Dual diagnosis, also known as co-occurring disorders or dual disorders, is a condition wherein the person suffers from both mental health problem/s and a substance use disorder. This concept was first introduced in the late 1980s due to the rising cases of young people with severe mental illness, who were also misusing drugs to cope with their mental health issues and life in the community.
Contrary to what many people think, dual diagnosis is fairly common. One research published in World Psychiatry shared that at least 50 percent of adults suffering from severe mental disorders also have co-occurring substance use disorders. In the United States, more than 9 million adults have been diagnosed with this condition according to the results of the 2018 National Survey on Drug Use and Health.
Reasons Why Substance Use Disorders and Mental Health Disorders Co-Occur
While substance use disorders and mental disorders often occur together, it does not necessarily follow that one condition caused the emergence of the other. Given that each person’s experience of dual diagnosis is unique, it can also be challenging to determine which condition occurred first. Nonetheless, researchers in the field postulate three possible reasons why these disorders occur together:
- Mental health disorders can lead people to misuse drugs or alcohol. People suffering from mental health disorders usually abuse drugs and alcohol to find relief from the discomforting symptoms of their mental issues. For instance, individuals suffering from depression may take drugs that produce feelings of euphoria like heroin to boost their mood. The more they rely on a particular substance to cope with their difficulties, the more they become susceptible to developing substance use disorder on top of their existing mental health issue.
- Substance use disorder can increase the risk of mental disorders. Drugs or alcohol misuse changes the areas of the brain that are associated with various mental disorders, such as anxiety, depression, and bipolar disorder. As such, addiction can trigger the development of a mental illness or worsen existing symptoms of a mental disorder. For instance, cocaine addiction may cause anxiety and panic attacks.
- Substance use disorder and co-occurring mental disorders have common risk factors. Addiction and mental health disorders share similar underlying root causes such as genetic influences, brain deficits, exposure to trauma, and high levels of stress.
Most Common Mental Disorders Linked to Substance Abuse
Studies conducted by the National Institute on Drug Abuse revealed that substance use disorders co-occur at high rates with the following mental health disorders:
Generalized Anxiety Disorder
Generalized Anxiety Disorder (GAD) is a condition that affects close to 7 million adults in the country. It is characterized by excessive and persistent worry about different issues, which lasts for at least six months. People who struggle with GAD tend to seek relief by using alcohol, as well as legal and illegal drugs. As such, it is not surprising that one in five of those with an anxiety disorder also suffers from substance use disorder.
Panic disorder is a type of anxiety disorder that triggers the onset of intense feelings of terror even in the absence of danger (panic attacks). The one-year prevalence rate of panic disorders in the United States is at 2 to 3 percent, which is much higher than those from Asian, African, and Latin American countries. People with panic disorders often turn to alcohol and drugs to calm their nerves or numb their fear. This form of self-medication does not only worsen the mental health issue, but also leads to a substance use disorder.
Post-Traumatic Stress Disorder
Post-traumatic stress disorder (PTSD) is a mental health illness that usually occurs after the individual has been exposed to severe physical or psychological trauma. These individuals experience severe anxiety, nightmares, and flashbacks that negatively impact their daily lives. According to the National Center for PTSD, around 8 million people suffer from PTSD in a given year, and 40 percent of them will most likely develop a substance use disorder as they attempt to address the distressing symptoms of this condition.
Depression is a serious mental disorder characterized by prolonged periods of emotional low. It affects more than 17 million adults in the country and is more common among women. Depressed individuals usually take drugs or alcohol on a regular basis to escape the feeling of emptiness or other negative emotions. One study published in the Journal of Psychoactive Drugs shows that the most commonly abused substance for people with major depression is alcohol, followed by cocaine and cannabis, respectively.
Formerly known as manic depression or manic-depressive illness, bipolar disorder is a type of mental health disorder that causes intense and unusual changes in mood, behavior, and activity levels. Based on the recent figures by the National Institute of Mental Health, close to 3 percent of adults in the country suffer from this condition in the past year alone. People with bipolar disorder often rely on drugs or alcohol to alleviate pain or manage their erratic mood even for a little while. As they continue to cope through substance use, the majority of people with bipolar disorder also develop substance use disorder.
