Addiction and Dual Diagnosis

Some people struggling with substance abuse also have coexisting mental disorders. When there is another psychological disorder present alongside addiction, this is called a dual diagnosis. Some of the most common mental issues involved in cases of dual diagnosis are anxiety, depression, bipolar disorder, borderline personality disorder, schizophrenia and obsessive-compulsive disorder.

Dual diagnosis can cause disruption if you’re trying to recover from drug or alcohol addiction. This is mostly the case when you’re not diagnosed properly. Other mental conditions can make treatment daunting and difficult. However, with proper diagnosis and the right course of treatment, you can tackle these issues and push on to recovery.

If you or a loved one are suffering from substance abuse, seek help from a competent addiction professional before rushing into treatment. This way, you’ll be evaluated and checked for other mental health conditions before your treatment plan is drawn up.

What is dual diagnosis?

Dual diagnosis is a term used to describe the presence of a mental health condition in a person struggling with addiction to drugs or alcohol. The mental conditions that are present in addicts are commonly referred to as ‘co-occurring disorders’ and ‘co-morbid disorders’. Comorbidity is also a term that can represent dual diagnosis.

Dual diagnosis is very common amongst addicts. If you’re suffering from alcoholism or addiction to drugs, there’s a real possibility you could have a separate mental illness. Research has shown that people addicted to drugs or alcohol have a higher likelihood to develop a mental illness than others.

Generally, addiction has been classed as a brain disorder, but it has a complex inter-relatedness to other forms of psychological disorders.

Mental illnesses may be present before addiction takes hold and are often responsible for (or predispose you to) addiction. In most cases, heavy drinking or drug use may precipitate psychological impairments by tampering with the brain’s chemistry.

You may even form a drug or alcohol addiction whilst trying to treat certain mental issues. For example, you could try to take heroin or prescription medications to reduce depression. Benzodiazepines – which are mostly addictive – are usually prescribed to treat anxiety and panic disorders and can draw you into addiction quickly. There are other cases too, such as taking drugs like amphetamines to reduce weight when you have an eating disorder.

It’s important that you consult a psychiatrist when you notice any psychological impairment, rather than self-medicate.

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Dual diagnosis in addiction treatment defined

Undetected mental health conditions can get in the way of addiction treatment. This is why clinicians place major importance in rooting out underlying or co-occurring mental issues via a series of psychological evaluations before treatment for addiction is properly initiated.

While addiction is in itself a mental illness, it may be accompanied by any other mental condition. The connection between addiction and other mental disorders can be quite hard to detect. Their association may come in several forms:

  • Mental illness may influence you to drink heavily or abuse drugs in a bid to soften your psychiatric symptoms
  • Binge drinking or drug abuse may initiate psychological disorders by tampering with neurochemical activity in the brain
  • The symptoms associated with various mental illnesses may be identical to the side effects of alcoholism and drug abuse (especially withdrawal symptoms)
  • The psychological effects of substance use disorder often come in the form of mental illnesses like depression, anxiety, mood swings, mania, etc

Because of these reasons, the process of accurately identifying a dual diagnosis can be quite challenging. However, experienced addiction experts will assess you in different ways to determine a relationship between your substance abuse and mental health condition.

An integrated dual diagnosis treatment will be initiated once the relationship between addiction and mental health has been identified. If you’re treated for addiction alone despite the presence of a mental condition, it may cause you to relapse.

Assessment of dual diagnosis

The relationship between substance abuse and mental illness can be somewhat blurred. This is because they have the ability to mask each other’s symptoms. As a result, there is a high level of difficulty when it comes to making an accurate dual diagnosis assessment.

Your rehab centre will normally carry out a neuropsychological evaluation once the remnants of the drug or alcohol has been eliminated from your system via detox. An assessment will be carried out during the initial stages of your rehabilitation, when you must have attained moderate abstinence and are drug-free. You could be evaluated further through intermittent testing during the latter period of your rehab, to weigh up how effective your treatment has been.

Assessments and evaluations that detect dual diagnosis cannot be carried out by every professional in mental health care. They can only be conducted by qualified psychologists, therapists, or psychiatrists, who are extensively cross-trained in both addiction treatment and mental healthcare.

