What Is A Dual Diagnosis?
Dual diagnosis is a clinical term used to describe the condition of a person who simultaneously suffers from both a mental health disorder and an addiction. Also known as co-occurring disorders, the Substance Abuse and Mental Health Services Administration (SAMHSA) reported that more than 8 million Americans were known to be affected by this condition in 2016.
Why Is A Dual Diagnosis Significant?
Mental illnesses and substance use disorders are both serious health issues, and one condition frequently contributes to, or exacerbates the symptoms of, the other. For example, someone who struggles with depression may turn to self-medication to help numb the negative feelings they’re experiencing.
While the use of drugs or alcohol may provide that person with temporary relief, their symptoms are often worse once the effects of the substance they’re using wears off. If left untreated, both the mental illness and addiction can escalate and wreak havoc on a person’s health and personal life.
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What Causes Co-Occurring Disorders?
Although researchers aren’t exactly sure why so many people meet the criteria for dual diagnosis, there are a number of possible contributing factors that have been identified, including:
- Genetics/Family History: Certain genes and a family history may predispose a person to develop both an addiction and another mental illness, or increase their chances of developing one of those disorders after the first one appears.
- Environment: Stress or a traumatic experience may cause a person to develop both a mental illness and an addiction.
- Brain circuitry: Certain areas of the brain are affected by both substance use disorders and mental illnesses, and changes resulting from one may have an impact on, or cause, the other.
- Early drug use: Evidence suggests that drug use as an adolescent—when the brain is developing—can increase the chances that a person will have substance abuse problems later on in life, and that it may also be a risk factor for developing mental illnesses.
What Are The Symptoms Of A Dual Diagnosis?
People with dual diagnosis will exhibit symptoms of both a drug or alcohol addiction and a mental illness (depression, anxiety, bipolar disorder, etc.) While symptoms of addiction—like excessive or frequent use of a substance, withdrawing from family and friends, risky behavior, etc.—may be relatively easy to detect, symptoms of mental illnesses may be more difficult to recognize.
These symptoms can include:
- Feelings of hopelessness/worthlessness
- Frequent crying
- Suicidal thoughts
- Changes in sleep habits
- Changes in appetite or weight
- Loss of interest in daily activities
- Poor hygiene
- Feelings of euphoria or extreme irritability
List Of Dual Diagnosis/Co-Occurring Disorders
There are a number of mental illnesses that can overlap with addiction issues in a dual diagnosis patient. Co-occurring disorders affect a person’s mood, behavior, interaction with others, and how a person views the world around them. They are oftentimes the underlying cause of a drug or alcohol addiction, which stems from the person’s use of substances as a coping mechanism for the symptoms of their mental illness.
The list of dual diagnosis/co-occurring disorders that frequently accompany addiction include:
- Bipolar disorder
- Generalized anxiety disorder
- Social anxiety
- Panic disorder
- Post-traumatic stress disorder (PTSD)
- Obsessive-compulsive disorder (OCD)
- Attention deficit hyperactivity disorder (ADHD)
- Schizoaffective disorder
- Antisocial personality disorder
- Borderline personality disorder
- Narcissistic personality disorder
- Avoidant personality disorder
- Eating disorders (bulimia and anorexia)
How Are Dual Diagnosis Patients Treated?
For many years, dual diagnosis patients were treated using “sequential treatment.” This approach involved treating either the addiction or mental illness first. Once the more acute illness was stabilized, the other condition would then be treated. These treatments were often completely separate from and unrelated to each other, and would sometimes even take place at different facilities. The popularity of the sequential treatment method began to diminish in the 1990s, though, when research revealed that patients being treated this way relapsed at a higher rate.
Another model for treating dual diagnosis patients is “parallel treatment.” In the parallel approach, both illnesses are treated simultaneously, but by different treatment professionals. For example, a person may participate in an addiction treatment program to address their substance use disorder, while their mental illness is treated by another team at a mental health facility. Even though both courses of treatment may be effective on their own, the fact that they are occurring separately and being led by different treatment teams can create problems. One team may minimize the seriousness of the disorder being treated by the other team, or have very different treatment philosophies. Situations like this can be confusing for the patient and hinder the recovery process.
The third method of dual diagnosis treatment is widely regarded as the best and most effective approach. In “integrated treatment,” the patient’s addiction and mental illness are treated simultaneously, at the same facility, and by the same team of clinicians. In this model, both disorders are addressed using the same philosophies, and the effects one illness may have on the other are closely examined. Because integrated treatment focuses on the totality and interrelationship of the patient’s issues, the chances of a full and long-lasting recovery are much better.
What Does Dual Diagnosis Treatment Involve?
Dual diagnosis treatment usually begins with inpatient detoxification, which allows the patient to rid their body of the substance(s) they’ve been dependent on while being closely monitored by medical professionals. This may involve being weaned off of a substance, or being given medication to help make the process easier. A supervised detoxification ensures the safety of the patient and helps lessen the severity of withdrawal symptoms.
Following detox, which may take up to seven days, inpatient treatment is usually considered to be the best next step for dual diagnosis patients. The benefits of inpatient treatment include getting medical and mental health care 24 hours a day, 7 days a week. For someone who is adjusting to being without a substance they’ve been dependent on for a period of time, who also has a mental health disorder, this care is crucial.
While in rehab, the treatment team may implement several forms of behavioral therapy to help aid in a person’s recovery. Some of these therapies are:
- Individual talk therapy: Talking to a licensed professional in a one-on-one setting about immediate or long-term issues that contribute to disorders like depression, anxiety, or substance abuse.
- Group therapy: Therapy sessions for a group of people, led by one or more psychologists. Group therapy provides a support network and sounding board for individuals, as well as a source of accountability.
- Cognitive behavioral therapy (CBT): A form of psychotherapy that works to minimize problems and increase happiness by modifying negative behaviors, emotions, and thoughts.
- Dialectic behavioral therapy (DBT): A form of psychotherapy that gives patients new skills to help manage painful emotions, self-harming behaviors, and conflict in relationships with others.
In addition, patients may be introduced to various recovery programs, or be prescribed medication to help control their mental illness. These can include antidepressants, mood stabilizers, or anti-anxiety drugs.
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Continuing Care For Dual Diagnosis Patients
Following rehab, it’s important that dual diagnosis patients continue to work on their mental health and recovery, and most treatment facilities will assist a client in creating an aftercare plan. Being proactive about continuing care can help a person lead a more normal life and decrease the chances of a relapse.
Things like ongoing therapy, participation in self-help and support groups (Alcoholics Anonymous, Narcotics Anonymous, SMART Recovery, etc.), and proper use of prescribed medications are all essential to maintaining a healthy, sober lifestyle. Other activities that can be beneficial to recovery are physical exercise, deep-breathing exercises, meditation, hobbies, journaling, and volunteering.
Find A Dual Diagnosis Treatment Program Today
Dealing with dual diagnosis/co-occurring disorders can be incredibly challenging and scary, but there is safe and effective help available. For more details about dual diagnosis treatment, or for information on addiction, detox, or rehab, contact us today.