10 Things You Need to Know About Dual Diagnosis Treatment

1. Dual Diagnoses Are Very Common
2. Certain Mental Health Disorders Are More Common in Dual-Diagnoses
3. Sometimes Substance Abuse Looks Like a Mental Disorder
4. Substance Abuse Can Lead to Mental Illness and Vice-Versa
5. Common Underlying Factors May Contribute to a Dual Diagnosis
6. Dual Diagnosis Has Adverse Physical Effects
7. Dual Diagnoses Can Worsen Emotional Health
8. Dual Diagnosis Has Social Effects
9. Dual Diagnosis Treatment is Complicated
10. Dual Diagnosis Treatment Must Address Both Substance Use and Mental Illness Together

What is a Dual Diagnosis?

The phenomenon of dual diagnosis describes a situation when a person is diagnosed with both a substance use disorder (such as alcohol use disorder) and a mental health disorder (such as depression, bipolar disorder, anxiety, etc.).

An interplay between both conditions can complicate an individual's recovery—resulting in a less favorable treatment outlook and a compounded risk for negative health consequences without proper treatment.

A dual diagnosis comes with a whole set of unique issues, and understanding these issues is key to treatment and recovery.

Dual Diagnoses Are Very Common

Struggling with a psychological disorder and substance abuse is not an uncommon occurrence.

With statistics such as these, it is clear that the dual diagnosis of mental health problems and substance abuse is an issue that mandates careful attention and treatment. If you are suffering under the weight of a co-occurring disorder, you can ask for help. Call  1-888-993-3112Who Answers? to get connected with an inpatient treatment center. Be sure to ask whether they are qualified to treat dual-diagnoses.

Mental Illnesses Can Be Associated With Specific Substances

The effects of different substances tend to interact with particular mental health issues in semi-predictable ways. Often the effects of a particular abused substance serve to counter the symptoms of the corresponding psychological condition—for example, relaxing drugs are used more by people with anxiety-related disorders; “feel-good” drugs are used more by people with mood disorders (such as depression).

Certain Mental Health Disorders Are More Common in Dual-Diagnoses

In general, substance abuse problems tend to be closely associated with a particular subset of mental health issues, including:

• Depression.
  
• Anxiety disorders.
  
• Schizophrenia.
  
• Personality disorders.
  
• Posttraumatic stress disorder (PTSD).
• Eating disorders (e.g., anorexia nervosa, bulimia nervosa).

• 
  Schizophrenia and antisocial personality disorder have some of the highest rates of comorbidity with substance abuse.

  • For example, 60-80% of people diagnosed with antisocial personality disorder were found to also be suffering from alcoholism, and 20-40% of people diagnosed with alcoholism were also diagnosed with antisocial personality disorder.
  • People diagnosed with schizophrenia are more likely to use stimulants (such as nicotine, amphetamines, cocaine, and marijuana) though it is often unclear whether the mental disorder or the substance abuse arose first.
• 
  Alcohol abuse is also associated with depression and anxiety.

  • One study found that people diagnosed with alcohol use disorder were 4 times more likely to have depression and 3 times more likely to have an anxiety disorder. 
• 
  The mental disorder most strongly related to substance abuse is bipolar disorder, with some estimates putting the lifetime prevalence at 50-60%. This means that the probability of substance use and bipolar disorder occurring together is 50 to 60%.

Sometimes Substance Abuse Looks Like a Mental Disorder

Substance use and abuse can elicit symptoms otherwise seen in the context of organic mental disorders. These symptoms are somewhat different than those of an independent mental disorder itself because they are a direct result of the substance use, and can typically be treated more quickly by discontinuing the substance. 

These symptoms may be related to a specific pattern of abuse, intoxication effects, as well as any withdrawal syndrome related to the substance.

Examples include:

• Methamphetamine-induced psychosis or mania.
• Severe anxiety as a result of discontinuing benzodiazepines.
• Depression as a result of stopping stimulants.
• Korsakoff's syndrome (memory and cognitive problems) due to chronic alcohol abuse. 

If a treatment facility is unfamiliar with the potential disorder-like symptoms of substance use, they may too hastily diagnose a person with comorbid substance abuse and psychological disorder. This can affect the treatment process, leading to improper individual treatment and misdiagnoses. Call 1-888-993-3112Who Answers? to find a treatment that suits your needs, and make sure to ask if staff are properly qualified to assess and treat dual-diagnoses and substance-induced disorders.

