Dual Diagnosis

Addiction, also called a substance use disorder (SUD), is a public health problem worldwide, and adding to the issue are co-occurring mental health disorders. These two disorders are intertwined, causing challenges for those treating people struggling with addiction. A person in treatment can be given a dual diagnosis if it is found that they have a substance use disorder and a mental health disorder at the same time.  However, there are beneficial treatment options for it.

What Is Dual Diagnosis?

Dual diagnosis is the clinical term for a person experiencing an SUD and symptoms of mental illness at the same time. Dual diagnosis is sometimes called a co-occurring disorder. It is fairly common for dual diagnosis to start with a mental health disorder, such as depression, and lead to an SUD. Alcohol and drugs are common substances people use when self-medicating. There are also instances where addiction can cause a person to experience mental health issues, such as anxiety.The 2018 National Survey on Drug Use and Health states 9.2 million people were given a dual diagnosis that year. Dual diagnosis can cover a wide range of mental health disorders, from depression to post-traumatic stress disorder (PTSD). Overlap of symptoms may be present for both mental illness and substance use. This can make determination challenging. For example, the warning signs of a mental health disorder can also be the warning signs of drug abuse:

  • Withdrawing from family and friends
  • Noticeable changes in behavior
  • Participating in risky behaviors
  • Has a high tolerance for the substance(s) and develops withdrawal symptoms
  • Feels like they need the substance to be able to function

Fortunately, treatment options are available for those with a dual diagnosis.

How Common Is Dual Diagnosis?

Dual diagnosis is not uncommon. In fact, it is often the determination when someone is struggling with an SUD and a mental health disorder.  Many people who struggle with mood disorders, such as anxiety and depression, also struggle with addiction. Teens with major behavioral problems are more likely to use substances like alcohol or drugs to deal with their issues. 

This is why most addiction treatment centers incorporate mental health checks into their regular intake process to better diagnose and place clients in the treatment programs that fit the client’s needs best.

 What Causes Dual Diagnosis?

The National Alliance on Mental Health relays that a mental health disorder does not necessarily cause a substance use disorder. They do say that self-medication can lead to a person with mental health issues to use substances. Sustained substance use can increase the risk of mental illness.

Dual diagnosis does not mean that one disorder caused the other. However, one disorder can often exacerbate the other. NIDA says, “multiple national population surveys have found that about half of those who experience a mental illness during their lives will also experience a substance use disorder and vice versa.”

A wide variety of factors, such as family life, brain chemistry, and environmental issues, can cause some people to be at a greater risk of developing a mental illness, according to the Mayo Clinic. Drug and alcohol use may be a risk factor for these people, which can tip the scale toward developing an SUD and mental health disorder, or a dual diagnosis.  

There are several causes for a dual diagnosis, but not all are exclusive of each other. All risk factors work with each other to increase the possibility of the development of a dual diagnosis. 

Below are a few causes:

Alternative Coping Mechanisms

Self-medication with alcohol or drugs is one of the more common causes of dual diagnosis. Generalized anxiety disorder (GAD) is a prevalent mental health diagnosis in the U.S., with 6.8 million people coping with it. Of those, a little over 43 percent are getting treatment for it.

Those who are not receiving treatment for it, or other mental health symptoms, usually try other methods to cope, including substance use with alcohol or drugs. Alcohol is frequently used to self-medicate because of its ability to alter mood. Non-medical use of prescription drugs, like benzodiazepines and opioids, are also used.

However, if these substances are consumed misused or consumed excessively, drugs and alcohol can elevate mental health disorder symptoms.

Risk Factors Overlap

There are some risk factors for addiction and mental disorders that can overlap and increase the number of people who struggle with a dual diagnosis. These can be:

Heredity

Some mental health disorders can be passed from one generation to the next, as can substance use disorder. Alcoholism is thought to be partly hereditary.

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Environmental factors

A stressful home or job environment can lead to depression of GAD as well as a substance use disorder. Also, parents who drink excessively are likely to have children with behavioral problems and may develop alcohol use disorder (AUD) themselves.