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Schizophrenia is a serious mental disorder characterized primarily by the occurrence of psychotic symptoms, such as hallucinations, delusions, disorganized motor behavior, and disturbance in thought processes. While the prevalence of schizophrenia in the country is relatively low, between 0.25 percent to 0.64 percent, this condition is linked to significant social, economic, and health issues, including the development of substance use disorder. One study published in the Dialogues in Clinical Neuroscience revealed that people with schizophrenia are prone to misuse alcohol, nicotine, cocaine, and cannabis.
General Warning Signs of Dual Diagnosis
Recognizing dual diagnosis can be challenging. For one, the symptoms of mental disorders sometimes overlap with substance use disorder. As such, most people are treated for one illness while the other issue remains unaddressed. Another reason why this condition is difficult to diagnose is the complexity and differences in symptoms. For instance, a person suffering from both depression and cannabis misuse will exhibit symptoms that are different from the symptoms of one suffering from schizophrenia and alcohol abuse.
While accurately diagnosing co-occurring disorders can be tough without the help of professionals, there are general warning signs that may suggest the presence of this condition. If you or any of your loved ones experience the signs below, it may be time to seek professional help:
- You use alcohol or drugs to relieve pain, manage your mood swings and unpleasant thoughts, face frightening situations, or improve concentration.
- There is a connection between your mental health and substance use. For example, you resort to drinking the moment you feel anxious or overwhelmed by painful memories.
- You have a family history of mental health illness or substance use disorder.
- You feel anxious, depressed, or unlike normal even when you are not drinking or using drugs.
- You have undergone treatment for mental health illness, but the treatment failed because of complications caused by substance abuse or vice-versa.
Common Elements of Dual Diagnosis Treatment
The ideal treatment approach for dual diagnosis is an integrated intervention. This means that the individual receives care from doctors and counselors for their mental health illness and substance use disorder at the same time. While the content of a treatment program varies depending on the recovery needs of the person, some elements are common to everyone, such as the following:
Detoxification, also known as detox, is the process of ridding the body of all traces of drugs or alcohol. It goes hand-in-hand with withdrawal management and is is the first crucial step in treating substance use disorder.
Detox can cause painful and dangerous withdrawal symptoms, particularly among individuals who have been misusing drugs or alcohol for a long time. For a safe and effective detoxification process, it is best to opt for inpatient care wherein experienced medical personnel monitor the individual 24/7 and immediately administer strategies to minimize the discomforting effects of withdrawal.
People with dual diagnosis may benefit greatly from staying inside a treatment facility for the duration of the treatment program. Apart from receiving appropriate medical and mental health assistance 24/7, those who opt for inpatient rehab can focus more on their recovery and avoid stressors that could worsen their situation.
Psychotherapy is a major component of a treatment program. It aims to assist people with mental health problems to better understand their feelings and struggles so that they can learn how to address their issues in healthy ways.
Medications are often used to address mental health illnesses. It is also used to assist people suffering from substance use disorder, particularly during the detox process.
Support groups offer individuals with co-occurring disorders opportunities to connect with those in a similar situation and, in the process, prevent feelings of isolation and loneliness. Groups like Double Trouble in Recovery, Alcoholics Anonymous, and Smart Recovery allow members to share their feelings, celebrate milestones, and receive encouragement and recovery pointers.
Finding the Right Dual Diagnosis Treatment Program
While there are plenty of treatment facilities in the country that caters to individuals with dual diagnosis, not all of them are created equal. You need to scrutinize each facility to ensure that you or your loved one will receive the best help.
Apart from confirming that the facility has the appropriate license and accreditation to operate, you should also check if the treatment approaches are supported by scientific research. Most importantly, the treatment program should be tailor-fitted to your recovery needs as there is no single foolproof therapeutic method that works for everyone.
Keep in mind that finding the right treatment program will not only address your mental health problem and substance use disorder, but will also help you learn healthy coping skills and strategies to improve your way of handling life’s stressors and avoid relapse. Discover reputable dual diagnosis facilities near you and start your recovery journey by browsing Better Addiction Care’s comprehensive directory of trustworthy treatment providers.
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