Dual diagnosis is so common that most alcohol and drug recovery centres expect to find it in a patient. It’s where a patient is diagnosed with a mental illness and a co-occurring addiction. This ranges from alcohol and drug addiction to an addiction to sex, gaming and stealing.
Studies show that at least 50% of people living with a mental illness have a substance abuse problem. Similarly, more than half of the people battling with alcohol and drug addiction have a common mental health disorder.
The fact that there’s a link between addiction and mental illness is fairly obvious. If you’re feeling out of sorts emotionally, you’re likely to reach for alcohol and drugs to cope. Likewise, if you’re regularly abusing alcohol and drugs, you’ll likely develop symptoms of a mental disorder.
In the medical world, it’s called a co-occurring disorder or comorbidity when a person has more than one mental disorder.
A simple analogy to help you understand a dual diagnosis is comparing it to the science of fire. It takes more than one element to ignite a fire. Similarly, it takes more than one element to ignite an alcohol and drug addiction.
The fire triangle
For a fire to ignite, it needs fuel, heat and oxygen. They say that when all three elements are present and combine in the right mixture, a fire is actually an event rather than a thing.
You can prevent a fire or put it out by removing ANY ONE of the three elements in the fire triangle. For example, you can remove oxygen by throwing a wet blanket over the fire and remove heat by dousing it with water. And a fire will naturally die out when it runs out of fuel (wood, paper, grass etc.).
If you don’t COMPLETELY remove that element, the fire will reignite. You think you’ve put the fire out but the woodpile is silently smoldering (heat). All it takes is for the wind (oxygen) to pick up and the fire reignites.
The Addiction Triangle
Let’s call a dual diagnosis the Addiction Triangle.
The three sides of your Addiction Triangle are alcohol and drugs, negative thought patterns and a mental disorder.
When all three elements are present and combine in the right mixture, a fire of pain and destruction will ignite. You can remove any one of the three elements to extinguish the fire of destruction but it’s only temporary if you don’t COMPLETELY remove it.
You can stop using alcohol and drugs and you can learn self-help tools to deal with feelings and situations that trigger a relapse. However, if you don’t deal with your mental illness; you’re highly likely to relapse if you turn to alcohol and drugs to cope with anxiety and depression.
This is why an integrated treatment plan is critical for a patient with a dual diagnosis. All three elements of the Addiction Triangle must be treated for successful recovery from alcohol and drugs.
Substance abuse and a mental health disorder needs to be treated simultaneously. If you’re staying at a recovery treatment centre that doesn’t offer an integrated approach, the chances of you relapsing are high.
Co-occurring mental disorders that go hand-in-hand with addictions include:
The integrated approach usually involves:
Detox is the first stage in the recovery process and the most grueling. The detox process purges your body of harmful chemicals and restores it to a clean slate.
During detox, a patient stops using what they’re addicted to immediately. You experience painful and very uncomfortable withdrawal symptoms which include seizures, hallucinations and cravings.
Withdrawal symptoms such as seizures and a sudden drop in alcohol levels can lead to sudden death. It’s critical that you have proper medical supervision when you detox. This is very important for alcohol and opioid detoxification.
Your medical team will keep you safe and comfortable using the right medication and therapy to see you through the detox process.
Behaviour therapy (cognitive behavioral therapy and psychotherapy)
Behaviour therapy helps people uncover and address the negative thoughts, false beliefs and insecurities that lead to substance abuse. In the process, patients are provided with self-help tools to deal with situations that trigger cravings and self-destructive behaviour.
When an addict understands why they feel or act in a certain way and understand how these feelings or situations trigger substance abuse, they’re more likely to succeed in their recovery.
Depending on the diagnosis, this could include:
A person living with a mental illness is more likely to abuse alcohol and drugs mainly because they mask symptoms such as of depression, anxiety, self-loathing and low self-esteem. Using alcohol and drugs over a period of time will make a mental illness worse and the medical treatment less effective.
A bigger problem is alcohol and drug abuse can trigger a mental illness. If you have a predisposition to a psychotic illness such as bipolar disorder or schizophrenia; alcohol and drugs may trigger your first episode which then becomes a lifelong illness.
The common mental health disorders linked to alcohol and drug addiction include:
Alcohol and drugs are a form of self-medication for people living with depression but it usually makes the problem worse. Feelings of self-loathing after alcohol and drug binges can drive a person deeper and deeper into depression.
People who suffer from generalised anxiety disorder (GAD) may use alcohol and drugs to cope with their anxiety. They’re more likely to abuse benzodiazepines which are prescribed for anxiety and highly addictive.
OCD (Obsessive Compulsive Disorder)
People living with OCD often suffer from high levels of anxiety and low self-esteem which leads to depression. They may use alcohol and drugs to cope with their feelings that arise from irrational obsessions and compulsions.
ADHD (Attention-deficit Hyperactive Disorder)
People, in particular school-going children, are prescribed a stimulant to treat their ADHD which can be habit-forming. When coupled with anxiety and low self-esteem, it can lead to destructive behaviour patterns and substance abuse.
People struggling with anorexia or bulimia often use drugs to suppress their appetite. Cocaine is a common drug used by models forced to keep their weight down to the bare minimum as it takes your appetite away completely.
PTSD (Post-Traumatic Stress Disorder)
The brain of a person struggling with PTSD produces less endorphins which often leads to depression. Someone who’s experienced a traumatic or violent event and has not dealt with it in therapy may turn to alcohol and drugs to cope with their anxiety and stress.
Alcohol and drugs provide temporary relief from the emotional, manic rollercoaster that people with bipolar travel in life. The statistics are that about half of people with bipolar disorder struggle with addiction.
BPD (Borderline Personality Disorder)
Research shows there’s a strong link between BPD and addiction. A person living with BPD is more likely to use alcohol and drugs to cope with their symptoms.
Schizophrenia is characterised by bouts of severe hallucinations and delusional thinking. A person with schizophrenia may use alcohol and drugs to cope with their symptoms and this can make things much worse.
The most difficult thing about a dual diagnosis is separating the addiction from the disorder. This is because many of the symptoms overlap. It all depends on the type of substance abused and the severity of the mental health disorder.
Overlapping symptoms include:
Dual diagnosis is used to describe a person living with an addiction and a mental health disorder. More than half of people with a chronic mental illness will also have a substance use or abuse disorder.
Comorbidity is used when a person has two or more mental health disorders. They may occur at the same time or one comes after the other.
If an addiction and mental illness co-occurs in a patient, they need an integrated dual disorder treatment programme delivered by a multidisciplinary team.
The more severe the mental illness, the more likely the person will be to use and abuse alcohol and drugs. People living with a mental illness commonly use alcohol, marijuana and/or cocaine to cope with their symptoms.
Males aged 18 to 44 years old living with a mental illness are at greatest risk of developing an alcohol or drug addiction.
Teenagers and young adults with serious behavioural problems are 7 times more likely to eventually use and abuse substances.
Dual diagnosis should ideally be made by a multi-disciplinary team at an alcohol and drug recovery centre and needs to be treated using an integrated dual disorder treatment programme.
White River Manor works closely with professionals with years of experience in dual diagnosis. Our multidisciplinary team includes a psychiatrists, cognitive behaviour specialist, counsellors, nursing sisters and a nutritionist. The aim is to ensure you or your loved one receive a tailor-made recovery programme that’s holistic and comprehensive.
Posted on April 14th, 2020 by Giles Fourie