Trauma

Active duty and veteran members of the military have a greater instance of dual diagnosis when they are diagnosed with post-traumatic stress disorder and an SUD. Head injuries, such as traumatic brain injury (TBI) coupled with high stress, can lead to self-medication and an SUD diagnosis. Consequently, the same applies to those who suffered from sexual or physical assault or a traumatic accident (involved or not).

Biology

Some biological factors may cause both SUD and mental health problems. For example, if neurochemistry in the brain is imbalanced, it can lead to depression of major depressive disorder. The  NIDA National Institute on Drug Abuse (NIDA) reports that people with schizophrenia are more likely to abuse tobacco, alcohol, and other drugs.

Signs of a Dual Diagnosis Disorder

There are some warning signs to be aware of:

  • Feeling unsatisfied without drink/drugs. You feel you need drugs or alcohol to feel like you can cope or feel satisfied. This is often where self-medicating starts.
  • Using substances to deal with stress or uncomfortable situations. You feel the need to drink or use drugs to connect with or talk to people, or in an unknown environment. Or you use substances to relieve stress, anxiety, or discomfort, or to escape.
  • Family history of mental illness. If mental illness runs in the family, you may be using drugs or alcohol to cope or to mask the symptoms of the mental illness you may be experiencing.
  • You’ve been involved in trauma. There are several types of trauma, such as being in a car accident, hearing about the loss of a loved one who died violently, or experiencing a physical or sexual attack or an injury.

You may notice some signs of a substance use disorder in family members or friends. These may include:

  • Sudden bursts or lack of energy
  • Sudden weight change
  • Sleep patterns change
  • Irritability
  • Skipping school or not going to work
  • Poorer performance in work or school
  • Relationships are strained
  • Self-isolation
  • Financial problems
  • Enlarged (dilated) pupils/ red eyes
  • Poor personal hygiene

Common Mental Illnesses with Dual Diagnosis

A few forms of mental illness can occur with drug and alcohol abuse. These are some of the most common mental health illnesses that are commonly found when someone is given a dual diagnosis.

  • Anxiety disorders
  • Depression
  • Personality disorders
  • Schizophrenia

Both disorders can occur at the same time, or one can lead into the other.

Dual Diagnosis Treatment

Mental health problems may go unnoticed and untreated for years and possibly lead to a substance use disorder. While it might seem smart to treat one disorder before the other, someone with a dual diagnosis would benefit from both disorders simultaneously. Many addiction treatment facilities will assess the client’s mental health status and level of substance use upon admittance.

Someone with a dual diagnosis will benefit from different forms of behavioral therapies, family therapy, and other treatment modalities. Addiction treatment should focus on the individual as a whole, and not just on the SUD, and include individualized treatment plans. When a dual diagnosed client’s mental illness is treated along with the substance use disorder, they will benefit from a treatment program that fits their specific needs.

Sources

U.S. National Library of Medicine. MedlinePlus. Dual Diagnosis. Retrieved from https://medlineplus.gov/dualdiagnosis.html#:~:text=What%20is%20dual%20diagnosis%3F,their%20lives%20and%20vice%20versa.

SAMHSA. Key Substance Use and Mental Health Indicators in the United States: Results from the 2018 National Survey on Drug Use and Health. Retrieved from https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf

National Alliance on Mental Health. (2017, October 4) Understanding Dual Diagnosis. Greenstein, L. Retrieved from https://www.nami.org/Blogs/NAMI-Blog/October-2017/Understanding-Dual-Diagnosis

NIDA. (2020, May 28). Part 1: The Connection Between Substance Use Disorders and Mental Illness. Retrieved from https://www.drugabuse.gov/publications/research-reports/common-comorbidities-substance-use-disorders/part-1-connection-between-substance-use-disorders-mental-illness

Mayo Clinic. (2019, June 8) Mental Illness. Causes. Retrieved from https://www.mayoclinic.org/diseases-conditions/mental-illness/symptoms-causes/syc-20374968

Anxiety and Depression Association of America. Facts & Statistics. Facts. Retrieved from https://adaa.org/about-adaa/press-room/facts-statistics

NIDA. (2008 December) Research Report Series. Comorbidity: Addiction and Other Mental Illnesses. Retrieved from https://www.drugabuse.gov/sites/default/files/rrcomorbidity.pdf

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