Dual diagnosis is a condition where someone suffers from a mental illness and substance abuse simultaneously. Dual diagnosis is quite common, and it’s estimated that over 7.9 million Americans suffer from it. The reason behind this large number is the lack of treatment for people with mental health disorders. As a result, this concern predisposes those affected to self medicate with drugs and alcohol.
Dual diagnosis is difficult to diagnose because the symptoms are often overlooked. Besides, it is tough to single out the exact cause of dual diagnosis in every person. However, what’s clear is that those who have some mental disorder tend to be dependent on drugs or alcohol to self-medicate. When self-medication manifests for an extended period, people develop substance addiction. The substances become part of their life, requiring them to function ‘normally’ every day. The only treatment is substance addiction therapy.
What Causes Dual Diagnosis?
Excessive use of drugs and alcohol can contribute to dual diagnosis. The reason is that substance abuse isn’t something anyone would be proud of, and often, people struggling with it will try to quit. The shame of their social image and the stigma associated with their addiction can cause issues if they don’t seek mental health treatment.
This issue can quickly escalate, driving them over the edge, and subsequently, developing mental illnesses once they become addicted. When disorders grow out of control, substance abuse tends to increase heavily, creating a vicious cycle of dependence.
Other factors that contribute to dual diagnosis are biological, physical, psychological, and environmental factors. These factors are thought to be the leading causes of concurrent mental disorders and substance addiction.
Biological Factors
Biological factors, also known as genetic factors, can cause substance addiction or dual diagnosis. A child developing a dual diagnosis, born from parents struggling with disorders and substance addiction, is highly probable. The reasoning behind this is that genetics plays a massive role in the child’s life. How they handle mental health issues or substances in their lives can be dictated by genetics.
The chances of an addicted parent passing on the trait to their children are high. Likewise, the chances of a mental disorder being passed down to a child are high. During their life, an adult addict’s child is likely to develop signs of substance abuse.
Likewise, mental illnesses are likely to manifest in a child of a parent with such disorders. Therefore, biological factors can predispose someone to develop a dual diagnosis, and either the addiction or disordercan occur first. Whichever occurs first, if left untreated, can eventually lead to dual diagnosis.
Physical Factors
Physical factors, such as physical health and financial issues, can also contribute to dual diagnosis. Those diagnosed with terminal diseases such as cancer can quickly develop dual diagnosis if they are not adequately counseled.
Terminal illnesses are life-threatening, and the thought of dying can be daunting, thus predisposing someone to mental disorders. It can also predispose the individual to substance abuse as a method of coping with pain. Without the right support and counseling, either the addiction or mental health issues can lead to dual diagnosis.
Besides, economic hardships and financial issues can contribute to dual diagnosis. Financial problems may ensue after experiencing job loss, and these concerns can lead to mental disorders and substance addiction. Those facing economic hardships tend to abuse drugs in an attempt to ‘escape’ their cruel reality.
If the situation prevails, it can easily lead to dependence and addiction. Addiction contributes largely to issues that lead to dual diagnosis. Likewise, financial problems can lead to depression and other concerns of mental illnesses, which can easily predispose someone to self-medicate. It also leads to addiction if not checked, contributing to dual diagnosis.
Psychological Factors
It is common for people with psychological disorders to resort to substance abuse to feel better. This ‘feel better’ concern is often referred to as self-medication. Self-medication leads to addiction because drugs lead to abnormal secretion of neurotransmitters in the brain, making the user feel high. Most people love the feeling, and it can quickly contribute to addiction.
Those with mental disorders become addicted because they find a way to escape the pain. They may, therefore, form a habit of resulting in drugs or substances to help ease the mental health disorders, and thereby, they eventually become addicts.
Environmental Factors
Specific issues, like traumatic events, especially during childhood, can contribute to dual diagnosis. Chronic stress and post-traumatic stress can lead to mental health disorders and addiction.
The reasoning behind environmental factors predisposing someone to dual diagnosis is the need to look for quick fixes. Children exposed to violence, deaths, rape, or other problems can develop trauma. As adults, they can result in drug abuse to “fix” their trauma.
Those experiencing post-traumatic stress (PTSD), can turn to drugs in an attempt to fix their mental disorders. The same can also be said for those with chronic anxiety. The need to self-medicate, rather than seek professional medical help, contributes to dual diagnosis. Others even result in abusing clinical drugs such as opioids to self-medicate and get quick relief.
What are the Signs and Symptoms of Dual Diagnosis Disorders?
