We have come a long way in treating substance abuse and mental health disorders. There was a time, not too long ago, when we treated one before going on to the next. That was the last century.This century, we subscribe to dual diagnosis treatment in order to help those with co-occurring disorders recover successfully. Other “standard” treatments have given way to a more integrated approach that assures clients better mental health management and a more permanent recovery.
What is Dual Diagnosis?
Many people who suffer from a substance use disorder also suffer from a mental illness. While in the past, we have treated the substance abuse first and have seen more relapses, we now look at the client more holistically and treat both at the same time in the same positive environment. Dual diagnosis entails looking for a root cause for the substance abuse though, many times, both disorders go hand in hand.
We have found that there are similar patterns in these types of clients, between their drug of choice and the mental disorder in effect. For example, those who partake in substances that sedate or relax usually suffer from anxiety-related illnesses. Conversely, those who do “feel-good” drugs likely suffer from depression or other mood disorders.
Cause and Effect
Sometimes it’s hard to tell which came first. Substance abuse can also lead to mental disorders through biological mechanisms, such as chemical imbalances in the brain, which can initiate or exacerbate a hidden mental illness. Exposure to more stress and having less emotional support for coping with that stress can be another factor..
The term dual diagnosis has given way to co-occurring disorder diagnosis as a better descriptor, since an individual can have more than one disorder. The best treatment for a person suffering from multiple disorders is to treat all disorders at the same time, because they are usually overlapping or entwined in scope.
Common Mental Illnesses and Addiction
Those suffering from a substance use disorder could also have one or more of these mental disorders:
There are five major types of anxiety disorder:
- Generalized anxiety disorder (GAD) – characterized by chronic anxiety, worry and tension, even when there is nothing to provoke it.
- Obsessive-Compulsive Disorder (OCD) – identified by recurring, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions). The repetitive behaviors, such as hand-washing are done in hopes of stemming the recurring thoughts. If the person is unable to do them, their anxiety increases.
- Panic Disorder – defined by unexpected and repeated incidents of intense fear and physical symptoms that may include chest pain, heart palpitations, shortness of breath, dizziness, or abdominal distress.
- Post Traumatic Stress Disorder (PTSD) – this develops after a traumatic event in which grave physical harm or danger occurred or was threatened. Episodes can be triggered by smell, sight, sound or touch.
- Social Anxiety Disorder – identified by overwhelming anxiety and excessive self-consciousness in everyday social situations.
Also known as Manic Depression or manic depressive illness, this is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks. These shifts can last from one to two weeks or for months on end. There are three different types of bipolar disorder, as well as specified and unspecified bipolar disorders:
- Bipolar Type I – manic episodes last at least 7 days, or the manic symptoms are so severe that the person needs immediate hospital care. The depressive episodes typically last at least 2 weeks.
- Bipolar Type II – a pattern of depressive and manic episodes, but not the complete hypomanic episodes described above.
- Cyclothymic Disorder – also called Cyclothymia, this is numerous periods of depressive and manic episodes that may last up to two years (one year in children and adolescents). Symptoms are not severe enough to be considered regular bipolar disorder.
There are many types of depression but the three major ones are:
- Major Depression – characterized by a depressed mood all or most of the day, diminished interest in activities, fatigue or loss of energy and insomnia.
- Dysthemia (Persistent Depressive Disorder) – when the major depressive symptoms last for 2 or more years, fluctuating above and below baseline symptoms the whole time – could last for decades.
- Premenstrual Dysphoric Disorder – mood and anxiety symptoms that are clearly related to the menstrual cycle with symptoms starting before menstruation and ending with it. These symptoms are much worse than PMS and must occur more often in order to be diagnosed.
There are three different types or clusters of personality disorders. In each cluster are three or four specific disorders.
- Cluster A is marked by behavior that is unusual and eccentric to others, and includes paranoid, schizoid and schyzotypal personality disorders.
- Cluster B is defined by behavior that is emotional, dramatic, or erratic and includes antisocial, borderline, histrionic and narcissistic personality disorders.
- Cluster C has anxiety and fear as the underlying behaviors. These are avoidant, dependent and obsessive compulsive personality disorders. Note that OCD is both, an anxiety disorder and a personality disorder.
This is a chronic and severe mental disorder that affects how a person thinks, feels, and behaves. People with schizophrenia may seem like they have lost touch with reality. Although schizophrenia is not as common as other mental disorders, the symptoms can be very disabling. It is characterized by hallucinations and delusions as well as disordered speech and thinking.
Dual Diagnosis Treatment vs. Standard Treatment
All these mental illnesses could be the result of an underlying or contributing factor to substance abuse. Standard rehabilitation treatment would ignore the mental illness or relegate it to another health professional outside the recovery program. This would severely hamper the recovery process and possibly lead to relapse incidents, and a permanent return to substance abuse. In the 1990s, it was discovered that this was not a successful way to treat patients with co-occurring disorders.
