What does dual diagnosis mean?
Dual diagnosis is a term used to describe patients struggling with both mental illness and drug or alcohol abuse at the same time. Personality disorders may also coexist with mental illness and substance abuse. Someone who has been diagnosed with multiple concurrent, active illnesses will require a more intensive treatment program when seeking help for addiction.
How common are co-occurring disorders?
Some recent statistics report the following:
- An estimate of 17.5 million Americans over the age of 18 were diagnosed with a mental health disorder in 2015.
- Out of those, 4 million were ALSO reported to struggle with co-occurring drug and/or alcohol dependency.
- In 2015, only fifty percent of these people sought treatment for their addiction.
These numbers are continuing to grow and so is the big debate – is “dual diagnosis” an accurate assessment regarding addiction? Many believe that when a patient is diagnosed with a co-occurring mental health disorder while abusing drugs or alcohol, the mental health diagnosis can not be relied upon because of the drug’s effects upon the user’s personality and behavior. This is due to the fact that many behaviors classified as a disorder also become present when one is abusing drugs or alcohol.
Regardless of the validity or accuracy of dual-diagnosis and the corresponding therapy models, mental illness and dependency do have some of the same defined risk factors, such as the following:
- Environmental triggers. Prolonged periods of unrelenting stress or an especially traumatic event can lead a person to drug dependency (as a possible coping mechanism), or can possibly manifest in various forms of mental illness. Common examples are post-traumatic stress disorder (PTSD), severe depression, panic disorder, etc.
- Life stages. According to research, mental illness and/or substance abuse that begins during adolescent years has a higher probability of becoming problematic again later in life. This is attributed to the fact that the brain is undergoing critical development during this time, and drugs or any chemical disruption (such as that from mental illness-related chemical imbalances, and/or the pharmaceutical treatment of these illnesses) can disrupt the normal growth process.
- Brain abnormalities. It’s been noted by some that those who suffer from mental illness may be more predisposed to addiction than those who have not been diagnosed with a mental illness. This is due to the perception that the individual’s brain responds to chemicals and stress in abnormal ways, and we know that many people turn to drugs or alcohol as a coping mechanism in times of extreme stress. It is important to keep in mind, however, that every person has the ability to define their own outcome, regardless of a medical diagnosis or any past decisions.
Is there a connection between mental illness and substance abuse?
The connection between addiction and mental illness involves multiples factors:
- Self-medication. Many patients have attempted various forms of drug and alcohol rehabilitation previously, and have not been successful at completing treatment, leading them to give up. In addition, a great number of these same patients have circumstances in their pasts which may be difficult or painful to face. Often, using drugs and consuming alcohol makes it easier to deal with life. People crave instant gratification, meaning they desire what makes them feel good in the moment, especially if those positive endorphins mask the negative emotions the user wants to avoid.
- Worsening underlying mental illnesses. Someone who already suffers from mental illness that begins to use drugs can start to have suicidal thoughts or deepen the wounds that are already there.
- Initiate an onset of symptoms. A person using substances that cause hallucinations or paranoia can bring an onset of psychosis.
The research proves unequivocally – there are many people suffering from co-occurring disorders and people suffering from substance abuse. What’s important is finding out if the mental issues were there before the drug use or if they came to be due to the substance abuse.
Why physicians must exercise caution when considering a dual diagnosis
There is no denying that numerous people suffer from both psychological disorders and substance abuse, but it’s been proven that certain addictions can mirror mental illnesses. Here are some examples of certain substances that can do just that:
- Alcohol: Alcohol may begin to act as a depressant when abused. Regular alcohol abuse can cause anxiety, high blood pressure and hyperactivity.
- Cocaine: Someone coming off of cocaine may appear overly depressed, extremely exhausted, and may experience insomnia to the point that they have hallucinations.
- Opioids: When abusing opiates, the user can become lethargic and depressed, thus leading others to believe a mental illness is present.
- Hallucinogens: Hallucinogens may make a user paranoid, lose track of time, or hear things that are not there. All of this could make one believe the individual is dealing with a co-occurring disorder, when it’s likely just the drugs.
Any of the symptoms that are listed below could cause a third party to believe that a patient is struggling with a mental illness, when they are in fact suffering from the long-term effects of drug use:
- Sexual dysfunction
- Difficulty sleeping
- Mood swings
- Memory loss
Remember, not all addicts are dealing with a mental illness
Someone who is struggling with addiction will likely show signs of mental illness, but that doesn’t mean they have one. They will need help with their dependency issue first, but before beginning many new, psychoactive medications, ensure that the addiction is not, in fact, the root of the symptoms.
Many times doctors prescribe psychoactive drugs, which can have harmful side-effects, and be even more detrimental when taken by a patient who doesn’t actually have a true mental illness. Certainly, a percentage of addicts suffer with co-occurring disorders, but we always suggest that physicians ensure the individual is struggling with a co-occurring mental illness before they prescribe additional medications.
Accepting that you or a loved one struggles with drugs or alcohol abuse is painful. Including a mental illness diagnosis can increase the difficulty of the situation and may result in the person feeling like they have no idea where to turn to for help.
Knowing why the patient turned to drug use, as well as what substance the patient has been abusing, is critical information.