Dual diagnosis is a condition affecting millions of people all over the globe. However, it is a condition that is tough to spot, and therefore it can affect anybody unknowingly. Besides, the dual diagnosis being unpredictable, those surrounding the person can also fail to notice. However, there are signs and symptoms of dual diagnosis that might help you identify the condition, which includes:
What Mental Disorders Are Associated with Dual Diagnosis?
Dual diagnosis is different depending on the co-occurring mental disorder. Some common mental illnesses include anxiety, depression, bipolar disorder, trauma/PTSD, OCD, personality disorders, schizophrenia, ADHD, and eating disorders. Each of these disorders calls for different methods of treating the underlying condition.
How is Dual Diagnosis Treated?
The Essential Guide to Best Dual Diagnosis Treatment
An alcohol or drug addiction rarely appears out of the blue. Most people with addictions do not simply choose to continue abusing drugs or alcohol without a reason for doing so. Oftentimes, pre-existing mental illnesses cause, contribute to or exacerbate a person’s addiction. The consumption of drugs or alcohol can also cause, contribute to or worsen an individual’s psychological conditions. When addiction and mental disorder exist simultaneously, it is referred to as a dual diagnosis or a co-occurring disorder. Any person struggling with both these problematic conditions requires specialized dual diagnosis care administered by qualified trained professionals.
If you or a loved one are experiencing signs of dual diagnosis or co-occurring disorders, please call 772-774-3872.
What is Dual Diagnosis?
While it didn’t always have an official term or named condition, mental illnessesand substance abuse have been linked for decades. Dual diagnosis can range from a person abusing drugs to cope with a preexisting disorder like depression, to someone who developed disorder as a result of using a specific drug over an extended period. No matter what the reason for substance abuse is, it has been conclusively proven that drugs and alcohol only make symptoms of psychological illnesses worse and can also lead to the development of other mental concerns. [1]
Being that both mental disorder and addiction primarily affect the brain, both conditions play off of each other, and the existence of one makes the occurrence of the other more likely. Symptoms of dual diagnosis vary widely due to there being a virtually endless amount of potential combinations. Here are some common symptoms to look for:
Understanding Dual-Diagnosis
Statistics show that there is a high prevalence of dual diagnoses in America. It’s estimated that 50 percent of people with a mental health disorder also have a substance abuse problem and that more than half of people with a substance use disorder also have a diagnosable mental illness.
Establishing an exact causality or directionality in the relationship between an addiction and amental health disorderis nearly impossible because of the myriad factors that can contribute to either condition.
Even if one condition appeared before the other, it does not mean one was caused by the other. This is because subclinical symptoms of a mental health disordermay prompt drug or alcohol use and people often have imperfect recollections of the exact moment they began abusing.
Common reasons for co-occurrence:
- Drugs or alcohol can cause people to experience symptoms of another mental illness
- Mental illnesses can lead a person to abuse drugs or alcohol as a means of self-medication. This can occur before the individual has a diagnosable mental health condition but is still struggling with subclinical symptoms
- Substance use disorders and other mental illnesses are caused by overlapping risk factors, including genetic predisposition, environment and early exposure to trauma
One of the most highly perpetuated errors in the addiction recovery industry is to focus only on a person’s drug or alcohol addiction even when there is knowledge of another preexisting mental condition. Many times this is simply because many addiction rehab facilities do not offer mental health services.
People with dual diagnoses need extra care in order to make progress in rehab. This frequently includes a combination of psychotherapy, behavioral therapies, medication and help from peer-support groups. Any rehab facility that does not include concurrent mental health treatment will be inadequate to help a person with a dual diagnosis.[2]
The first step in dual diagnosis treatment includes a full assessment of the severity of both conditions. This can prove difficult because in many cases, symptoms of one disorder mimic symptoms of the other. The ensuing dual diagnosis treatment stages should provide education to the client and his family about the mental illness and how it interacts with the addiction. Patients should also be taught social skills and healthier coping mechanisms to help them safely navigate through the symptoms of mental illness and stressful situations.
One potential problem in providing effective dual diagnosis treatment is that many healthcare providers have minimal training in this area. In these situations, the psychiatrist, physician or addiction care specialist may have focused on one condition or another during their education and training, with only a few classes on the others. Additionally, because many dual diagnosis patients present a large amount of obstacles during rehab, they are often not thought of as good candidates for treatment and have their treatment terminated early or are allowed to dropout prematurely. [4]
The treatment of patients with dual diagnoses can be difficult to approach. Determining how one condition is affecting the other, the severity of each condition on its own, or even determining which condition came first presents a challenge. Both conditions can have conflicting and overlapping symptoms so studying one condition in the immediate presence of the other condition relies on a degree of trial and error.
