Substance abusers who have an underlying mental health disorder fall into the category of dual diagnosis, a term that describes a person who is affected by a substance abuse disorder and mental illness at the same time. The term dual diagnosis, also known as co-occurring disorders or comorbidity, came about in the 1990s, so it’s relatively new to the healthcare scene.
Psychiatry and drug treatment professionals are still more focused on how to offer the best care for dually diagnosed people, whose needs differ from those who are dealing with only one condition. It is agreed, however, that both the mental illness and addiction must be treated together at the same time.
Mental health disorders that dual diagnosis clients might possess include:
Borderline personality disorder
Eating disorders (such as anorexia, bulimia, binge-eating)
Generalized Anxiety Disorder
Obsessive-compulsive disorder (OCD)
Post-traumatic stress disorder
More than 8.9 million persons have co-occurring disorders; that is they have both a mental and substance use disorder. Only 7.4 percent of individuals receive treatment for both conditions with 55.8 percent receiving no treatment at all.
WHY ARE SUBSTANCE ABUSE DISORDERS AND DUAL DIAGNOSIS LINKED?
Dual diagnosis is a broad category, according the National Alliance on Mental Illness, and it encompasses various situations and conditions. “It can range from someone developing mild depression because of binge drinking, to someone’s symptoms of bipolar disorder becoming more severe when that person abuses heroin during periods of mania,” says the Alliance on its website.
The relationship between substance dependence and/or addiction and mental illness is complex. Because of this, there is no single answer to explain what causes it, why it happens, or the order in which it happens. “Diagnosis of a mental disorder may not take place until the symptoms have progressed far along enough to be recognized,” says the National Institute on Drug Abuse. “However, subclinical symptoms may also prompt drug use or abuse started can create confusion as to which came first,” it writes.
NIDA says three scenarios may explain why substance use and mental illness co-occur:
Drugs of abuse can cause abusers to experience one or more symptoms of another mental illness.
Mental illnesses can lead to drug abuse.
Both substance abuse disorders and mental illness are brought about by overlapping factors such as underlying brain deficits, genetic vulnerabilities, and/or early exposure to stress or trauma.
People who are at high risk of dual diagnosis include people from low-income households, military veterans, and individuals with more general medical illnesses. Professionals who work with mental health clients look for signs and symptoms of a substance abuse disorder.
WHY DO PEOPLE WITH MENTAL ILLNESS USE ALCOHOL AND DRUGS?
The more severe the mental illness, the more likely the person will use or abuse an illegal substance. Alcohol, marijuana, and cocaine are among the most abused substances among the dually diagnosed population.
People with addiction who have a mental health disorder typically use drugs, alcohol, and other substances to medicate themselves as they try to ease or manage their mental health symptoms on their own.
Using substances to relieve pain or manage it, however, can only worsen the condition of people with dual diagnosis and lead to substance dependence and addiction. Either substance abuse or mental health illness can come first, but what can be more challenging is figuring out the conditions and the relationship between those conditions because they can occur at the same time. It also is challenging to address a client’s substance abuse when they are dealing with a mental illness as well.
The fact that they can affect a person at the same time has, in many cases, meant that a large group of people with addiction have mental health disorders that have not been diagnosed properly, if at all. This means they have gone untreated, putting individuals at risk of relapse.
Signs of a mental health issue include:
Excessive fears, worries
Flashbacks, memories of traumatic events
Depression (feelings of hopelessness, sadness, irritability)
Severe mood swings
Signs of Drug Use Include:
Changes in appearance (dilated pupils, weight loss, weight gain, needle marks)
Changes in behavior
Changes in schedule, friends or associates
Presence of drug paraphernalia
Sudden financial problems, job loss
Disappearance of valuables from the home
Longer times spent in the bathroom
HOW IS DUAL DIAGNOSIS DETERMINED?
A mental health professional must first carefully evaluate the individual’s condition according to the latest version of the Diagnostic and Statistical Manual of Mental Disorders to determine whether dual diagnosis is present. This is not as easy as it sounds because symptoms of one disorder can appear as symptoms of another. Once it has been established that dual diagnosis is present, people who meet the criteria for it may be eligible to receive treatment at a center that offers specialized care.
