Dual diagnosis (also referred to as co-occurring disorders) is a term for when someone experiences a mental illness and a substance use disorder simultaneously. Either disorder—substance use or mental illness—can develop first. People experiencing a mental health condition may turn to alcohol or other drugs as a form of self-medication to improve the mental health symptoms they experience. However, research shows that
How Common Is Dual Diagnosis?
According to the National Survey on Drug Use and Health, 9.2 million U.S. adults experienced both mental illness and a substance use disorder in 2018.
Different types of addiction
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), a reference manual used by healthcare professionals as the authoritative guide to the diagnosis of mental disorders – the symptoms of alcohol abuse disorder and different substance abuse disorders are similar. The DSM breaks out substance disorder into the following categories:
Alcohol use disorder
Cannabis Use Disorder
Stimulant Use Disorder
Hallucinogen Use Disorder
Opioid Use Disorder
Drinking that is problematic or severe can be diagnosed as an alcohol-use disorder and is characterized by excessive alcohol intake, loss of control during alcohol consumption and a negative emotional state when not consuming alcohol. Alcohol-use disorders are ranked on severity – mild, moderate and severe and can impair relationships, school and/or work functioning.
The age range of people who misuse alcohol is between age 20-35 and studies have shown a difference in the patterns of drinking between men and women. Women, who seem to start drinking later in life and progress faster, are most likely drink alone to hide their guilt and shame about their alcohol use. While men tend to drink out socially. Many who struggle with alcohol abuse have other underlying disorders such as anxiety, depression and bipolar disorder, and use alcohol to make them feel better. Although, because alcohol is a depressant, alcohol abuse may lead to worsening symptoms.
Similar to alcohol use disorder, excessive or compulsive use of a substance that problematic or excessive and impairs relationships, school and/or work functions. However, the difference between those who misuse alcohol and those who abuse drugs is that substance are illegal and many people obtain felonies and other legal problems trying to get funds to purchase drugs. Misuse of drugs typically starts in adolescents, peaks into early adulthood and tapers offer with age. More than 50 percent of those will substance abuse disorders have other co-occurring disorders. Additionally, those who abuse drugs have difficulty with impulse control, controlling emotions, low self-confidence and managing stress.
Behavioral /Impulsive Control Disorder / Gambling disorder
Negative behaviors or impulses that are compulsive or excessive and cause impairment in work, school and social/intimate relationships can be considered an addiction. Behaviors and impulses can include gambling, sex, pornography, video games, food and internet addiction. People with these type of addictions tend to use the behavior as a way reduce negative emotions and detach from their problems. Many who struggles with these excessive or impulsive behaviors struggle with co-occurring disorders and use these activities as a replacement for developing and sustaining intimate relationships or friendships.
Causes of addiction
While there is no definitive cause to alcohol, substance or behavior disorders, there are several factors that can trigger addictive behaviors. Those include:
Genetics a growing body of research have linked genetics and addiction. Those who relatives had a substance or alcohol-abuse disorders are at a greater risk of developing an addiction. When you start drinking alcohol or using substance, you may be at a predisposition for the disorder to develop and progress faster in those who relatives struggled with addiction.
Environmental those who have a limited support system, or whose peer group engages in excessive alcohol consumption or substance use can contribute to development of these disorders. Additionally, those who are victims of trauma – sexual, physical, emotional — are more prone to alcohol and substance abuse disorders, as well as impulse behaviors, such as sex addiction, gambling, pornography, food.
Chemical changes in the brain Studies have found that the pleasure center of the brain gets activated producing a euphoric effect which can only be repeated with more drugs or alcohol. Re-experiencing that pleasure typically requires more alcohol or substance use to get the same effect resulting in reliance or addiction.
Signs & Symptoms
- Use of larger quantities of the alcohol or substance over a longer period than intended.
- The intention or desire to cut down or control the alcohol or substance but with limited ability to stop.
- Spending a great deal of time trying to obtain alcohol or substance, use them or recover from the aftereffects of the drug or alcohol.
- Consistent cravings or desire to use alcohol or substances.
- A consistent failure to fulfill major responsibilities or obligations at schools, work or home
- Recurrent use of alcohol or substances despite its interference in interpersonal relationships or responsibilities.
- A reduction of activities or obligations you once enjoyed because of alcohol or substance use.
- An increase in risky behaviors or hazardous situations because of alcohol or substance use.
- Continued use of alcohol or substance despite knowing that the alcohol or substance is contributing to poor physical or psychological health.
- A need for larger quantities of alcohol or substances to get the desired effect or development of a tolerance to the previous amount.
- Experience of physical withdrawal symptoms — nausea, shaking, sweating, heart racing when the effects of the alcohol or substances were wearing off.
Symptoms of a mental health condition can also vary greatly. Warnings signs, such as extreme mood changes, confused thinking or problems concentrating, avoiding friends and social activities and thoughts of suicide, may be reason to seek help.
Treatment for Alcohol, substance use and behavior disorders
Interventions for alcohol, substance and behavior disorders have shifted away from in-patient facilities to multi-faceted treatment options in an outpatient setting. Both medication and psychotherapy in conjunction have been shown to be effective in treating those with alcohol and substance abuse disorders.
Substance and behavioral addiction services consist of highly structured and intensive individual approaches to helping clients develop healthy levels of personal understanding and adjustment regarding maladaptive behaviors.
The best treatment for dual diagnosis is integrated intervention, when a person receives care for both their diagnosed mental illness and substance abuse.
Following are the common methods used as part of the treatment plan:
Detoxification. The first major hurdle that people with dual diagnosis will have to pass is detoxification. Inpatient detoxification is generally more effective than outpatient for initial sobriety and safety. During inpatient detoxification, trained medical staff monitor a person 24/7 for up to seven days. The staff may administer tapering amounts of the substance or its medical alternative to wean a person off and lessen the effects of withdrawal.
Inpatient Rehabilitation. A person experiencing a mental illness and dangerous/dependent patterns of substance use may benefit from an inpatient rehabilitation center where they can receive medical and mental health care 24/7. These treatment centers provide therapy, support, medication and health services to treat the substance use disorder and its underlying causes.
Supportive Housing, like group homes or sober houses, are residential treatment centers that may help people who are newly sober or trying to avoid relapse. These centers provide some support and independence. Sober homes have been criticized for offering varying levels of quality care because licensed professionals do not typically run them. Do your research when selecting a treatment setting.
Psychotherapy is usually a large part of an effective dual diagnosis treatment plan. In particular, cognitive behavioral therapy (CBT) helps people with dual diagnosis learn how to cope and change ineffective patterns of thinking, which may increase the risk of substance use.
Medications are useful for treating mental illnesses. Certain medications can also help people experiencing substance use disorders ease withdrawal symptoms during the detoxification process and promote recovery.
Self-Help and Support Groups. Dealing with a dual diagnosis can feel challenging and isolating. Support groups allow members to share frustrations, celebrate successes, find referrals for specialists, find the best community resources and swap recovery tips. They also provide a space for forming healthy friendships filled with encouragement to stay clean. Here are some groups NAMI likes:4
- Double Trouble in Recovery is a 12-step fellowship for people managing both a mental illness and substance abuse.
- Alcoholics Anonymous and Narcotics Anonymous are 12-step groups for people recovering from alcohol or drug addiction. Be sure to find a group that understands the role of mental health treatment in recovery.
- Smart Recovery is a sobriety support group for people with a variety of addictions that is not based in faith.