Dissecting Dual Diagnosis

Dual diagnosis was first recognized over two decades ago. The term was coined to diagnose individuals that were suffering with severe mental illness and substance abuse disorders. The occurrence of dual diagnoses is much more common than you’d think, and the treatment for the co-occurring disorders or addictions is more intense and complex than that of a single addiction.

Defining Dual Diagnosis

According to the National Alliance on Mental Illness, “dual diagnosis (also referred to as co-occurring disorders) is a term for when someone experiences a mental illness and a substance abuse disorder simultaneously.”

The Substance Abuse and Mental Health Services Administration (SAMHSA) has discovered the following facts and statistics dealing with dual diagnosis:

• An estimated 17.5 million Americans over age 18 have been diagnosed with a serious mental disorder in the past year, and about 4 million of them also had a co-occurring addiction or alcohol dependency.
• In only 6 years, the amount of people seeking help for dual diagnoses increased from 12% to 16%.
• Among full-time workers, it is estimated that 10.6% have a substance abuse disorder, 10.2% struggle with a mental disorder, and 2.4% have been diagnosed with both.
• Working men are more likely to have a drug addiction problem, and working women are more likely to develop severe mental health issues.
• Of the estimated 3 million employed adults living with co-occurring disorders, only 40% got treatment intervention for a single disorder and less than 5% of them received treatment for both of their issues.
• Between the years 1995 and 2001, the number of women that were admitted into treatment centers with dual diagnosis increased from 28% to 44%.
• In the 2000s, prescription painkillers have become one of the biggest offenders with dual diagnosis patients, with 21% of patients being addicted to them.

Dual diagnosis is much more complicated to treat because the cause of the diagnosis lies in trauma, anxiety, depression, or other issues. In many cases, these substance abuse issues arise because of the preexisting mental health disorders. It is important to treat both of the disorders, either sequentially or separately – depending on the specific addictions and disorders being treated.

The Dangers of Dual Diagnosis

Dual diagnosis is definitely an epidemic. 1 in 4 adults that are diagnosed with a mental illness also struggles with a substance abuse disorder.

Here are several things that everyone should know about dual diagnosis.

1. Dual diagnosis is not rare and as many as half of the people diagnosed with a drug or alcohol abuse issue also have a mental illness of some kind.
2. Dual diagnosis can take many forms as there are many combinations of co-occurring disorders – anxiety and alcohol abuse, depression and sex addiction, gambling and alcohol use disorder. Any combination of mental illness and substance abuse qualities as a dual diagnosis.
3. It is very difficult to treat co-occurring disorders as symptoms of both disorders can overlap, and it is difficult to know which symptoms is being caused by which disorder. For instance, is the addict doing drugs to treat his depression or is his depression caused by the drug use?
4. Dual diagnosis patients are more likely to commit suicide and have are more likely violent tendencies.
5. People that suffer with mental illness are more likely to develop an addiction as many people self-medicate with drugs and alcohol.
6. Not all rehabilitation facilities are equipped to handle dual diagnosis patients because the process of detoxification is so intense and complex with dual diagnosis patients. Treating a patient with a dual diagnosis requires experienced medical personnel to be able to safely guide the patient to recovery.
7. Integrated, or simultaneous, treatment is the best way to treat dual diagnosis patients.
8. Dual diagnosis recovery usually takes longer thanks to a complicated rehabilitation process.
9. The best dual diagnosis rehab facilities will move at a pace that the patient is comfortable with.

Understanding the Link Between Mental Illness and Addiction

Mental illness is frequently linked to substance abuse and addiction. Generally, there is a “cycle of self-destruction” that the person goes through – mental illness, then substance abuse followed by a worsened mental illness that increases the person’s dependency on the substance.

Some physical signs that can point to the development of dual diagnosis are:

• Withdrawal symptoms
• Changes in sleeping patterns
• Gaining or losing weight
• A lack of personal hygiene
• Red, bloodshot, or dilated eyes

Some behavioral signs that can point to the development of dual diagnosis are:

• A lack of motivation
• Paranoia or anxiety
• Isolation
• Troubles with money; legal troubles
• Self-centered behavior

Some mental health issues are serious repeat offenders when it comes to dual diagnosis. The most common mental health disorders that are linked to dual diagnosis are:

• Attention-deficit hyperactive disorder (ADHD) – This is a medical condition that affects a person’s attention, ability to sit still, and self-control. Those that suffer from ADHD tend to have seriously poor impulse control.
• Bipolar Disorder – This is also known as manic-depressive illness. It is a brain disorder that is characterized by unusual and quick shifts in mood, energy, activity levels, and even the ability to perform daily tasks.
• Borderline Personality Disorder – This disorder is characterized by self-image issues, difficulty managing emotions and behavior, and a tendency of forming unstable relationships. It negatively impacts the way you think and feel about yourself.
• Depression – This is a mental disorder that is characterized by severe despondency and dejection. It includes long periods of sadness and often results in isolation.
• Eating Disorders – These disorders are caused by feelings of inferiority and low self-esteem. Those that suffer eating disorders may starve themselves or binge on food and vomit. On the contrary, some people may constantly overeat, as well.
• Generalized Anxiety Disorder (GAD) – This is the most common mental health condition in the United States. It is characterized by excessive and unrealistic anxiety about more than two aspects of one’s life and is often accompanied by physical symptoms like palpitations, shortness of breath, and dizziness.
• Obsessive Compulsive Disorder (OCD) – This particular anxiety disorder is characterized by recurring and unwanted thoughts, ideas, and sensations that make them feel like they must do something repetitively.
• Post-Traumatic Stress Disorder (PTSD) – This mental condition arises after someone has experienced major trauma, injury, or psychological shock. Those that suffer from PTSD will usually have sleeping problems and frequent vivid recalls of their trauma.
• Schizophrenia – This mental disorder is a long-term condition that breaks down the relationships between thoughts, emotions, and behaviors, resulting in inappropriate actions and feelings, a descent into fantasy and delusion, and mental fragmentation.