The 21st century brought with it a blending of mental health and substance abuse treatment that allowed clients to be more successful in their recovery while managing their mental illness. Many rehabs now have psychiatrists or clinicians who have the added training to facilitate a thorough diagnosis and treatment for co-occurring disorders. Many of these rehabs also offer holistic therapies including yoga, massage and acupuncture. Other offerings may include equine therapy, Tai Chi and exercise.
By providing a positive treatment experience that addresses both disorders, each client receives the necessary support to work on making healthier choices in their behaviors, enhancing the ability to manage symptoms throughout the recovery journey. Dual diagnosis treatment may complicate recovery a bit, but if family and friends are willing to get a better understanding, they, too, can help with recovery from this complex condition.
Dual Diagnosis Statistics
These are just some of the statistics regarding substance abuse and dual diagnosis.
- A 2014 National Survey on Drug Use and Health showed that 7.9 million people have dual diagnosis and over half, 4.1 million, of them being men.
- In the last six years,the number of patients in rehabs that had a co-occuring disorder increased from 12% to 16%.
- Of the almost 3 million adults employed and living with a dual diagnosis, only approximately 40% received any treatment intervention at all for either disorder, and less than 5% received treatment for both issues.
- 60% to 80% of people diagnosed with antisocial personality disorder were found to also be suffering from alcoholism, and 20% to 40% of people diagnosed with alcoholism were also diagnosed with antisocial personality disorder.
- One study found that people diagnosed with alcohol use disorder were 4 times more likely to have depression and 3 times more likely to have an anxiety disorder.
- Many of those living with a dual diagnosis receive treatment for only one of their ailments. It is estimated that of the adults living with co-occurring disorders:
- 34% receive mental health treatment
- 2% enroll in drug rehab
- 12% get the help they need for both disorders.
In the 1990s, alcohol was the primary drug of choice for more than 50 percent of dual diagnosis patients. Since the turn of the millennium, it has shifted downward: Alcohol, although still the primary substance of abuse, is only prevalent in 45 percent of dual diagnosis patients. The biggest increase in use for any one substance, in the 2000s, has been prescription painkillers. About 21 percent of dual diagnosis patients are addicted to prescription opiates.
The statistics are still bleak for those suffering from co-occurring disorders; however, with new studies and theories on dual diagnosis treatment, the future for those still suffering is looking a lot brighter.
Why Co-Occurring Disorders?
There are plenty of theories as to why mental illness and its compatriot, substance abuse, are becoming more prevalent. Biology or genetics is known to play a role in some mental illnesses. Whether a person’s physiological makeup is imbalanced due to a missing chemical or compromised electrical activity in the brain, behavioral and mental health are put at risk.
Sometimes, people develop an addiction as a coping mechanism for a mental illness. This is never a good long-term solution, because the body gets used to the substance and will start needing more and more in order to get the same sensory result.
Improper diagnosis of a disorder is also another common problem, in which two different disorders with similar symptoms are diagnosed as only one and then not treated correctly.
People with co-occurring disorders may face different symptoms due to the same brain abnormality. For instance, schizophrenia and drug use may be two sides of the same coin, with one decreasing dopamine uptake to the reward center of the brain, while the other sensitizes the psychosis part of the brain to dopamine. Self-medicating is contra-indicated because the drugs may cause more psychosis, instead of diffusing it.
Overlapping environmental triggers are another reason some people develop mental illness, due to trauma or some other painful experience. A childhood trauma, such as sexual abuse, may lead to anxiety disorders or depression, especially if the guilt is internalized. If left untreated, this can also lead to PTSD. This type of abuse and associated disorders leave scars on the mind and soul, as well as the body. Mental illness can develop and, as time progresses, often lead the victim to self medicate, escalating to addiction.
Dual Diagnosis Treatment as Part of Recovery
When deciding on a rehab for yourself or a loved one, it may be best to find one that recognizes dual diagnosis treatment and co-occurring disorders. A person may have started out having a mental health disorder and then self-medicated with drugs or alcohol. Contrary-wise, they may have started out using a substance, ended up addicted, and developed a mental health disorder as a result, such as with heroin use. Since addiction statistics indicate the likelihood of a co-occurring disorder being present, it’s better to have dual diagnosis treatment as an option, just in case.
Acceptance Recovery Center is a rehabilitation center in Scottsdale, Arizona that provides an integrated approach for treating substance use disorders, while specializing in dual diagnosis. We put focus on understanding the cause, whether it be trauma or another underlying reason for the addiction, and offer client-centric solutions. Learn more about us and our philosophy on addiction treatment.
Unsure if dual diagnosis is the problem in you or a loved one?
Dr. Greg Gale has been practicing and providing leadership in the field of psychiatry, substance use, and integrated care in the Phoenix metropolitan area for over 11 years. He joins us from his role as a national medical director overseeing behavioral health, substance use, and integrated care services for Humana Behavioral Health. Previously, he was CMO and VP of Clinical Services at Partners in Recovery, a not-for-profit behavioral health and substance use service organization, which operates five clinics throughout Maricopa County.