Several components are involved in dual diagnosis. A qualified psychologist will undertake a series of tests that involves researching your medical history, as well as conducting face to face interviews. This information is collected for a number of reasons:

  • To assess your cognitive function (such as working memory, verbal ability, and information processing)
  • To evaluate your self-concept and personality
  • To appraise your emotional affect and mood
  • To understand your state of social interaction

Because you may have a simultaneously occurring medical issue with your addiction, it would be futile to go through recovery on your own, because these mental issues (if present) will make it difficult to fight addiction.

Signs and symptoms of common co-occurring disorders in addiction

If you are addicted, there are signs and symptoms that will indicate the presence of a co-occurring disorder. The following indicators should give you an idea if you have a dual diagnosis.

If there’s a history of mental illness in your family

If any member of your family has experienced symptoms related to a mental disorder or been diagnosed in the past with bi-polar disorder, depression, anxiety or addiction, there’s a high risk that you will develop a psychological illness. This mental illness may result in drug or alcohol addiction and could spring up as a result of your addiction.

Your addiction started because you tried using drugs or alcohol to alleviate certain mental issues

If you started using drugs (either prescription medications or illicit substances) or alcohol to nullify feelings of anxiety, phobia, stress or other types of mental illnesses, the psychological issue you initially tried to treat will have likely followed you into addiction. This is an indication that you may have a dual diagnosis.

If you have previously experienced trauma

Traumatic experiences tamper with the brain’s chemistry and can cause mental disorders. Trauma can include a past experience of sexual or physical abuse, witnessing a tragedy or death, or experiencing a disastrous event.

The onset of co-occurring mental disorders can be rendered by a history of trauma, according to the Substance Abuse and Mental Health Services Administration. What’s more, trauma can also induce alcoholism or drug abuse. If you have experienced a traumatic event in the past and are struggling with addiction, please ensure you consult a qualified professional to check for dual diagnosis.

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Addiction and dual diagnosis: Why substance abuse and mental health go together

Several studies have shown that substance abuse and mental illness go hand in hand. According to a Journal of American Medical Association (JAMA) report, about 50% of people with severe psychological conditions have problems with alcohol or drug addiction.

The report clearly shows that mental health and addiction certainly go together. It further states that 53% of individuals with a drug addiction have a mental illness, as well as 37% of alcoholics.

Other reports have shown over time that people with mental health issues are twice as likely to become addicted as others.

It’s easy to choose drugs or alcohol as a means to escape your mental issues. While this will make you feel better by tampering with brain activity, it only serves to draw you into addiction. Even if you used drugs or alcohol for recreational purposes, your addiction will likely precipitate one psychological disorder or the other.

So, while substance abuse may be the by-product of untreated mental and emotional impairment, co-occurring psychological issues can also emanate from alcohol or drug abuse.

Differentiating pre-existing and substance-induced issues

Dual diagnosis depends heavily on distinguishing a substance-induced psychological disorder from a pre-existing mental illness. Treatment plans will vary according to the situation of your dual diagnosis. If your addiction is the cause of your mental illness, your treatment plan will be different from one that treats a dual diagnosis where the pre-existing mental illness is responsible for the addiction.

It’s always difficult to accurately detect whether addiction or mental illness came first and which caused which, because of the close connection of both disorders. A treatment plan that targets only addiction will backfire if the substance abuse was caused by a mental illness.

If your mental symptoms (such as depression, schizophrenia, anxiety, or psychosis) resulted from alcoholism or drug abuse, you will experience an improvement in these areas when you avoid drugs or alcohol for a long time. Along the same lines, directly treating your mental disorders when they’re responsible for your addiction will initiate a change of behaviour towards the substance to which you are addicted.

However, regardless of which issue came first, dual diagnosis calls for the need to simultaneously treat both substance abuse and any co-occurring mental illness, albeit with different approaches, depending on which came first. This is because both go together and you will likely relapse if one case is treated and the other is neglected.

A qualified therapist will devise tests and evaluations to mark out which condition prefaced the other. Please make sure you answer every question honestly to give your psychologist a clear picture of your situation.

How common is dual diagnosis?

Dual diagnosis is very common amongst those suffering from addiction, and even mental problems. Studies in the UK have suggested that 30-50% of individuals suffering from mental health problems also have substance abuse issues. A study carried out in London among acute psychiatric ward inpatients found that the majority of people suffered from dual diagnosis. Another study put the figure at 50%.