Of the patients with both a mental illness and a drug addiction, only 7.4 percent get treatment for both conditions.
– Substance Abuse and Mental Health Services Administration
Research has shown that the best treatment of patients with dual diagnoses are derived from evidence-based practices (EBPs), which have been researched academically or scientifically, proven effective and replicated by more than one study. This treatment model stems from the prioritization of scientifically-proven methods along with individual patient values. There are five steps in the evidence-based practice treatment process[5]:
- Assess the patient and discover his or her critical needs
- Acquire relevant research including all studies and investigations
- Appraise the validity and quality of your research as it applies to the patient
- Discuss your findings with the patient and determine how best to approach treatment given his or her values and needs.
- Develop a plan that works for the patient and the provider and apply it
Just as co-existing conditions vary, so do their methods of treatment. Some variant EBPs employed in the treatment of different conditions are cognitive behavioral therapy for insomnia and depression; exposure therapy for anxiety, phobias and post-traumatic stress disorder (PTSD); and motivational therapy, which is similar to an intervention, for helping patients overcome their substance addictions.[6]
Despite the variations in types of evidence-based practices, most EBPs include some form of an integrated intervention, which entails the patient receiving care for both the mental illness and substance abuse. Additionally, many EBPs comprise the same several steps when applied to substance abuse.
- Detoxification – The patient undergoes withdrawal during this period, either tapering off of the substance that he or she is dependent on or abruptly stopping its use.
- Inpatient Rehabilitation-Inpatient or Outpatient Rehabilitation
- Medication– Used to blunt the effects of withdrawal or to help treat and manage symptoms of mental illness.
- Psychotherapy – All addiction therapy services involve an analysis of the old behavior that led the patient to his or her current situation – a key step in ensuring that history doesn’t repeat itself.
- Support Groups – Maintaining a support system following treatment is vital. Having a forum to share your successes and struggles as well as to hear what others are going through can help you get through the uncertain, early stages of sobriety.
This leads to repeated substance abuse, creating a dangerous drug addiction in addition to a pre-existing mental illness. Stopping a substance abuse habit in a patient that also has a mental illness is possible, but it takes time, willpower and therapy. Today, drug addiction is viewed as a mental illness, as both conditions drastically alter the brain.
A drug addiction can form so rapidly in the presence of mental illness due to the nature of how the brain processes pleasure. The brain views all pleasure in the same way, whether it comes from food, money, sex, drugs, etc. No matter the source, pleasure triggers the release of the neurotransmitter dopamine in the nucleus accumbens of the brain. However, the consumption of addictive drugs causes a huge amount of dopamine to be released into the brain, resulting in the strongest pleasure reaction. Depending on how quickly, consistently and intensely this reaction takes place, the individual is more or less likely to become addicted to the drug that he or she is abusing.
The consumption of addictive drugs causes a huge amount of dopamine to be released into the brain.
Based on this principle, mental health patients often find themselves with a substance abuse issue long before they are even aware of their undiagnosed mental illness. Oftentimes, patients will know that something is wrong with them and that consuming their drug of choice temporarily makes them feel better. What they don’t know is that they are only making their problem worse and creating a new problem on top of it.
In most cases, these patients have an undiagnosed illness, meaning that they aren’t being treated, leaving it up to them to find a way to manage their symptoms. Undiagnosed mental illness frequently leads to substance abuse as the patient continually attempts to deal with the symptoms of his or her condition with drugs or alcohol.
Those with mental health conditions are more sensitive to drugs or alcohol, which compounds the degree of their addictions. The most common substances that mental health patients use to self-medicate are alcohol, tobacco, cocaine and marijuana. In addition to the increased risk of addiction among all those with mental illnesses, certain mental disorders have higher substance abuse rates than others.
Other mental health disorders that commonly occur with drug addictions are depression, obsessive compulsive disorder, eating disorders, and schizophrenia.[7]
A drug addiction changes the brain in fundamental ways, rearranging a person’s normal hierarchy of needs and wants and introducing new priorities associated with acquiring and using the substance of abuse.
Addiction changes the brain, disturbing the normal hierarchy of needs and desires.
– National Institute on Drug Abuse
https://www.drugabuse.gov/publications/research-reports/comorbidity-addiction-other-mental-illnesses/drug-addiction-mental-illness
The following inability to control impulses preceded by compulsive behavior in spite of life consequences, occurs with numerous mental illnesses as well.[8] The changes to the brain caused bydrug and alcohol abuseare what make addiction amental health disorder.
