What is Dual Diagnosis?
Many people diagnosed with a substance use disorder (SUD) are also suffering from a co-existing mental health or behavioural disorder. This is known as a dual diagnosis. It is also commonly referred to as co-morbidity, or co-occurring mental health and substance use disorder.
Some of the most common mental health disorders that overlap with substance use disorders include:
- anxiety disorders
- personality disorders
- post-traumatic stress disorder (PTSD).
These conditions negatively affect the way we feel, behave, interact with others and perceive the world. Drugs and alcohol are often used as dysfunctional coping mechanisms to help us live with the painful symptoms of these mental illnesses. Unfortunately, the more we use drugs and alcohol in this way, the greater the risk of becoming addicted to them.
While mental health conditions can lead to co-occurring substance abuse there are cases where the opposite appears to be true. A substance use disorder can be the starting point, triggering a mental illness – or worsening an underlying mental health problem – over time.
Dual diagnosis is still a relatively new and evolving field, and researchers are still discovering information about the relationship between mental health disorders and substance addictions – and how to develop effective strategies for prevention, treatment and recovery.
Everyone experiences dual diagnosis differently depending on the type of mental health problem, the type of substances used, and how the two combine together. As well as differences across age ranges, the type and pattern of dual diagnosis is known to vary with culture, gender, peer group and social settings.
It is also common for those with mental illness to develop other behavioural disorders in addition to substance abuse, such as gambling addiction, sex addiction or shopping addiction.
While mental health treatment and addiction treatment still tend to be separated systems of care, research continues to reveal that people with co-occurring disorders need a specialised form of treatment, referred to as integrated services or dual diagnosis treatment. The two conditions impact hugely on each other, and unless they are treated together, a high incidence of relapse results.
Through professional care and support, those experiencing the complexities of dual diagnosis can learn how to overcome both conditions and successfully manage their wellbeing.
Why do Mental Health and Substance Abuse Disorders Occur Together?
Although these disorders frequently occur together, researchers are still unclear as to why they occur together. Current understanding of the complex relationship between the two disorders suggests there are three possibilities:
- Common risk factors
- Mental health disorders contribute to substance use disorders
- Substance use disorders can directly cause mental health disorders
Those with mental health disorders may use drugs or alcohol to find temporary relief from their symptoms. Self-medicating over a prolonged period of time can alter the brain and make addiction more likely.
Substance use can change the brain in ways that make some individuals more likely to develop mental health problems. It can also trigger or exacerbate existing or underlying mental health illness. Additionally, the effects of withdrawing from many drugs can produce or mimic symptoms of mental health problems, as can the excessive use of stimulants.
What are the Most Common Combinations in Dual Diagnosis?
There is no limit to the combinations of substance use disorders and mental health disorders in dual diagnosis; however, some of the most common examples include:
- cocaine or alcohol abuse and bipolar disorder
- alcohol addiction and depression
- prescription drug addiction and anxiety disorders
- opioid or alcohol addiction and PTSD
- poly-drug abuse and borderline personality disorder
- cannabis and schizophrenia
For those with bipolar disorder, the substance of choice often depends on which symptoms are present – whether the individual is in a manic or depressive cycle. As with any other disorder, it can be tempting to self-medicate to provide a source of temporary relief from the symptoms.
Many people with depression turn to drugs or alcohol as a coping mechanism to mask their symptoms. This form of self-medicating often makes the problem worse. The crash after the high can be overwhelming for those with a pre-existing depressive condition. For some, depression is the primary condition, and the drug or alcohol addiction develops over time. For others, alcohol addiction is the starting point, and symptoms of depression arise due to alcohol abuse.
There are many different types of anxiety, including panic disorder, social anxiety disorder, specific phobias and obsessive-compulsive disorder. The symptoms experienced can be so intense and debilitating that people often turn to medications to manage them. Unfortunately, many of the prescription medications used to treat anxiety disorders are highly addictive.
Post-traumatic stress disorder (PTSD) can develop after an individual experiences one or more traumatic events. This condition affects millions of people each year, but most of them do not seek the professional treatment needed to manage their symptoms properly. Many turn to alcohol or prescription painkillers to numb the intensity of their symptoms, which can include panic attacks, insomnia, flashbacks, and recurring disturbing thoughts.
Studies have shown that addiction and borderline personality disorder (BPD) often occur together. Over two-thirds of people with BPD resort to taking drugs at some point in their lives, as a means of self-medicating their symptoms.
