A dual diagnosis refers to someone who suffers from two separate but intertwined conditions. One is a substance abuse problem such as heroin or cocaine addiction. The other is a mental illness like severe anxiety, depression, or bipolar disorder. Correctly giving a dual diagnosis is often difficult because substance abuse can mimic or mask the symptoms of mental illnesses.
It may be hard to accurately diagnose a mental condition even if one is suspected. A person with a mental condition is often adept at hiding their problems. They may present as a highly-functioning addict with few obvious external signs.
The Cause of a Dual Diagnosis
In most cases, the mental illness comes first, and the substance abuse is a result of self-medication. The person tries to alleviate their symptoms through drug or alcohol abuse. For example, someone may suffer from severe anxiety to the point where they are unable to function in group settings. To counteract the problem, they calm their nerves with a few drinks. While this may help them feel more comfortable in the moment, over time it takes more alcohol to achieve the same effect. In time, they develop alcohol addiction.
In other cases, the substance abuse may actually come first. Addictive drugs may actually alter the chemistry and structure of the brain to the point where it develops a condition.
The Challenges of a Dual Diagnosis
Treating someone with a dual diagnosis, also referred to as co-occurring or co-existing disorders, is more challenging than treating substance abuse alone. People with a dual diagnosis are at higher risk of not following their prescribed course of treatment, relapsing, and developing other medical conditions.
People with a mental condition often use alcohol or drugs as a way to cope with the problem or hide it from others. They may be fearful of treatment because it will allow their mental illness to surface.
If the substance abuse is the only aspect treated, the person has an increased likelihood of relapse whenever the symptoms of mental illness surface. With each relapse, it can be harder to get them to enter treatment again because it seems destined to fail.
Common Conditions with a Dual Diagnosis
While a person with any mental illness can turn to substance abuse, certain conditions seem to be more likely to lead to substance abuse. Some cases start with prescription medications that have a risk for abuse, such as anti-psychotic medications or anti-depressants. If the patient develops a tolerance for these medications, they lose their effectiveness and the patient turns to illegal substances, such as heroin or methamphetamines. Alcohol is often used to deal with mental illness symptoms as well.
Mental illness often carries a stigma, so people attempt to hide their symptoms through drug use. Some examples include the following:
- Cocaine and Anxiety – Cocaine provides euphoria and feelings of power, which counteracts anxiety
- Marijuana and Schizophrenia – Marijuana induces calm in sufferers of schizophrenia
- Opioids and PTSD – People with post-traumatic stress disorder sometimes use prescription pain medication to deal with serious physical injuries, which becomes addictive
- Heroin and Depression – Heroin induces short-term feelings of euphoria, which counteract the feelings of depression
- Alcoholism may be paired with demetia, mania, and anti-social personality disorders
One issue for dual diagnosis sufferers is that while initially the substance hides the signs of the condition, withdrawal symptoms are often similar to the symptoms of the illness. The person must then seek out more of the substance to avoid withdrawal, which worsens the condition they wish to avoid.
Here is a list of mental conditions and the symptoms the person may try to alleviate or disguise:
- Bipolar Disorder – Intense mood changes from mania to depression
- Post-Traumatic Stress Disorder – Hypervigilance, constant distress, nightmares, detachment after a trauma
- Attention Deficit Hyperactivity Disorder – Inattention, inability to focus, inability to complete tasks, distracted behavior
- Anxiety Disorder – Constant worry or apprehension
- Obsessive-Compulsive Disorder – Obsessions with certain tasks, compulsions to do things to an extreme
- Depression – Continual sadness, feelings of hopelessness, loss of energy and interest in hobbies
- Panic Disorder – Multiple panic attacks which are evidenced by sweating, trembling, chest pain, feeling dizzy, nausea and even fear of dying
- Schizophrenia – Delusions, hallucinations, disorganized behavior and conversations
Treatment for Dual Diagnosis
The complexity of dual diagnosis cases makes accurately diagnosing a substance abuse and a mental condition difficult. However, once the two conditions have been diagnosed, treatment is possible.
Treating co-existing disorders must be approached differently from treating substance abuse alone or the person is likely to relapse. Treatment should be planned by the same medical team in the same facility. If one doctor treats the substance abuse while the other treats the mental illness, and each doctor creates their own treatment plan with no coordination, the results will not be very effective.
Another approach is treatment in sequence, which means the two conditions are treated one after the other. Substance abuse is treated first, then the underlying medical condition. Sadly, patients often relapse after addiction treatment before getting the help they need for the mental illness.
The most effective method of treatment is when the person is treated for both conditions at the same time at the same treatment center. If more than one doctor are on the case, they share information and work together on a comprehensive treatment plan. Because of the complexity of dual diagnosis, many people attend inpatient rehabilitation programs to give them the support they need for success.
An assessment of the person’s psychiatric health is conducted to ensure an accurate diagnosis of the mental condition. The person begins treatment for the drug addiction, taking into consideration how it will impact the mental illness. Detoxification or removing the substance from the person’s body may move at a slower pace to avoid triggering symptoms of the mental condition.
Once initial detox from alcohol or drugs has been completed, a plan is implemented to treat the mental condition and the triggers that lead to drug use. Medication is often prescribed to control the symptoms of the mental condition while behavioral modification therapy is used to discourage substance abuse in the future. The person may participate in individual counseling and attend support groups. Alternative therapies, such as massage therapy, music therapy, nutritional counseling, yoga, and more are often used in a dual diagnosis treatment plan.
A key goal of treatment is relapse prevention. The patient often returns for therapy sessions long after they have been released from the rehab program. They often need continual support to help them avoid relapse and ensure they continue taking the prescribed medication for their mental illness.
Treating two conditions in a dual diagnosis can be a lengthy and complicated process. However, recovery is possible. If you or someone you love is struggling with a dual diagnosis, call Nova Vitae Treatment Center today for help. Our professional team is highly experienced in dual diagnosis treatment. We are happy to provide a no-cost, no-obligation consultation with one of our treatment advisors.