Substance Abuse Can Lead to Mental Illness and Vice-Versa

Mental disorders may lead to substance abuse through a number of different ways: 

• 
  Self-medication: A person with a mental disorder may be using the substances in a misguided attempt to self-medicate and treat their symptoms. For example, a person with depression may take drugs with euphoric effects, such as heroin.
• 
  Increased exposure to drug use: Certain disorders may make a person more likely to be exposed to drugs and substance use. For example, conduct disorder in young people has been associated with later substance abuse.
• 
  Lowered barriers to experimentation with drugs: A person with a mental disorder may be more inclined to experiment with different substances, particularly disorders that involve impulse control problems.

The opposite direction of influence is also possible. A substance abuse problem may lead to a mental disorder:

• 
  Biological mechanisms: Substances may affect the chemical balance of the brain which, over time, can create, exacerbate, or uncover various mental disorders. For example, cocaine use may precipitate panic attacks and anxiety.
• 
  Environmental effects: Substance abuse may expose a user to more stress and result in fewer sources of emotional support to cope with the increased stress—facilitating the potential development of a mental disorder.

Common Underlying Factors May Contribute to a Dual Diagnosis

Certain characteristics may contribute to the simultaneous development of both substance abuse and a psychological disorder:

• Genetics: Genes can create certain temperaments or dispositions that make one more (or less) likely to use drugs, or develop a mental health disorder that then facilitates the path towards drug use. Genes also affect the way a substance interacts with the brain and body. 
  
• Personality: A propensity for risk-taking and novelty-seeking are personality traits that relate to substance abuse and other mental disorders.
  
• Brain chemistry: Dopamine is a brain chemical that is affected by both substance use and certain psychological disorders. Brain changes from one disorder may spur the development of the other.
  

In addition, similar environmental triggers may underlie both disorders. High levels of stress, a history of trauma, and early exposure to drugs are all related to the development of dual diagnosis conditions. Each of these factors must be considered when evaluating an individual for a potential dual diagnosis.

Dual Diagnosis Has Adverse Physical Effects

The health consequences of a dual diagnosis depend on both the substance being abused and the mental disorder present. Each disorder may compound the negative effects of the other, leading to exaggerated symptoms of both. Because a person with a dual diagnosis can experience more extreme and chronic symptoms, they may be more likely to neglect personal care.

Both disorders have overlapping health consequences, and a dual diagnosis of both conditions indicates that a person is at increased risk for developing various diseases. Unfortunately, many people with either or both of these disorders have less access to adequate health care services, which may also explain why these negative health consequences persist in these populations.

Dual Diagnoses Can Worsen Emotional Health

The summation of these emotional consequences can greatly impact treatment adherence. Dually diagnosed individuals are often at a greater risk for relapse. If you are suffering from a mental illness and have problems with substance abuse, you should consider seeking comprehensive treatment. Please call 1-888-993-3112Who Answers? and connect with a treatment program that suits your needs.

Dual Diagnosis Has Social Effects

A person diagnosed with substance abuse and another mental disorder can be particularly challenged by the social difficulties of a dual diagnosis. Because they are experiencing twice the problems of any disorder alone, relating to society and other people can be especially difficult.

Some people may distance themselves from people close to them, reducing their support network without intending to. Friends and family members of a person struggling with a dual diagnosis may find it difficult to remain close to their loved one.

Dual diagnoses are also associated with financial problems, employment problems, housing problems, and legal problems.

Unfortunately, a dual diagnosis can give way to dual stigmas if it is not well understood, leading to poorer social support. Proper treatment must address the social struggles of a dual diagnosis as well as the disorders themselves.

Dual Diagnosis Treatment is Complicated

Once a professional makes an official diagnosis, treatment can begin. Patients struggling with both a substance abuse disorder and a mental health issue tend to have symptoms that are more persistent, extreme, and resistant to treatment than either disorder alone.

These challenges can affect a dual diagnosis patient’s approach and response to treatment, making recovery more complicated.

Dual Diagnosis Treatment Must Address Both Substance Use and Mental Illness Together

Adequate treatment will integrate both disorders in the recovery process, rather than have the patient work on each disorder separately.

Addressing both disorders together recognizes that both have a powerful impact on the person’s life, and may even have positive synergistic effects when it comes to treating them. Treatment will often target common symptoms of the disorders, such as negative mood or impulse control problems.

Treatment should also inspire incentives for change in order to keep dual diagnosis patients engaged. Because drugs provide instantaneous positive effects, it is important that treatment help the patient find their own alternative incentives and rewards for recovery.

A dual diagnosis of substance abuse and another mental disorder brings with it many different challenges to the individual, their friends, and their family. The presence of a dual diagnosis may complicate the course of treatment somewhat but, with better understanding and education, this complex condition can be successfully recovered from.

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