The impact of dual diagnosis

The impact of dual diagnosis will vary from person to person. However, your life will be affected negatively by this condition. A mental health condition on its own has unfavourable effects. Coupled with drug or alcohol abuse, effects on your social life and general health can become more adverse.

Dual diagnosis has adverse physical effects

The consequences of a dual diagnosis on your physical health will heavily depend on both the mental disorder present and the substance being abused. Each disorder may aggravate the adverse effects of the other, which will provoke more severe symptoms of both problems.

There are overlapping health consequences involved in both disorders. A dual diagnosis is always a tell-tale sign that you may be more prone to developing various health issues.

Some of the adverse physical effects of a dual diagnosis include:

  • Blood and heart disease
  • Cancer
  • Stroke
  • HIV/AIDS
  • Lung disease
  • Hepatitis B and C
  • Bone and muscle disease
  • Cancer
  • Metabolic and Nutritional disease
  • Sexual dysfunction

Dual diagnosis can worsen emotional health

Just like with physical health, the substance being abused and psychological condition present will factor on how your emotional health is affected. Comorbidity of substance abuse and mental illness can result in feelings of depression, anxiety and disconnection from the world. It may cause low-self-esteem and also induce suicidal thoughts. The things you once found exciting will no longer interest you.

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Dual diagnosis has social effects

Relating to other people and society at large can be especially difficult as a result of dual diagnosis. Because you suffer from addiction, you’ll find it difficult connecting with the rest of the world.

Dual diagnoses can also be the cause of social problems such as stigma, theft, financial difficulties, unemployment, incarceration and legal problems.

Dual diagnosis impacts society

When mental health is combined with substance abuse, society as a whole is impacted. According to a finding by Mental Health UK, 16% of inmates in prisons and jails are estimated to suffer from dual diagnosis.

This issue has a great impact on those incarcerated and society as a whole. Without the establishment of more programmes that support integrated treatment plans for dual diagnosis, the cycle of prison, treatment, relapse, offence and then prison again will continue.

Conditions that can be discovered in dual diagnosis

A number of behavioural disorders and mental health conditions occur simultaneously alongside the compulsive behaviour of addiction.

Some of the following mental conditions may be the root cause of your addiction or an offshoot of your substance use disorder.

Attention-deficit hyperactive disorder (ADHD)

ADHD is characterised by a low span of attention or uncontrolled hyperactive behaviour. If you have ADHD, you may be predisposed to abuse alcohol or drugs as a way to cope with (or ease) your symptoms.

Stimulants like amphetamine and methamphetamine are prescribed for the treatment of ADHD. These prescription medications have habit-forming properties that can easily lead to abuse and addiction. Due to their feel-good effects, you may be tempted to use them repeatedly and exceed your prescription schedule and even dosage. As these drugs don’t totally cure ADHD, abusing them will lead to a case of dual diagnosis.

Bipolar Disorder

Bipolar disorder involves sharp swings in mood, activity levels, enthusiasm, energy, and ability to engage in daily activities. One moment, you’re euphoric, while the next, you’re depressed. About 1 in every 100 people suffer from bipolar disorder, according to Mental Health UK. About half of those people are likely to turn to alcohol or drugs.

However, symptoms of bipolar disorder are consistent with those brought about by substance abuse. In fact, you can develop bipolar disorder through drug abuse, even if you don’t have a history of mental illness.

Substance abuse symptoms mimic those of bipolar disorder, because alcohol and certain drugs alter the chemical balance of the brain that is responsible for regulating moods.

Bipolar disorder symptoms are frequently present in cases of addiction. Although they make treatment more challenging, you can still defeat your addiction with the right recovery plan.

Borderline Personality Disorder

Borderline Personality Disorder (BPD) is one of the most recognised personality disorders. Symptoms of this disorder include emotional instability, impulsive behaviour, disturbed patterns of perception and thinking, unstable self-image and shaky personal relationships, amongst many others.

BPD is estimated to affect between 0.7 and 2% of the general population in the UK and studies have shown that BPD is quite prevalent in alcoholism and drug addiction.

Those who have BPD may be tempted to use drugs or alcohol to feel good or mask the symptoms of their mental condition. Using these substances can lead to repeated use and addiction.

Side effects of substance abuse also resemble BPD symptoms. Sometimes, BPD may even emerge from addiction. One of the main challenges with treating dual diagnosis (where BPD is involved) is finishing treatment.

