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Dual Diagnosis

Dual diagnosis is the term most frequently used to designate the condition of an individual suffering from both a mental health disorder and a substance abuse disorder or addiction at the same time. There are special considerations for treating those who suffer with a dual diagnosis, as more than one condition needs to be treated in order for a more successful outcome. Dual diagnosis is now being referred to as co-occurring disorders.

What Is Dual Diagnosis?

When someone has been designated as having a dual diagnosis, it means that they have both a mental illness and an abuse or addiction problem with drugs, alcohol, or both. There is a wide range of possible combinations when it comes to co-occurring disorders which vary in severity. Some individuals may experience mild depression or anxiety while others may be dealing with schizophrenia or other forms of psychosis. Individuals also may vary in their drug or alcohol abuse. Some may be dependent on certain substances, while others may be addicted. Still others may misuse drugs or alcohol. Although co-occurring disorders may be the official diagnosis, treatment may be very different between individuals depending on the specific mental illness and type of substance abuse experienced.

Which Occurs First, Mental Illness or Substance Abuse?

It is often difficult to determine whether the mental illness or substance abuse occurs first if the individual involved is not currently in treatment for one aspect of the dual diagnosis prior to being diagnosed with the second. When mental illness is left untreated, sufferers will often turn to drugs or alcohol in an effort to feel better. Taking drugs or alcohol, especially in large amounts and over a period of time, can result in long term changes in the brain and the potential for the development of certain mental health conditions.

How Do both Mental Illness and Substance Abuse Occur Together?

There has been no set factors to determine what results in co-occurring disorders. It could be that those who have biological or psychological predisposition to one also have it for the other. Certain mental health issues, such as ADHD, are linked with a higher incidence of substance abuse. Perhaps the presence of a mental illness triggers something in the brain leading to substance abuse. In some cases, a traumatic event may lead to the development of both a mental health issue and a substance abuse problem. The use of certain drugs can enhance the symptoms of underlying mental illness. Furthermore, using certain drugs can actually cause changes in the brain, leading to the symptoms of mental illness.

How Many People Suffer from Co-Occurring Disorders?

According to information provided by the Substance Abuse and Mental Health Services Administration (SAMHSA) and published on DualDiagnosis.org1, approximately 4 million people suffer from a dual diagnosis. Further statistics provided by the National Alliance on Mental Illness (NAMI)2 include:

  • Nearly half of those who suffer from a severe mental illness also have a substance abuse problem.
  • 53 percent of those who abuse drugs suffer from a mental illness.
  • 37 percent of those who have a problem with alcohol use also suffer from at least one mental health issue.
  • Those with schizophrenia are 4 times more likely to suffer from a substance abuse problem than the general population.
  • Those with bipolar disorder are 5 times more likely to have a substance abuse problem than the general population.

What Is Self-Medicating for Dual Diagnosis?

The term self-medicating is often used in the field of co-occurring disorders. There are a couple of different theories on this term, including the definition of the meaning and the results. There is some belief that those with untreated serious mental illness often turn to drugs or alcohol to obtain some relief from symptoms, that the substance abuse is simply a way to resolve the mental illness. Others believe that self-medicating refers to use of drugs or alcohol in an effort to resolve side effects brought on by certain mental illness drug treatments. The only relevance this term may have is it might be helpful in determining a proper course of treatment for the mental health aspects of a dual diagnosis. It is not a free pass to use substances just because an individual suffers from a mental illness.

Special Treatment Considerations for Dual Diagnosis Patients

Treatment may be complicated for those who suffer from co-occurring disorders because both mental illness and substance abuse involve changes in the brain, including affecting the levels of various neurotransmitters. Also, certain treatments for mental health issues can lead to an increased desire for alcohol or drugs in some individuals. Additionally, certain types of drugs cause the presentation of some mental illness symptoms. This can be problematic in making an accurate diagnosis. It is important for professionals to be able to distinguish between an actual mental illness and symptoms presented by certain types of substance abuse. Often symptoms associated with mental illness will resolve themselves once substance abuse is controlled and abstinence is maintained for a period of time.

Receiving Treatment for Co-Occurring Disorders

It is important that those who suffer with the co-morbid conditions involved in a dual diagnosis receive treatment for both conditions at the same time. In the past, treatment was typically performed by separate providers. Those suffering with a dual diagnosis would receive mental health treatment from a professional who specialized in the mental health field while also receiving treatment from a separate professional who specialized in addiction or substance abuse recovery. This was found not to be very effective for most individuals with co-occurring disorders. Today, professionals can receive training and specialize in co-occurring conditions in order to more effectively treat patients with a dual diagnosis. This reduces the number of different appointments for the patient, making it easier for the individual to attend all treatment sessions. There is also no need for two separate professionals to find the time to talk together and discuss the patient and progress in both treatments.

Inpatient Treatment for Those Who Suffer from Dual Diagnosis

There are treatment facilities that specialize in the treatment of co-occurring conditions. Individuals can receive treatment for both mental health issues and substance abuse problems from the same professional or team of professionals, keeping all progress for both conditions in one place. Inpatient treatment is especially important for those with a dual diagnosis, as many people with mental illness tend to stay alone. Inpatient treatment will help with necessary social support. Individuals will also be able to remain focused on treatment of both issues, without outside distractions. Those with a dual diagnosis can receive around the clock care for both mental health issues and substance abuse issues. Inpatient treatment also allows for better stabilization of both the mental illness and the substance abuse so that there can be more focus on managing mental illness and overcoming substance abuse or addiction.

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