: Yeah, thanks for being [00:18:00] here. Appreciate it. And to our listeners, thank you for listening to a Wise Mind podcast presented by Sabina Recovery. To listen to more episodes, just search a Wise Mind presented by Sabino Recovery in your chosen podcast platform, we discuss topics that can be difficult to process on a wise mind. There is no shame in seeking help for resources or to find someone to talk to. Please visit the links in the description below.