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Depression

Depression is one of the most common psychological illnesses around. This disorder negatively affects how you think, feel, and act. About 10% of 25 to 64-year-olds suffer from depression in the UK. Illicit drugs and alcohol can take away your depressed moods temporarily, which is why substance abuse is very common amongst depressed individuals.

Drug abuse also causes depression – even if you weren’t depressed before taking the substance in question. By tampering with the reward and motivation regions in your brain, drugs and alcohol can leave you depressed when they are abused.

In severe cases, addiction can induce an extreme state of depression or worsen the already existing problem to the point of causing suicidal ideations.

Eating disorders

Eating disorders are mental illnesses, marked by an inability to eat properly. If you have an eating disorder, you either don’t know how to control how much food you eat, or you eat far less than your body needs. Eating disorders can be life-threatening if left untreated.

This kind of mental illness can easily lead to addiction. This is because you may turn to habit-forming drugs to help control your weight or appetite. Side effects of addiction – especially during withdrawal from most drugs – can also induce eating disorders, such as loss of appetite.

Generalised Anxiety Disorder (GAD)

GAD is depicted by a chronic state of constant worry. If you have this disorder, you will be unable to control your concern and state of distress when faced with daily life issues and circumstances. Generalised anxiety disorder is conceivably the most prevalent anxiety disorder in the UK and is present in 5 to 6% of the population.

GAD commonly co-occurs alongside substance abuse. This is because you may turn to drugs or alcohol to temporarily shut down the anxiety regions of your brain. The feel-good effects of drugs and alcohol make them serve as escapes from your worrisome reality. Examples of drugs used to quell anxiety include benzodiazepines, methamphetamine and cocaine.

However, drugs can cure this. For example, when you abuse alcohol or drugs, your mental illness will still co-exist with your addiction. Your substance abuse will also worsen your state of worry. If you’ve abused drugs or alcohol due to chronic anxiety, please ensure you get treated for dual diagnosis.

Obsessive Compulsive Disorder (OCD)

OCD is a behavioural disorder, responsible for a number of compulsions and obsessions. Some of these behaviours include phobias, such as an irrational fear of germs (germophobia) and the compulsive need to stay clean. There are several versions of this mental illness. Disorders such as depression and anxiety can also be caused by OCD, which can lead to drug or alcohol abuse.

Post-Traumatic Stress Disorder (PTSD)

Substance abuse is common in people with PTSD. This is due to the low levels of dopamine in those suffering from the disorder. People with this condition are mainly those that have experienced some kind of traumatic event; this is why PTSD is extremely prevalent amongst soldiers. If you have PTSD, you may turn to substances that spike dopamine production (to make you feel happy) such as alcohol and certain illicit drugs, which can easily lead to addiction.

Schizophrenia

Schizophrenia is marked by delusional thinking and hallucinations. When it is present alongside addiction, it can be hard to trace, because its symptoms are identical to those caused by substance abuse. You may fall into addiction via schizophrenia by trying to self-medicate and nullify any psychological difficulties.

Although substance abuse isn’t directly responsible for schizophrenia, it can act as a catalyst to environmental predispositions.

Multi substance use disorder

Also called polysubstance use disorder, this condition is characterised by the compulsive need to abuse more than one substance. This condition calls for an integrated form of treatment, as treating only one case of addiction will certainly prove futile.

Effects of using drugs or alcohol when you have a mental illness

Although you may feel free of symptoms (of your mental condition) when you take alcohol or drugs, this respite from reality is only temporary. Repeatedly abusing these substances to alleviate symptoms of your mental illness will only aggravate what you’ve been trying to run away from.

If you suffer from any mental condition, it’s advisable to get treated by a licensed psychologist rather than self-medicate by abusing alcohol and drugs.

Firstly, when you use alcohol or drugs to self-medicate for a mental illness, you’ve stepped on a trajectory to addiction – another brain disease. By falling victim to addiction, you’re not just exacerbating your underlying mental illness, but also opening yourself up to the adverse side effects of addiction.

Substance abuse will only extend the issues related to mental illness – financial difficulties, strained relationships, legal issues, employment and housing problems are all additional hazards of abusing addictive substances. Also, by adding substance abuse to the mix, you’ll make your recovery more complicated.