Under normal circumstances, the brain maintains a delicate balance of chemicals known as neurotransmitters or molecules that enable sections of the brain to communicate with the other sections and ultimately allow the body to regulate its various behaviors. Drug or alcohol consumption leads to an imbalance of neurotransmitters in the brain, resulting in drowsiness, loss of coordination, euphoria and other common symptoms of intoxication by numerous substances.
In most cases, the brain corrects this imbalance following a period in which it is not exposed to any drugs or alcohol, however, with continued exposure, the brain begins to adapt to the regular changes in its chemical environment. In the case of long-term,severe drug and alcohol abuse, the brain will assume that it will always maintain a presence of the given substance, meaning that it will begin to rely on the substance for things it would otherwise produce naturally. This chemical inequality is where substance addiction comes in.[10]
In the case of a mental illness co-occurring with a drug addiction, it isn’t apparent if one condition caused the other, regardless of which came first. Even determining which condition was first is difficult as is establishing the cause of either condition. However, research suggests that mental disorders and drug abuse are both capable of leading to the other.
Habitual self-medicating with alcohol, tobacco, cocaine, etc., mental illness or not, is known to lead to dependence followed by addiction. Additionally, predisposed genetic vulnerabilities can result in greater susceptibility to mental illnesses and/or drug addictions either at first or after the initial disorder appears.[11]
In order to achieve a full recovery from drug addiction, treatment must also address mental health. If left untreated, a mental illness that co-occurred with substance abuse could lead a recovery right back to where he or she started.
Dual Diagnosis Treatment at Behavioral Health Centers
We set ourselves apart at Behavioral Health Centers by offering a combination of treatments and therapies designed to help break the cycle of mental illness and addiction. We understand that dual diagnosis patients face enormous struggles with both substance abuse and symptoms of one or more psychological disorders. Our understanding uniquely positions us to treat patients with co-occurring disorders.
Each of our patients receive a personalized treatment plan that focuses on his or her specific obstacles to recovery. Our Dual Diagnosis Treatment Includes:
Medical Detox
The patient undergoes withdrawal during this period, either tapering off of the substance that he or she is dependent on or abruptly stopping its use.
Life Skills Training
It’s critical that dual diagnosis patients be taught how to function in everyday society without the aid of drugs and/or alcohol. Treatment at UBH includes preparation for reentry into the “real world.”
Family Program
Just as dual diagnosis patients have to understand how addiction andmental disordersfeed off of one another, it’s equally important that family members understand what their loved one is dealing with. Our family program brings siblings, spouses, parents and children closer together.
Mental Health Expertise
A large portion of addiction patients have been dealing with undiagnosed mental illness for years. Our psychiatry services not only provide valuable insights into our patients’ mental health, but also helps them understand how to manage and treat their conditions better.
Holistic Treatment
Used to blunt the effects of withdrawal or to help treat and manage symptoms of mental illnesses
Dual diagnosis treatment at Behavioral Health Centers begins with a compassionate, medically supervised detox and mental assessment. We then blend holistic remedies with group and individual counseling, psychological services, physical therapy and a traditional 12-step process. Each of our patients receive a personalized treatment plan that focuses on his or her specific obstacles to recovery.
Every patient is different, as is their journey to addiction and rehab. Some may have resorted to drug and alcohol abuse to help deal with symptoms of depression. Others may unknowingly be struggling with undiagnosed schizophrenia or bipolar disorder. No matter what your specific needs are, our mission is to find the dual diagnosis treatment strategy that will most effectively address them.
Help is just a phone call away for you or a loved one who may have a mental illness and is simultaneously self-medicating with drugs or alcohol. Contact our addiction care experts and specialists who will craft a custom rehab program tailored for your specific dual diagnosis treatment needs. You can learn more about our programs or begin rehab by calling us at 772-774-3872.
References:
- https://www.nami.org/Learn-More/Mental-Health-Conditions/Related-Conditions/Dual-Diagnosis
- https://medlineplus.gov/dualdiagnosis.html
- https://www.mentalhelp.net/articles/10-things-you-need-to-know-about-dual-diagnosis-treatment/
- https://jdc.jefferson.edu/cgi/viewcontent.cgi?article=1233&context=jeffjpsychiatry
- https://guides.mclibrary.duke.edu/ebptutorial
- https://deploymentpsych.org/treatments
- https://www.helpguide.org/articles/addiction/substance-abuse-and-mental-health.htm
- https://www.drugabuse.gov/publications/research-reports/comorbidity-addiction-other-mental-illnesses/drug-addiction-mental-illness
- https://pubs.niaaa.nih.gov/publications/AA77/AA77.htm