What Is Dual Diagnosis?

People who have been diagnosed with a substance use disorder (SUD), likewise endure a co-occurring mental or behavioural condition. These two factors have been described as contributing to what is described as a dual diagnosis.

Dual diagnosis requires a combined treatment strategy which focuses on both disorders as intertwined problems.

The Relationship Between Substance Abuse and Mental Health

A study performed by the National Survey on Drug Use and Health (NSDUH), has released that as many as 45% of persons coping with addiction also display symptoms of ongoing mental health disorders.

As soon as you suffer from a substance abuse problem as well as a mental health concern like depression, bipolar disorder, or anxiety, it is defined as dual diagnosis. Handling destructive behaviours such as substance abuse, alcoholism, or drug addiction is challenging, and becomes even more detrimental when you are faced with mental health disorders.

In dual diagnosis, the mental health issue and the drug or alcohol addiction have their own separate symptoms that may hamper one’s ability to perform at work or school, maintain a peaceful life at home and relationships.

What makes the condition even more difficult is cohabiting disorders that also have an impact on one another.

When alcohol or drug abuse spirals, mental health problems can peak. Having a dual diagnosis occurs more often now than it did a few decades ago. This is also because of the improved diagnosing methods.

The Journal of the American Medical Association has made the following discoveries:

  • An estimated 50 percent of persons suffering from a harmful mental illness are affected by a substance abuse.
  • 37 Percent of excessive drinkers and 53 percent of drug abusers, additionally suffer from at least one harmful mental illness.
  • 29 Percent of people who have been diagnosed as being mentally ill, have been noted to abuse alcohol or drugs.

While it may seem impossible to get help, victims should understand that they do not have to feel this way. There are things they can do to conquer their addictions, mend relationships, and recover.

With the right help, dedication, and treatment, you can overcome dual diagnosis and get your life back on track.

Substance Abuse vs Mental Health Issues. Which Occur First?

Substance abuse and mental health disorders are closely related; however, one does not actually directly cause the other. Overusing substances like methamphetamine has been proven to cause long-lasting psychotic reactions. On the other hand, alcohol has been shown to worsen mental issues like depression and anxiety.

It has been frequently observed that alcohol and drugs are used many times to self-medicate the symptoms of underlying mental health issues. In many cases, alcohol or drug abuse numbs the indicating factors of an undiagnosed mental issue, to handle difficult emotions or an attempt to momentarily improve one’s mood.

Self-medicating with drugs or alcohol does more harm than good and has been shown to cause side effects including even worsening of the mental health issue. Addiction can increase the negative feelings people originally sought to relieve.

Alcohol and drug abuse can heighten the danger of mental disorders. Seeing that mental health problems originate from a technical interplay of genetics, the environment and more, it is not yet understood whether abusing substances is a direct cause.

Compelling evidence has shown that those who overuse opioid painkillers tend to be a greater risk for depression. Overuse of cannabis, on the other hand, has been proven to increase disorders such as schizophrenia.

In essence, overconsumption of alcohol and drug abuse worsen mental health problems. Substance abuse could rapidly increase symptoms of mental illness or allow new symptoms to emerge.

Abuse of both alcohol and drugs can also have a counterproductive effect on medications such as antidepressants, anxiety medications, and mood stabilizers, rendering them ineffective at managing symptoms and delaying recovery.

Identifying Dual Diagnosis

Identifying a dual diagnosis is tricky as signs and symptoms of dual diagnosis vary and are reliant on both the mental health issue and the sort of substance being abused. For example, the indicating factors linked to excessive marijuana use and anxiety are viewed differently from the signs of depression and alcohol abuse. Although, there are warning signs that you may give rise to a dual diagnosis.

Questions to consider

  • Is alcohol or drugs used as a coping mechanism with negative memories or emotions? Is it used to numb pain or change your mood?
  • Is there a relationship shift between substance use and your mental health?
  • Has a family member battled with a mental disorder or been faced with an alcohol or drug addiction?
  • Are you experiencing feelings of depressions, anxiety, or emotionally of balance even when you are sober?
  • Have you ever been treated for your addiction or your mental health problem? Perhaps both?
  • Has the substance abuse treatment failed due to complications arising from mental health issue or the other way around?

Facing Denial and Dual Diagnosis

Denial remains a huge part of fighting both substance abuse and mental health issues.
It is often difficult to confess how reliant one may be on alcohol or drugs as well as how these substances impact your daily existence.

Likewise, the symptoms of mental illnesses related to depression, anxiety or bipolar disorder could be scary. People who suffer from these conditions often attempt to ignore their reality or feel a sense of shame or fear of being branded as a weak individual for admitting they have a serious condition.

The harsh reality is that substance abuse and mental health-related problems can happen to anyone. Admitting there is a problem and seeking help is the best initial step towards recovery.

Defining Substance Abuse

Commonly abused substances, such as prescription medications, recreational or street drugs are often abused. Alcohol, a widely sold legal substance is also abused by millions around the world. By default, any illegal substance use is abuse, as they were never meant to be used in the first place.

When is a legal substance being abused, though? With prescription drugs, any type of intake different from the prescribed (quantity, dosage, frequency) is considered abuse. If a substance causes any harm or becomes a risk in any way – then substance abuse is present.

Treating Dual Diagnosis

The best way to treat dual diagnosis is by formulating a unified approach, where both the substance abuse and the mental disorder are treated at the same time. Regardless if a mental health or substance abuse-related problem arose first, recovering depends on acquiring treatment for both disorders from one treatment provider or team.

Successful treatment depends on:

  • Mental health-related issues can be treated through medication, individual or group therapy, implementing self-help measures, lifestyle changes and support through companionship.
  • Substance abuse can be treated through detoxification, coping with withdrawal symptoms, behavioural consultations and support groups.
  • Staying sober while undergoing treatment is the key to a better life. In the event that a medical professional prescribes medication for a mental health problem, avoid taking it with alcohol or drugs as this will have devastating effects. In the same sense, counselling is far less helpful when a person is intoxicated by drugs or alcohol. This is why dual diagnosis treatment begins with detoxification.

Having a relapse is sometimes part of the recovery process. Although it is a step backwards, it shouldn’t make you feel discouraged or down. By putting in hard work, many people have recovered from their relapses and advanced positively with their recovery process.

Fellowship groups and sponsors often help manage urgent situations once out of rehab. It’s important to be able to lean on others who know exactly what they are experiencing and draw wisdom from their experiences.

Finding the Right Treatment Program

When looking for treatment for dual diagnosis, ensure that the programme is licensed and accredited. In the UK, the Care Quality Commission is a reliable source of information regarding the quality of the service provided within a health clinic.

In addition, consider the treatment methods – are they founded on research? Is there an aftercare programme?

Ensure that the programme leads have experience and knowledge related to your specific problem and diagnoses. For example, they may have experience treating depression and anxiety, but lack experience in treating schizophrenia or bipolar disorder.

The very best treatment methods related to dual diagnosis, look at both the substance abuse issue as well as the mental health challenges.

Good treatment includes education about any disorder present and its corresponding symptoms and signs. Within these treatment programmes, people suffering from dual diagnosis will learn healthy coping skills and methods to decrease the chances of resorting to substance abuse.

Dual diagnosis can be treated but it requires a commitment to achieve the needed improvement in life, relationships and overall prospects.

Jason Sheirs
Author / Jason Shiers / Dip. Psych MBACP
Jason Shiers is a Certified Transformative Coach & Certified Psychotherapist who is a specialist in addiction, trauma and eating disorders. He has been working in the field of addiction for 25 years now.