Fortunately, there are solutions to these issues. If you have slipped into addiction by self-medicating, you can get help. Integrated treatment plans are available that will address your underlying mental condition and get to the root of your substance abuse.

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Treatment for substance abuse and mental health problems

Treating a dual diagnosis requires a dualised treatment plan that is well integrated. This treatment approach will tackle both the substance abuse and co-occurring mental illness simultaneously. If only one condition is treated, you will likely relapse when the symptoms of the neglected condition erupt.

Comprehensive treatment will start with detox to eliminate the drugs from your system, while psychotherapeutic measures are also carried out to tackle other disorders. You’ll go through intensive one-on-one therapy sessions with a licensed psychiatrist and also undergo group therapy whilst in rehab.

These treatment methods will holistically work to modify your behaviour via various behavioural therapies and dislodge your mental pull towards addiction.

What to know about dual diagnosis treatment programmes

Treatment programmes for dual diagnosis will vary according to the facility you attend. There are some things you need to check when selecting the right treatment programme for your dual diagnosis.

These include the qualifications of the staff, the privacy of the clinic, your need for proximity to home, available payment methods and whether the environmental and social conditions of the facility suit your particular needs.

Getting these things right can go a long way towards ensuring your treatment goes smoothly. However, you may be in an uncomfortable situation as a result of the problems you’re facing with substance abuse and mental health. As such, you may find it daunting to handle the logistics of treatment.

Self-help for substance abuse and co-occurring disorders

You can get psychological help to recover from your dual diagnosis through self-help programmes such as the twelve-step principle and other support groups.

These programmes create a platform to learn from the experiences of other addicts who have also suffered from one form of comorbidity or another.

There are 12-step self-help programmes designed to specifically deal with dual diagnosis. This is because taking the traditional single addiction treatment won’t be effective if you’re suffering from multiple simultaneously occurring disorders.

Helping a loved one with a substance abuse and mental health problem

Dual diagnosis is not your regular case of addiction or mental illness. Try to understand if your loved one has a mental illness attached to their addiction before you take any further steps.

If they don’t know about their condition and how their behaviour has been impacting those around them, you can call them to order without sounding judgemental.

If a ‘one-to-one’ doesn’t work, you can set up an intervention. Gather a team of close-knit friends and relatives that have considerable influence over your loved one and pool your resources to help call them to order. If you don’t know how to set up an effective intervention, a professional interventionist can help. Also ensure that treatment plans have been put in place, should they agree to seek help.

Dual diagnosis can be daunting. The experience can be quite an ordeal to go through and treatment can be just as tough. As a result, please make sure your involvement doesn’t end at finding your loved one help. Try to be there throughout the course of their treatment and support them emotionally.

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Choosing the best dual diagnosis treatment programme

Remember that choosing the best treatment programme requires being familiar with the rehab facility you’re looking to select. From privacy to pricing, making the right choice means checking the right boxes and ensuring that the facility is suitable for your needs.


FAQs

What is dual diagnosis?

Dual diagnosis is the co-occurrence of mental health conditions and substance abuse in any individual. If you are addicted to drugs or alcohol and exhibit other psychological or behavioural disorders, you have a case of dual diagnosis.

What are the risks of dual diagnosis?

Dual diagnosis is accompanied by risks associated with both the mental illness present and the substance abused.

How is a dual diagnosis identified?

Dual diagnosis is identified through specialised testing techniques applied by expert psychologists who are cross-trained in addiction care and mental health. Though your doctors may discover your dual diagnosis via the symptoms you exhibit, it is important that a trained professional makes an exact assessment of your situation.

Why is treatment important?

The right course of treatment is important in dual diagnosis, because getting it wrong or treating just a single condition can lead to relapse.

How do you treat dual diagnosis?

Dual diagnosis is treated through an integrated plan that tackles every condition involved, simultaneously.

What are the components of dual diagnosis interventions?

The components of dual diagnosis interventions include:

  • Staged Intervention for Addiction and Mental Health
  • Motivational Interventions
  • Addiction and Mental Health Counselling
  • Social Support and Long-Term Perspective

Can dual diagnosis affect anyone?

Yes, dual diagnosis can affect anyone. Your mental condition may drive you to abuse alcohol or illicit substances. Even if you used alcohol or drugs for recreation – without a history of mental illness – your substance abuse can cause a mental disorder.

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