How to Recognize Co-Occurring Disorders

The likelihood of someone becoming a victim of co-occurring disorders is twice as high when they are diagnosed with a mental illness, so it is important to know the factors that contribute to dual diagnosis and how to spot it in yourself and your loved ones.

There are four factors that tend to overlap with one another and worsen mental health issues and substance abuse disorders, causing dual diagnosis, and they are:

• Brain Responses – Some drugs will mimic mental illness symptoms when they are abused.
• Genetics – Your genetics can predispose you to addiction and mental illness.
• Environmental Triggers – If you are exposed to chronic stress, anxiety, or experience a traumatic event, you are more likely to develop an addiction or mental disorder.
• Exposure at an Early Age – Those that start experimenting with drugs and alcohol at an early age are more likely to become addicted and develop mental disorders. Young users of drugs and alcohol are more likely to suffer brain damage from the use than adults.

Some, if not all, of these four factors are present in nearly everyone that presents with a mental illness or a substance abuse disorder. In addition to these factors that can almost predict the dual diagnosis that someone will develop, there are also symptoms of co-occurring disorders that you can watch for if you suspect that you or a loved one is suffering from dual disorders.

The symptoms of someone who is suffering from dual diagnosis include:

• Sudden changes in everyday behavior
• Sudden difficulty managing daily responsibilities and duties
• Avoidance of events and social gatherings or activities that were once enjoyed
• Obvious neglect of health and hygiene
• Cynical thinking and/or impaired cognitive function
• Refusal to seek or failure to complete treatment
• Talk of suicide of behaviors that can be deemed reckless or suicidal
• Increase of impulsive and out of character behaviors
• Financial issues
• Poor performance at work and/or school

Getting Help with Dual Diagnoses

The frequency of which dual diagnosis is manifesting itself in our country is showing no signs of slowing. In fact, the likelihood of people developing co-occurring disorders is actually increasing. The National Institute on Drug Abuse (NIDA) reports that “people with severe mental illness are about four times more likely to be heavy alcohol users. They are also over 5 times more likely to be daily tobacco smokers.”

Additionally, in 2012, the National Survey on Drug Use and Health (NSDUH) reported that “nearly 8.4 million adults in the U.S. have both a mental and substance use disorder.” Furthermore, the NIDA has reported that “people addicted to drugs are twice as likely to suffer from mood and anxiety issues.”

The bottom line when it comes to dual diagnosis is that it is a dual disorder in which both harmful issues feed off of one another while also making each other worse. The mental illness creates the substance abuse disorder which exacerbates the mental illness. The substance abuse causes a mental illness which causes the user to abuse the drug even more to escape. It is a truly vicious, circular cycle that needs to be broken as soon as possible.

All hope is not lost. Dual diagnoses and co-occurring disorders have been more thoroughly studied and better forms of treatment and different kinds of therapies have been created and/or adapted to fit the complex needs of the diagnosis.

Why Inpatient Rehabilitation is a Dual Diagnosis Patient’s Only Option

Traditional home or doctor-guided detoxification and outpatient rehabilitation will not work for a dual diagnosis patient’s recovery because of the complications that arise from overlapping withdrawal symptoms and the sensitive nature of the patient’s already fragile mental state. The only option for recovery with co-occurring disorders is inpatient treatment with medically supervised detox.

Because not all rehabilitation facilities are properly equipped to handle dual diagnosis patients, it is important to be thorough when you are looking for an inpatient treatment program. Make sure you do plenty of research and gather the answers to the following questions:

• Do all of your residents receive individualized treatment plans?
• Do you have therapy available that is structured specifically for dual diagnosis?
• Does your facility have a licensed psychiatrist or physician evaluate each incoming patient when they are admitted?
• Will your facility view two disorders that are present at the same time as co-occurring or separate illnesses?
• How will you treat my dual diagnosis – separately or simultaneously?
• How does your facility handle relapses during the rehabilitation program?
• Does your treatment program offer referrals for continuing care after the program is completed?

The answers to these questions are incredibly important to know before committing to a treatment program because, if the program does not properly treat both disorders that are occurring together, the recovery will not be successful. Be very diligent in finding a truly equipped rehabilitation center that has a significant success rate with treating dual diagnosis patients to ensure that you have to best and most effective recovery program.

In Conclusion…

While dual diagnosis has been researched more and more in recent years, there is still much to be learned about the nature of co-occurring disorders, especially when it comes to the detoxification process and the continuing care for dual diagnoses to both issues are fully addressed for the best possible chance of recovery.

In a changing world that sees more mental illness diagnosed than ever before, it is vital to change the way we view the effect of mental health issues on addiction and how we address substance abuse disorder and alcohol use disorder when they co-occur with a mental illness.

If you’re trying to get addiction treatment for yourself or for someone you love, reach out to The Hills for comprehensive and caring treatment that will help patients detox and learn the skills to cope with their triggers and their addiction. You have options, let The Hills be one of them.