MICA Counseling Techniques

The acronym MICA stands for “Mentally Ill Chemical Affected.” Such a person’s treatment, often referred to as a “dual diagnosis” case, deals with the challenges of two independent but coexisting disorders. Treatment methods must take into account the presence of a persistent and severe mental health condition such as bipolar disorder or schizophrenia, plus the interaction of substance abuse in a person’s system.

Complications of Dual Diagnosis

The challenges of treating dual-diagnosis clients stem not only from the illnesses themselves but also from their interaction with each other. People with a psychiatric disorder are at a higher risk for substance abuse than others. Frequently, this comes from trying to “self-medicate” the symptoms of a pervasive and life-disturbing mental health condition.

People with a dual diagnosis are more susceptible to recurring severe problems of a social, emotional and medical nature. The presence of two or more disorders also increases the likelihood of a worsening mental health condition or a relapse of substance abuse. It’s a vicious cycle: Alcohol and other drugs can increase or worsen the symptoms of a mental health condition; in turn, when the symptoms become more severe, a person resorts to substance abuse to “control” or forget them.

Because of the complexity of treating two or more interactive disorders, dual diagnosis treatment tends to be long-term and produce incremental progress.

Residential Programs

Nationally, only a few long-term residential programs exist for clients dealing with a dual diagnosis. Facilities such as the Wellness Resource Center in Boca Raton, Florida, offer independent living arrangements so clients can practice activities of daily life while participating in on-site psychiatric treatment, group therapy and individual therapy.


Some methods of traditional therapy—such as individual psychotherapy, group therapy, art and creative expression, and dialectical behavioral therapy—are employed in both residential and local treatment programs. Addiction therapy, including the common 12-step treatments, are used to address the drug-addicted behavior.

In many dual diagnosis programs, a commonly used treatment is dialectical behavioral therapy (DBT), which emphasizes principles of present-mindedness and emotional awareness. It trains clients in distress tolerance, how to remain in control and calm as stressors increase.

Similarly, traditional cognitive-behavioral therapy is used to address the addiction cycles of dual diagnosis clients. Activities and debriefing through the cycle of cognition (how and what you think), affect (what you’re feeling) and behavior (how you act because of thoughts and feelings) help clients identify the patterns that lead to their substance-abuse behaviors. As this process is broken down, clients can relearn to choose different responses at each step of the cycle.

The acronym MICA stands for "Mentally Ill Chemical Affected."  Such a person's treatment