Several studies have found that cannabis (marijuana) is one of the most commonly abused substances among those with schizophrenia. When someone has schizophrenia, they often have a difficult time coping with the disruptive symptoms, and self-medicating can, temporarily, help with this. However, if a person already has schizophrenia (or a predisposition to it) and uses the drug for a short-lived ‘high’, their symptoms are likely to get worse and they may end up having far more psychotic episodes as a result.
It is now widely accepted that a mental health disorder can induce a substance addiction – and vice versa – but research is ongoing into what actually causes both conditions to occur simultaneously.
What is clear is, when it comes to recovery from any combination of co-occurring disorders, treatment must target both the mental illness and the addictive disorder in order to produce effective, lasting results.
What are the Signs and Symptoms of Dual Diagnosis?
It is important that dual diagnosis is identified and treated as early as possible, but with co-occurring disorders, it can be difficult to recognise the warning signs and symptoms. The signs will vary depending on the mental health disorder and the substance(s) being used – and often present themselves in unique ways with each individual.
An additional complication is that some mental health issues and addictions have very similar biological, psychological and social components and therefore look alike and often overlap.
In general, those living with co-occurring disorders will find daily functioning difficult, if not impossible. While symptoms are often complex and can vary in severity, there are some common signs of dual diagnosis including:
- social withdrawal: isolating from friends, family, and those who offer support
- sudden changes in behaviour (including engaging in risky or violent behaviours)
- changes in appetite and sleep patterns (including insomnia or excessive sleep)
- inability to concentrate and confused thinking
- intense or prolonged feelings of despair, hopelessness, and worthlessness
- anxiety issues that can only be relieved by certain behaviours or rituals
- difficulty staying in employment or meeting other responsibilities
- trouble maintaining relationships because of erratic behaviour or mood swings
- dramatic shifts in moods or energy levels and an inability to control emotions
- use of drugs and alcohol as coping mechanisms for any of the above, despite the dangers.
Dual diagnosis disorders can be challenging to diagnose due to the complexities of both conditions. Mental health disorders can present symptoms of addiction, and addictions can present symptoms of mental health disorders. A proper diagnosis of a co-occurring disorder needs to be made by trained professionals.
What are the Treatments for Dual Diagnosis?
It takes a significant amount of expertise to identify and treat co-occurring conditions properly. It is not uncommon for people with dual diagnosis to receive treatment for one disorder while the other disorder remains untreated. Sometimes this happens because the symptoms are so similar or overlap and an incomplete diagnosis is made.
A report by Substance Abuse and Mental Health Services Administration (SAMHSA) states:
It is clear that without treatment for substance abuse issues, individuals will make little progress in learning how to manage their mental health symptoms, and without mental health treatment, long-term sobriety is unlikely.
Research suggests that co-occurring conditions need to be treated at the same time, with an integrated treatment programme. Specialised dual diagnosis treatment has the ability to provide intensive care for both diagnoses and is key to a full recovery.
Early detection and treatment of both conditions greatly improve recovery and significantly reduce the risk of relapse. However, it is important to understand that those with dual diagnosis often have symptoms that are more persistent, severe and resistant to treatment than those who have either disorder alone.
Research shows that highly effective dual diagnosis treatments include:
- a staff of psychiatric professionals and addiction therapists, with specialised training in the treatment of co-occurring disorders
- integrative treatment for mental illness and addiction at a single location
- close collaboration between the professionals involved in treatment
- individual counselling, peer group support, and aftercare recovery support
- access to medications to manage craving and withdrawal symptoms during detoxification, and / or to relieve the symptoms of some mental health conditions
- complementary, holistic therapies, such as hypnotherapy, acupuncture, equine-assisted therapy, mindfulness therapy and massage.
Dual Diagnosis Treatment at White River Manor
Our professional, multi-disciplinary team and caring staff have one goal in mind: to support you in restoring balance to your mind, body and soul.
At White River Manor, we provide a holistic treatment programme for dual diagnosis, which is shaped around your personal needs and addresses any addictions and mental health disorders simultaneously.
Combining intensive therapy, medical management, psychiatric evaluation, exercise options, healthy eating and nutrition – the White River Manor approach ensures deep transformational healing and a full recovery.
If you’d like to find out more about the dual diagnosis treatments we offer, please contact us today and begin your recovery journey.