Dual-Diagnosis

In the addiction recovery field, dual diagnosis describes a comorbidity between substance abuse and mental health disorders. Comorbidity is two disorders occurring in one person, either at the same time or in close succession. Comorbidity can also imply that the two illnesses affect one another.

For instance, a person who suffers from depression may self-medicate with alcohol. In that case, the depression symptoms worsen when the addictive substance has a hold over them. Addiction itself is a form of mental illness.

In the addiction recovery field, dual diagnosis describes comorbidity between substance abuse and mental health disorders. Comorbidity is two disorders occurring in one person, either at the same time or in close succession. Comorbidity can also imply that the two illnesses affect one another.

For instance, a person who struggles from depression may self-medicate with alcohol. In that case, the depression symptoms worsen when the addictive substance has a hold over them. Addiction itself is a form of mental illness.

According to the National Institute on Drug Abuse (NIDA), addiction can fundamentally change the brain, affecting the reward center and the way it processes a normal hierarchy of needs. Compulsive behavior that comes from addiction is similar to the effects of other mental illnesses and can exacerbate or lead to mental problems.

Unfortunately, due to the stigma that still surrounds both substance use disorders and mental health disorders, many people will avoid seeking treatment for either issue, instead choosing to self-medicate and plunge themselves deeper into a dangerous form of isolation that could prove to be deadly.

Ending the negative associations attributed to both addiction and mental health disorders is the first step in ensuring that people with comorbid substance use and mental health disorders can get the proper addiction treatment they need, in this case, dual diagnosis.

MENTAL HEALTH DISORDERS ASSOCIATED WITH SUBSTANCE ABUSE

Dual-diagnosis can occur with many mental health issues and psychological disorders. However, a few conditions frequently occur with drug and alcohol abuse. Any person that comes to addiction treatment with another co-occurring issue should have their needs addressed.

However, there are some common issues that addiction treatment professionals see on a daily basis. Addiction can happen to anyone, but it seems to happen more frequently among people that have specific mental health disorders. Substance use disorders may appear as a result of self-medication, but it may also be due to similar risk factors or genetic vulnerabilities.

Here are some of the most common psychological disorders that can co-occur with a substance use disorder:

• Depression — Depression is a common co-occurring disorder with substance use problems. Depression often feeds off of addiction and alcoholism, making both disorders worse. Depression may lead to addiction because of self-medication, which is when you use alcohol or drugs to seek relief from negative symptoms. Addiction can negatively impact your life but interfering with your health, relationships, and finances, which can lead to negative feelings and depression.
• Anxiety — Anxiety is one of the most common disorders affecting Americans today. According to the National Institute of Mental Health, more than 19 percent of American adults had an anxiety disorder in the past year as of 2017. Anxiety can increase your risk of a variety of other issues, including insomnia, depression, heart disease, and a weakened immune system. However, it can also lead to substance use disorders.  Anxiety disorders can also cause people to seek relief from drugs or alcohol. It’s common for people to use alcohol to overcome social anxiety, but excessive drinking can lead to alcohol use problems.
• Post-Traumatic Stress — Post-traumatic stress disorders are caused when people experience a physically or psychologically jarring event. It’s common among military veterans who experience combat situations or severe injuries. However, it can also occur in situations when people experience assault, rape, car accidents, or childhood trauma. PTSD is often associated with panic, flashbacks, and painful memories that can be debilitating.
• Mood Disorders — Mood disorders are issues that affect a person’s mood daily, and sometimes without any external cause. Depression is a mood disorder, but so is bipolar disorder, which is often misdiagnosed. Like depression, some people might start drinking alcohol or using other drugs to help mask their psychological symptoms. However, psychoactive drugs can often make mood disorders worse. Alcohol, in particular, can worsen depressive symptoms.
• Psychotic Disorders — Psychosis is characterized by a lost connection with reality. Someone dealing from a psychotic episode might have hallucinations, delusions, or imagined threats. Schizophrenia is a common psychotic disorder, and it can come with delusions, anxiety, sleep problems, and depression. Stimulant drugs can cause temporary psychotic symptoms in some people. Other drugs like LSD, MDMA, and even marijuana can trigger psychosis in people who have schizophrenia or are predisposed to it.

Both disorders can occur simultaneously, or one can bleed into the other. The depressant nature of substances like opioids or alcohol can cause or worsen depression symptoms. However, co-occurrence does not always mean one disorder causes the other. Mental disorders and addiction have several possible causes, many of which overlap like heredity, family life, and environment.

WHAT CAUSES DUAL DIAGNOSIS

Depending on a variety of factors like family life, heredity, stressful occupations, chronic medical conditions, and isolation, some people are at higher risk of developing a mental illness. Because drug and alcohol abuse is a risk factor for mental illness, according to the Mayo Clinic, it can be what tips the scales towards developing a disorder.

Mental illness can also lead to substance abuse by means of self-medication. People wrestling with anxiety or depression often use alcohol or other drugs for a brief period of relief. However, these substances ultimately exasperated mental disorders and can develop into substance abuse disorders.

It’s important to note that comorbidity does not always mean that one disorder was responsible for the other.

In fact, according to NIDA, it is frequently difficult for even doctors to determine accurately which disorder came first.

This is due to the shared risk factors for both disorders, and there is also the fact that many people are unaware that substance use disorders are actually a form of mental illness.