Integrated dual disorder treatment is generally seen as an effective way to help people get the help they need. It is important that each illness is treated separately but at the same time.
DUAL DIAGNOSIS TREATMENT OPTIONS
For treatment to work, dually diagnosed clients must stop using drugs and alcohol and enter a recovery program that requires treatment for both the substance use disorder and the mental health disorder simultaneously. Therapy methods teach the client how to change their behaviors when dealing with substance abuse.
Detox and medication are monitored by counselors at inpatient facilities to help the client control the behavioral effects of substance abuse and mental illness. Dual diagnosis clients have several treatment options to choose from. Here are some of the more popular ones:
A client lives at an inpatient treatment facility. This type of rehab is recommended for clients who deal with more severe addictions. A team of specialists is available 24-7 to assist the client. Detox, group therapy, individual counseling and therapeutic activities are some of the treatment options at inpatient facilities.
The client can live at home while going to rehab. Outpatient treatment also helps clients who are transition to an inpatient facility. Group therapy and counseling are available for clients throughout the day.
Clients who are in recovery can receive additional counseling at group therapy meetings or by enrolling into 12-Step programs. Groups, such as Narcotics Anonymous, allow clients to continue utilizing the practices taught in rehab. The client is surrounded by people suffering from a similar disorder, which fosters community and relationships. The communal environment created in group therapy also helps the client when dealing with behavioral issues.
Dialectal Behavior Therapy, or DBT, reduces self-harming or suicidal thoughts by teaching the client how to channel their emotions in a less invasive, nonjudgmental way. The client is counseled on how to harness their emotions when reacting to a negative situation.
Cognitive Behavioral Therapy, or CBT, focuses on behavioral changes for clients who find it difficult to cope with negative situations. This type of therapy teaches the client how to come up with a healthy strategy to handle life’s circumstances.
Integrated Group Therapy teaches people dealing with bipolar disorder and substance abuse preventative mechanisms from relapsing in both disorders.
MEDICATION USED IN DUAL DIAGNOSIS TREATMENT
Specialized treatment plans for co-occurring disorders may include the use of medications. Among those are:
Lithium (Eskalith or Lithobid) is prescribed as a mood stabilizer for bipolar clients. This medication is also used to help with co-occurring alcohol and cannabis use.
This medication is commonly used to treat substance abuse clients. Known for its mood-stabilizing effects, anticonvulsants are typically used for epilepsy and seizure patients.
SSRIs are common when treating co-occurring alcohol abuse and anxiety. This class of drug is used as an antidepressant of depressive and anxiety disorders.
Buspirone (BuSpar) is an anti-anxiety medication. Buspirone is also used to treat anxiety while topiramate, an anticonvulsant medication, is used to treat clients dealing with cocaine abuse and anxiety.
IS DUAL DIAGNOSIS TREATMENT RIGHT FOR YOU?
If you or a loved one are battling with substance abuse and have a mental health disorder, you may want to consider dual diagnosis treatment. The following checklist offers signs and symptoms of dual diagnosis. If you experience these symptoms, a recovery program addressing dual diagnosis could be the best route for you:
You experience extreme guilt or anxiety when you use.
Your behavioral health and substance abuse have placed a strain on relationships with your spouse, children, siblings, friends, and other loved ones.
You experience depression.
You have clouded judgment.
You don’t know how to recover from substance abuse or bipolar disorder on your own.
You are surrounded by peer pressure or the triggers that can lead you to substance abuse.
You retreat to substance abuse when coping with a negative situation.
You can’t function properly because of sudden mood shifts, bouts of anger or extreme anxiety.
You’ve tried alternative options, but they haven’t worked.
If two or more of these apply, seek an evaluation immediately from a health care professional.
With more modern-day facilities beginning to address co-occurring disorders, the options for treatment are becoming more diverse. Inpatient, outpatient and group therapy can be utilized during any phase of rehabilitation and recovery. Financial plans can also be discussed when considering treatment, including post-treatment arrangements that can help clients find employment as they continue in recovery.