Dual Diagnosis

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Part of the Complete Guide to Understanding Addiction

Table of Contents

  1. What is Dual Diagnosis?
  2. Addiction or Mental Illness, Which Comes First?
  3. How to Identify If You are Suffering from a Co-Occurring Disorder
  4. Understanding Denial
  5. Mental Illnesses Co-occurring with Substance Use Disorder
  6. Finding Treatment for Dual Diagnosis

What is Dual Diagnosis?

Dual diagnosis is when person suffering from Substance Use Disorder is diagnosed with a co-occurring mental health disorder.  Illnesses such as depression, bipolar disorder, and anxiety have long been linked to drug and alcohol addiction. When entering drug or alcohol rehab, in order to achieve sobriety, it is vital for both issues to be addressed in tandem.

It is very common for people with Substance Use Disorder to concurrently be struggling with serious mental health issues. Data shows that mental illnesses in all of its forms, including both anxiety disorders like PTSD and mental disorders such bipolar disorder, manifest at significantly higher rates in people suffering from addiction than the general population. Furthermore, people with Serious Mental Illness (SMI) are at an even higher risk for addiction.  The Journal of the American Medical Association reports that nearly 50% of people with serious mental disorders are affected by addiction.  SMI is defined by the National Institute of Mental Health (NIH) as a mental, behavioral, or emotional disorder resulting in serious functional impairment, which substantially interferes with or limits one or more major life activities. These include major depression, schizophrenia, and bipolar disorder, among others. Almost a quarter of individuals diagnosed have a SUD as well.

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Addiction or Mental Illness, Which Comes First? 

The cause and affect of addiction and mental illness has been hotly debated for years. It has become increasingly clear that there is not one specific way that co-occurring disorders are caused. Although neither makes the other happen directly, their link to one another is obvious, and backed by research and proven data.

There are three basic categories of correlation between the two.

  1. Self-medication

In an attempt to alleviate the symptoms of mental illness, many often turn to drugs or alcohol. The pain is great and the temporary relief these substances provide serve as an escape from the darkness. Unfortunately, the side effects that follow in its wake can be lasting. The initial comfort it provides quickly subsides. It may even worsen as an addiction develops and the body creates a tolerance for the substances chosen.  A person suffering from depression may look to heroin to increase dopamine levels. With regular use, dopamine levels will plunge even further, and the depression will only be exacerbated.

  1. Risk of mental health disorders increase with drug and alcohol use.

Mental health disorders are rooted in many different elements. They include genetics, environmental factors, and life stresses. With drug and alcohol use and abuse, risk for developing a mental illness increases. There have been studies showing an increase in depression amongst opioid users, as well as psychosis from extended marijuana use.

  1. Alcohol and Drug use exacerbates mental illness.

Substance abuse may trigger an already underlying illness. Symptoms will rise to the surface and create dysfunction in a person’s day to day routine. Sometimes, if someone is taking medications for his mental health disorder, adding drugs will create a cocktail in the body, making the needed medications less effective and even harmful.

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How to Identify if You Are Suffering from a Co-occurring Disorder? 

Properly diagnosing co-occurring disorders can be difficult. Symptoms of drug and alcohol abuse can mimic those of a mental health disorder. Common manifestations of depression include concentration problems, strong feelings of guilt or a debilitating lack of self-esteem. These symptoms can also stem solely from addiction. Identifying the cause of these symptoms is critical to ascertaining a dual diagnosis. It takes time and significant clinical effort from experienced professionals to properly categorize where a particular chronic feeling is coming from.  However, there are basic warning signs that may point to a co-occurring disorder.

People suffering from addiction can ask themselves the following questions:

A. Are drugs and alcohol something you turn to deal with difficult moods, situations, or uncomfortable memories and feelings?

B. Is there a connection between using substances and how you feel mentally at a given time? I.e. When you drink or use, do you feel sad, worthless, or insignificant as a human being?

C. Is there a history in your family of mental health disorders?

D. Did you struggle with mental health even before you started to abuse drugs or alcohol?

E. When you are sober, how do you feel? Are you in a better place or mentally, or are your struggles similar even while not under the influence?

F. What is your treatment history? Have you been diagnosed with any conditions relating to mental health in the past? Have you been in addiction treatment in the past and feel that it failed due to unresolved mental illness?

G. Is there any unresolved emotional trauma or experiences in your past?

The answers to these questions can help determine if  your battle with addiction is accompanied by or compounded by a mental illness.

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Understanding Denial

Just as denial is common in addiction, it is common in mental health. Facing conditions that a person feels is beyond his or her control can be understandably intimidating. Ignoring the destruction it is causing in life and the consequences it brings is very scary, and sometimes it is easiest just to ignore it in the hope it will dissipate by itself. Shame and feelings of weakness can also deter an individual from tackling the issue head on. It is quite understandable. But it is critical to remember that mental illness and drug addiction is a disease and can happen to anybody. Allowing yourself to admit that is the first, and perhaps most important step to turning around your life and entering recovery.

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Mental Illnesses Co-occurring with Substance Use Disorder

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Finding Treatment for Dual Diagnosis

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Treatment for a patient suffering from co-occurring disorders must be integrated to address both issues. Long-term recovery is predicated on discovering any possible underlying issues concurrent with the addiction and learning how to manage them. Mental illness will sometimes require medication, counseling and understanding how to cope. Going through the clinical process to achieve sobriety, such as detoxification and residential and outpatient therapy, will not be enough, should the mental health component be ignored. It is irrelevant which came first or if one element is more serious than the other. To sustain recovery and avoid relapse, the healing process must include the entirety of a client’s struggle.

At the Avenues Recovery network of drug and alcohol rehab facilities, we are committed to helping our clients fully understand the scope of what they are dealing with and giving them the tools to overcome their adversity. Our team of medical professionals, expert clinicians, and seasoned counselors are trained to see the warning signs of dual diagnosis, and map out a treatment plan appropriate to the needs of each individual.  No one is beyond hope and everyone has a way back. We help each person find it.

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Brooke Abner,

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