Interview with Dr. Gutiérrez, psychiatrist and technical director of Chanaes treatment facility (Dianova Uruguay)
World Mental Health Day is observed on October 10 every year with the overall objective of raising awareness on mental health issues while fighting stigma, myths and false ideas that are most often associated with mental health. On this occasion we have interviewed Dr. Maximiliano Gutiérrez, psychiatrist, resident physician and technical director of Chanaes, a center operated by Dianova Uruguay, specializing in the treatment of the dual pathology.
Chanaes is a residential public centrer operated by the Dianova Uruguay Foundation, in coordination with the National Network of Drugs (RENADRO). Chanaes facility is specialized in treating men between 15 and 24 years presenting a dual pathology. Inaugurated in September 2013, the center has a capacity of 18 beds and it is staffed with interdisciplinary professional teams including doctors, psychologists, social workers, educators, nurse assistants and workshop facilitators.
What is dual pathology?
Most people with an addictive disorder are also diagnosed with mental disorders and vice versa. This is what psychiatrist call dual pathology or dual diagnosis, among other terms applied to patients with both an addictive disorder and another mental illness. Depending on the circumstances, patients having such characteristics may go through periods of instability, with a greater number of psychiatric hospitalizations, and more emergency admissions. Moreover, patients tend to live in dysfunctional families and to be more socially marginalized. Many of them have a poor compliance to prescription drugs, accordingly exhibiting a bad treatment response. Last but not least, their access to the health system is limited.
What disorders are involved, which one of them are treated at Chanaes?
Chanaes center works with patients with various psychiatric disorders including schizophrenia, bipolar disorder and personality disorders. Also, many have a lower level of intellectual abilities.
Which came first, the mental health disorder of the addiction?
That's impossible to say. Patients with psychiatric disorders present an addictive disorder more frequently than others. In addition, when a person starts using drugs at an early period of their development, i.e. during adolescence, it is more difficult to make an appropriate diagnosis, because some of the symptoms induced by substance abuse resemble those that are common to other psychiatric disorders. Hence the importance of helping the individual to achieve lasting abstinence in order to establish a definitive diagnosis.
Do these problems affect one another?
They do, substance abuse has a negative impact on the gravity and prognosis of mental illness. Treatment dropouts are also more frequent as well as episodes of decompensation, and low functioning levels. Typically, those patients use multiple substances: at Chanaes center, freebase cocaine was the drug abused mostly prior to admission, followed alcohol, cocaine, marijuana and psychoactive drugs.
Once solved the addiction problem (at least physically) is there a decrease in the severity of mental health problems?
Yes, when we successfully help patients quit substance use over a prolonged period of time, the impact can be very beneficial to the prognosis of mental illness. The disease can be stabilized and the patient's global assessment of functioning significantly improved, with a lesser need for medication. As a matter of fact, it would be impossible to treat such disorders separately. They are so closely related that they should be treated jointly if one wants to achieve an acceptable result.
What's the treatment objective?
The overall objective is to improve patients' overall quality of life, in a biospychosocial perspective. This goal can be achieved by working jointly on the psychiatric disorder and the addictive disorder. More specifically, we try to develop the individual's autonomy, to improve their self-esteem and ti help them realize their full potential. We also work with families in order to improve the way they relate with patients and vice versa.
What kind of treatment do you utilize at Chanaes?
Treatments are often multifaceted; we may of course rely on pharmacological treatments depending on the patient's psychiatric condition, but we've also implemented a psychotherapeutic and a family approach with the center's psychologists and social services. Group therapy is another essential part of the treatmentprogram as well as occupational workshops, recreational activities and other daily routines.
WMHD 2014 insists on "Experience-sharing as a source of mutual support", does according to you peer support play a significant role at Chanaes?
It does. I think the role played by peer support is paramount. Patients support each other when they are not feeling good, or when they have craving symptoms. Moreover, even though they are all different, with much different backgrounds and realities they all share similar experiences related to substance abuse.
Do you work with external resources, and of which purpose?
Yes, we do it on an ongoing basis. Such resources are mostly related to recreational, cultural or physical education activities. We are also in touch with a number of health resources, or with vocational programs in view of the forthcoming reintegration of residents.
Do you think we can de-stigmatize mental health issues in society? Is it important?
In my view, this aspect has already improved greatly in our society. The public is generally more aware of the importance of taking care of their mental health. The fear of being labeled as "crazy" if one consults a psychiatrist or psychologist has diminished greatly – although there's still a number of labels that we need to work on.