HOW COMMON IS DUAL DIAGNOSIS?

Dual diagnosis of substance abuse and mental health disorders is relatively common. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), millions of people live with both a mental health issue and addiction.

People who struggle with mood and anxiety disorders are twice as likely to wrestle with addiction and vice versa when compared to the overall population. Adolescents with significant behavioral problems are seven times more likely to have used or abused substances like drugs or alcohol in the past month.

According to the SAMHSA 2015 National Survey on Drug Use and Health, 8.1 million people (or 41.2 percent) among 12.6 million adults with past-year Substance Use Disorder also possessed at least some form of mental health disorder.

In other words, nearly half of those that struggled with a dependence on alcohol or drugs are also concurrently dealing with a co-occurring mental health disorder, which also known as a dual diagnosis.

Though there are greater numbers of people who struggle with substance abuse disorders without any diagnosed second disorder, substance abuse dramatically raises risk factors for developing other mental health disorders.

DUAL DIAGNOSIS TREATMENT

The comorbidity between mental health disorders and addiction is significant. Professionals in the addiction treatment field are urged to develop a comprehensive treatment plan for patients struggling with a dual diagnosis.

In the middle of the opioid crisis, states are also working to improve treatment options for people with a dual diagnosis. Before a treatment plan is developed, a professional will evaluate you and your experience with both addiction and mental health issues.

For dual diagnosis treatment to have a real, tangible level of effectiveness, the treatment facility must use an integrated approach to being able to treat both mental health disorders and addiction.

There are a few important factors that must be taken into consideration when it comes to the treatment of a dual diagnosis patient, such as:

• What kinds of drugs or alcohol were they abusing?
• What is the co-occurring mental health disorder?
• How long were they using drugs or alcohol as a form of self-medication?

Different mental health disorders require different therapeutic techniques. The therapy for someone with bipolar disorder is not going to be the same as someone with schizophrenia. Dual diagnosis treatment must be done on an individual basis to properly meet a given patient’s unique set of needs.

WHAT TYPES OF THERAPY ARE USED IN DUAL DIAGNOSIS TREATMENT?

As we just mentioned, dual diagnosis treatment plans will vary from person to person depending on their co-occurring disorder and what therapy type will prove most effective for them. It’s never a one-size-fits-all situation, but there are some common therapy types that people are likely to experience as part of their dual diagnosis treatment, including:

• Cognitive Behavioral Therapy: Commonly known as CBT, this is widely considered to be the gold standard in therapy treatment for both substance use disorders as well as mental health issues, making it the go-to for many dual diagnosis treatment plans.
• Meditation: Mindfulness can be an extremely helpful technique for those with anxiety or similar disorders, and meditation is a common starting point for instilling habits of mindful, centering behavior.
• Yoga: Similarly, yoga has also long since been a staple of not only holistic therapy but also in many mainstream addiction treatment therapy programs. Yoga can help instill focus, relaxation, and patience. It’s another way to provide centering of the self, which is useful in both addiction therapy and mental health treatment.
• Family Therapy: Addiction is often referred to as a “family disorder,” both due to how it often runs in families as well as how when someone has a substance use disorder it affects their entire family. Mental health disorders can function this way as well, and so it is often a very practical form of therapy for both disorders to work with the patient and their family side-by-side to build a better understanding of their disorders and open healthy methods of communication.

WHAT ARE THE BENEFITS OF DUAL DIAGNOSIS TREATMENT?

Treating either a substance use or mental health disorder on its own when struggling with both is not really treatment at all. The two disorders feed off of each other unless they are addressed together. Then, it is only a matter of time before you slide back into a cycle of one disorder flaring up and making the other worse.

Untreated mental health issues can drive someone back to using drugs or alcohol as a means of coping, while an untreated substance use disorder can intensify the worst symptoms of mental illness. Dual diagnosis treatment is the only way to do more than put a bandage on the problem.

Dual diagnosis treatment can be a revelation for some.

Many people may not even be aware that they’re struggling with a co-occurring disorder until they check into treatment for a substance use disorder and are diagnosed with a mental health disorder as well. Finally being able to understand part of what is feeding into their addictive behaviors will help to better learn healthy, positive coping methods as well as get the proper treatment for something they might not have even known was there.

Sources

L. (2015, October 23). Co-occurring Disorders. Retrieved April 17, 2018, from from https://www.samhsa.gov/disorders/co-occurring Mental illness. (2015, October 13). Retrieved April 17, 2018 from https://www.mayoclinic.org/diseases-conditions/mental-illness/symptoms-causes/syc-20374968

National Institute on Drug Abuse. (n.d.). Comorbidity: Addiction and Other Mental Disorders. Retrieved April 17, 2018 from https://www.drugabuse.gov/publications/drugfacts/comorbidity-addiction-other-mental-disorders

National Institute of Mental Health. (n.d.). What is Psychosis? Retrieved from https://www.nimh.nih.gov/health/topics/schizophrenia/raise/what-is-psychosis.shtml

National Institute of Mental Health. (2017, November). Any Anxiety Disorder. Retrieved from https://www.nimh.nih.gov/health/statistics/any-anxiety-disorder.shtml

U.S. National Library of Medicine. (2019, April 03). Mood Disorders. Retrieved from https://medlineplus.gov/mooddisorders.html