Dual Diagnosis for Substance Abuse
Substance use disorders — the repeated misuse of alcohol and/or drugs — often occur simultaneously in individuals with mental illness, usually to cope with overwhelming symptoms. The combination of these two illnesses has its own term: dual diagnosis, or co-occurring disorders. Either disorder (substance use or mental illness) can develop first.
When examining someone with a dual diagnosis, it isn’t always easy to tell whether the substance abuse or mental health disorder came first. However, with the right treatment and recovery plan, people with co-occurring disorders can live healthy, sober lives. They can also gain the confidence to face their mental illness head-on and use coping skills to manage it daily.
In 2019, 9.5 million American adults between the ages of 18 to 25 were diagnosed with at least one co-occurring disorder alongside a substance use disorder. Among this group, only 742,000 people (7.8%) received treatment for both a substance use disorder and mental health disorders simultaneously.
What Is Dual Diagnosis Treatment?
Someone who struggles with substance addiction and a co-occurring mental health condition, such as depression or anxiety, is said to have a dual diagnosis. Dual diagnoses require integrated and comprehensive care to fully address and rectify both conditions. This type of treatment is offered by rehab centers that provide treatment for substance abuse and help with mental health-related issues. Only treating one issue may put the person at an increased risk of relapse.
Why is Dual Diagnosis Treatment Important?
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), nearly 8 million adults struggled with both a substance use disorder and a mental disorder in 2014. However, only a fraction of people with substance abuse problems and/or mental illnesses seek professional help to get the treatment they need. Sometimes one condition might contribute to or worsen the other. For example, someone with a mental illness might use drugs or alcohol to cope with their symptoms. In other cases, substance abuse may uncover a mental illness or exacerbate related symptoms.
Signs And Symptoms Of Co-Occurring Disorders
Even though all mental illnesses have their own unique sets of signs and symptoms, you can’t always tell if a dual diagnosis exists as well. By knowing these signs in advance, you can help your loved one get the dual diagnosis treatment they need to be sober and mindful.
You Have A Dual Diagnosis If You Show The Following Signs:
- Developing a tolerance to certain substances like alcohol or drugs
- Having trouble quitting drugs or alcohol
- Stealing or lying about your drug addiction and other negative behaviors
- Stopping old hobbies in favor of new friends and activities
- Feeling guilty about compulsive behaviors
The Following Are Physical Symptoms Of A Dual Diagnosis:
- A dramatic change in mood and energy levels
- Withdrawing from friends and family
- Losing interest in activities you used to enjoy
- Feeling worthless and hopeless for more than two weeks in a row
- Difficulty maintaining friendships, keeping a residence, or holding a job due to mood swings
- Having delusions or hallucinations
- Following high standards and specific rituals to relieve anxiety
Common Mental Health Conditions of Dual Diagnosis
Dual diagnosis isn’t as rare as one might think. In fact, 7.9 million Americans are classified as having a dual diagnosis.
Some mental health conditions are more common than others in dual diagnosis patients. The more common mental health condition associated with dual diagnosis are:
- Depression. Substances can mask symptoms such as hopelessness, loneliness, sadness, and suicidal thoughts.
- Bipolar disorder. One of the most common disorders associated with alcohol abuse, bipolar patients use substances differently depending on their cycle. It’s especially dangerous during a manic phase which already makes a patient prone to reckless and careless behavior.
- Obsessive-compulsive disorder (OCD). Substances are appealing to OCD patients because it distracts them from the sometimes debilitating symptoms of their disease.
- Anxiety. Substances may help anxiety sufferers by allowing them to relax and place their focus on something other than what’s causing their anxiety.
Common Underlying Factors
Certain characteristics may contribute to the simultaneous development of both substance abuse and a psychological disorder:
- Genetics: Genes can create certain temperaments or dispositions that make one more (or less) likely to use drugs, or develop a mental health disorder that then facilitates the path towards drug use. Genes also affect the way a substance interacts with the brain and body.
- Personality: A propensity for risk-taking and novelty-seeking are personality traits that relate to substance abuse and other mental disorders.
- Brain chemistry: Dopamine is a brain chemical that is affected by both substance use and certain psychological disorders. Brain changes from one disorder may spur the development of the other.
Dual Diagnosis and Denial
Denial is common in both substance abuse and mental health issues. It’s often hard to admit how dependent you are on alcohol or drugs or how much they affect your life. Similarly, the symptoms of conditions such as depression, anxiety, bipolar disorder, or PTSD can be frightening, so you may try to ignore them and hope they go away. Or you may be ashamed or afraid of being viewed as weak if you admit you have a problem. But substance abuse and mental health issues can happen to any of us. And admitting you have a problem and seeking help is the first step on the road to recover.
Treatment for Co-Occurring Disorders
There is evidence that with help, people with a dual diagnosis can stabilize and recover. A large part of the treatment for dual diagnosis involves behavioral interventions. Once a professional makes an official diagnosis, treatment can begin. Patients struggling with both a substance abuse disorder and a mental health issue tend to have symptoms that are more persistent, extreme, and resistant to treatment than either disorder alone.These challenges can affect a dual diagnosis patient’s approach and response to treatment, making recovery more complicated.
Types of behavioral therapy commonly used in dual diagnosis treatment include:
- Dialectic behavioral therapy, which has the goal of reducing self-harming behaviors that often accompany mental health conditions and substance use disorders.
- Integrated group therapy, which seeks to treat the symptoms of both substance use disorders and mental health illnesses all at once.
- Cognitive behavioral therapy, which works to minimize problematic beliefs and behaviors and develop healthier thinking and behavioral patterns to sustain sobriety.
- Individual psychotherapy, which treats behaviors related to substance abuse and/or particular behavioral or mental health problems.
Aftercare for Dual Diagnosis
Now that you no longer need drugs or alcohol to function, you might think you’re out of the woods. However, you’ll still encounter triggers and cravings which could lead to relapse. Aftercare is essential for preventing this from happening, and it will also help you conquer your mental illness for the long term. A dual diagnosis comes with a whole set of unique issues, and understanding these issues is key to treatment and recovery.
Aftercare services like art therapy, outdoor therapy, meditation, yoga, and holistic services like acupuncture and tai chi can all bring you closer to peace. Learning how to live life sober can be an exciting experience, and this is an important time for you to find yourself. With proper aftercare, you can learn how to handle your dual diagnosis safely and responsibly.
Helping a Loved One
Helping someone with both substance abuse and a mental health problem can be a roller coaster. Resistance to treatment is common and the road to recovery can be a long journey.
The best way to help someone is to accept what you can and cannot do. You cannot force someone to remain sober, nor can you make someone take their medication or keep appointments. What you can do is make positive choices for yourself, encourage your loved one to get help, and offer your support while making sure you don’t lose yourself in the process.