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This is the wrong door syndrome: the drama of patients with dual pathology

2022-12-09T11:05:22.956Z


Experts warn of the difficulty in diagnosing and treating addiction and other mental disorders in an integrated way


Eduardo Matute was 16 years old when he started using hashish and marijuana.

Then, to the addiction to joints, others were added: alcohol, cocaine and tobacco.

At the age of 23 he had his first psychotic break.

It took him almost a decade to receive a diagnosis: bipolar schizoaffective disorder, a variant of schizophrenia that combines the psychotic symptoms of schizophrenia with the states of mania and depression associated with bipolar disorder.

At 47, he tells EL PAÍS, he has not consumed hashish or marijuana for 14 years, and around eight years without consuming alcohol and cocaine.

“Now I am stable.

Sometimes I have crises, although now without psychotic or manic outbreaks thanks to the medication.

These crises are caused by stress, by time destabilization or lack of rest, but fortunately no longer by consuming ”, he explains.

Currently, Eduardo is under guardianship (under care) by the Madrid Adult Guardianship Agency (AMTA) and lives in a studio belonging to the Sociedad San Vicente de Paul in the heart of Madrid, a few steps from the Gran Vía. the path has passed through several supervised apartments and therapeutic communities.

Also for several relapses.

“Sometimes they give me an example to follow, but the truth is that young people don't need to have as many relapses and as many incomes as I have had.

With a good diagnosis of dual pathology, adequate treatment is achieved by good professionals.

In this way, the problem can be tackled sooner and remove a lot of suffering from patients and their families.

My mother has suffered a lot with me”, acknowledges Matute.

Néstor Szerman, psychiatrist at the Institute of Psychiatry and Mental Health of the Gregorio Marañón Hospital in Madrid and president of the World Association of Dual Disorders (WADD, for its isglas in English), explains the problem: “Eduardo was told that the psychosis he had it was as a result of cannabis use, so that led to what we call 'wrong door syndrome', which defines the difficulty in diagnosing and treating addiction and other mental disorders in an integrated way.

And he was like that for 10 years, when I started treating him and told him that his addictive disorder and his psychosis are different symptomatic expressions of a single disorder.

That single disorder is known as “dual disorder” and designates the clinical condition of the existence of an addiction and another mental disorder.

Part of a principle supported by scientific evidence: addictions are also mental disorders.

“You choose to use alcohol, cannabis, cocaine or tobacco, but no one chooses to have an addictive disorder.

Only 10% of people exposed to substances with addictive capacity end up developing an addiction, which in order to develop depends on the existence of a previous individual, genetic and neurobiological vulnerability", points out Szerman, who points out that, contrary to what might be thought Given the little knowledge of the concept, dual pathology is not the exception, but rather the norm.

According to various investigations by the US National Institute on Drug Abuse,

The wrong door syndrome

Lola Callealta, president of the Association of Relatives of Dual Patients (AFEDU), also ironically calls the wrong door syndrome “ping-pong therapy”, because dual patients go from mental health to drug addiction and vice versa without receiving a comprehensive treatment that responds jointly to all your disorders.

“Mental health treatment is fragmented.

What we generally consider mental disorders are treated on the one hand, while addictions are treated on the other, at a more local level, in centers that work very well, but do not have the essential figure of the psychiatrist," denounces Callealta. .

He knows what he's talking about.

From her own experience and as president of AFEDU, she has seen how many patients and her relatives (they are reluctant to give names because they fear the stigma that accompanies dual pathology) run into that wrong door barrier over and over again.

“I have accompanied many mothers from the association and I have seen in person how from psychiatry they referred their children to outpatient treatment centers until they stopped using.

And yes, by spending a while without consuming, they come out better;

but since there is no psychiatric treatment behind it, these boys and girls relapse easily.

It is the whiting that bites its tail.

There are real tragedies in families.

And especially in prisons, which are full of abandoned people with dual pathology, without treatment and without psychiatrists, ”she denounces.

The words of Lola Callealta are seconded by Dr. Carlos Roncero, head of the Psychiatry Service of the Salamanca Hospital and president of the Spanish Society of Dual Pathology, which calls for integrated treatment of all mental disorders in patients: "Parallel treatment [when there are two people or two teams treating the same patient] it is a complex model that often leads to failure due to coordination difficulties.

And trying to address the addiction first and then the mental disorder or vice versa has even worse results, because in the end patients are always on one leg: they are fine in one aspect, but relapse or decompensate in another”, he argues.

Addictions, a gap in the Mental Health Strategy

In Spain, psychiatric care was not included in the coverage of the National Health System until the approval in April 1986 of the General Health Law.

"Until then, psychiatry was marginalized and in the hands of provincial councils and local entities," recalls Dr. Néstor Szerman, who points out that that law, however, left out of the National Health System (SNS) people whose manifestation The most relevant clinic is addictions, whose care ended up in "parallel and marginal networks with respect to the SNS that depend on town halls, councils and autonomous communities".

"Addictions have always been the poorest or least valued branch of psychiatry," adds Dr. Carlos Roncero, who considers that this conception has its historical reasons, since in some periods "official psychiatry" rejected addictions, especially to illegal substances such as heroin or cocaine.

“It was considered that addictions were a matter of bad social environments, bad company or the presence of drugs on the streets.

Fortunately, due to the fact that times are changing, the actions of scientific societies such as ours, and a greater sensitivity of professionals and families, a new perspective is appearing on addictions that are accompanied by other mental disorders and on the need to make a good approach from the psychiatric point of view”, he affirms.

Lola Callealta, president of the Association of Relatives and Dual Patients of Cádiz (Afedu), this week, at the organization's headquarters.Juan Carlos Toro

However, Szerman denounces, despite the fact that all international classifications include the conception of addiction as a mental disorder, the NHS Mental Health Strategy still does not incorporate the concept of dual pathology.

“It would never occur to anyone that the devices that treat anorexia are not coordinated.

Well, in the case of addictions it is like that.

Mental disorders and addictions are treated in separate compartments and patients always find themselves before two different doors, with disastrous results”, laments the psychiatrist.

While the incorporation of the concept of dual pathology into the Mental Health Strategy of the SNS arrives and, with it, the generalization of the integrated treatment that psychiatrists, patients and relatives demand, Eduardo Matute continues trying to stay away from the stimuli that arouses in anyone the surroundings of an area such as Madrid's Gran Vía.

“On the Gran Vía there is a lot of temptation.

Many times I have gone down to the bazaar that I have under my house to buy a Coca-Cola and my gaze has escaped towards the beer, but I have spent many years making an effort.

The treatment helps me not to have the desire to consume and I do not associate with people who consume, which is the fundamental thing, ”he says.

On Mondays and Wednesdays Eduardo goes to play sports at the ONCE gym on Calle de Prim, on Thursdays to a craft workshop at ONCE itself, and on Fridays a psychoeducation group goes to the CPRS of Hermanas Hospitalarias in Retiro, where he also receives psychiatric treatment to stabilize his mental disorder.

The rest of the time he goes to exhibitions, he meets friends he has made in the sheltered apartments, he walks, watches the news and, above all, listens to a lot of music and tries to have healthy routines so as not to become destabilized.

Before saying goodbye to the journalist, Eduardo is very clear about what his last message should be: "Addictions are not a vice, they are a mental disorder."

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Source: elparis

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