What is Dual Diagnosis?

A dual diagnosis, also known as a "co-occurring disorder", is a term used to described when a person is diagnosed with a mental health problem and an addiction issue simultaneously. These co-occurring disorders can be tricky to diagnose because the symptoms of substance abuse can mimic the symptoms of mental illness. At the same time, addiction can exacerbate an underlying mental health issue.

In the past, it was common practice to treat a mental health disorder separately from an addiction problem. They were regarded as two separate issues, which were attended to by different professionals often at separate facilities. It was believed that one area of a person’s life had to be stabilized before addressing another, leaving many patients at risk with an untreated mental illness or a drug/alcohol relapse.

Fortunately, in the mid-1980's, professionals saw these issues as so entwined that it may not be possible to separate treatments, which led to dual diagnosis treatment programs. This type of program attempts to get to the core of addiction while addressing mental illness at the same time. The dual diagnosis treatment is now the basis for many programs in use today.

Dual Diagnosis and Substance Abuse

It is common for patients to mask symptoms of mental illness with drugs in an attempt to self-medicate. Making matters worse, continuous substance abuse is known to cause mental health problems. For example, continuous use of amphetamines can lead to severe depression when the user is sober. Cocaine, LSD and amphetamines are known to greatly increase the risk of schizophrenia.

Diagnosing a co-occurring disorder is difficult because a mental health issue could be a result of addiction, or a mental illness may lead a patient into addiction. A professional can help diagnose if someone has a co-occurring disorder, while many clinicians today are specially trained to help patients with treatment for both, resulting in successful and lasting recovery.

How Common is Dual Diagnosis?

A 2014 National Survey on Drug Use and Health claimed that 7.9 million people in the United States experience comorbidity (co-occurring disorders) leading to dual diagnosis. In 2017 that number was raised to 8.2 million adults.

Some critics claim the rate may be much higher since homeless people and those who were not institutionalized were not counted in the study. Furthermore, many who are treated for mental illness may not have been treated for addiction and vice versa. In fact, some professionals estimate that only 12% of patients with co-occurring disorders receive treatment for both.

Fortunately, both professions are sharing a greater understanding of this condition. Professionals are now certified in the treatment of dual diagnosis, and programs that use integrated intervention are becoming more widespread.

Dual Diagnosis Symptoms

A wide variety of symptoms can accompany a dual diagnosis disorder. There are many combinations of mental illness disorders and many types of substance abuse, so the symptoms often overlap and intertwine. This makes it difficult for the professional to diagnose and treat the problem.

Recognizing some of the signs that can accompany a co-occurring disorder may help lead you or a loved one to evaluation and possible treatment. Some of these signs may include:

  • Financial Issues
  • Withdrawal from family and friends
  • Using drugs or alcohol during times of stress
  • Under-performance at school or work
  • Mood swings

Some symptoms are the result of substance abuse, and are known as “substance-induced mental disorders.” They can mimic mental health conditions such as:

  • Depression
  • Delirium
  • Hallucinations
  • Psychotic disorder

There are some mental health disorders that are known to accompany addiction, but may be independent of the addiction problem. These can include:

  • Bipolar
  • Depression
  • Post Traumatic Stress Disorder (PTDS)
  • Personality Disorder
  • Schizophrenia
  • Anorexia

Substance related symptoms vary from drug to drug and the individual's reaction to it. Symptoms of substance abuse also vary in severity depending on how much a person uses, how often they use and the purity of the drug. Some symptoms of drug abuse can include:

  • Cravings for the drug
  • Reliance on the substance to feel normal
  • Increasing tolerance of the drug
  • Repeated use of the drug despite consequences or health issues
  • Isolation
  • Change in appearance such as extreme weight loss or poor hygiene
  • Mood swings

Certain symptoms may be the result of a mental illness or symptoms of drug abuse, resulting in a dual diagnosis. It is difficult to pinpoint if these symptoms are due to a mental issue or addiction, so may require thorough investigation. These may include:

  • Depression or anxiety
  • Personality changes
  • Delusional thinking
  • Suicidal thoughts
  • Poor hygiene and diet changes

How to Treat Dual Diagnosis

Treatment for dual diagnosis includes both mental health treatment and addiction recovery. There are many combinations of mental health disorders and addiction so, personalized programs are best planned out with the help of an addiction specialist who is also a certified specialist in dual diagnosis treatment.

The first stage of addiction recovery is physical withdrawal and detoxification. If heavy substance abuse is a factor, then this stage may be completed at an inpatient facility. This ensures oversight and can help manage severe withdrawal symptoms such as depression or suicidal thoughts.

After physical detoxification, treatment should include individualized programs such as individual or group therapy, 12-Step programs or evidence-based therapies that have a successful record of treating dual diagnosis, such as Cognitive Behavioral Therapy. The patient will also be treated for their mental health condition, which may include several behavioral therapies and possibly medication.

Treatment may be performed at an inpatient or outpatient facility. An inpatient facility works best for long-term or intense issues and can create a better chance for full recovery with oversight. Outpatient facilities are an option for those who may need to work, go to school or be at home during treatment for financial reasons. Outpatient programs require dedication to recovery by the patient.

In any case, dual diagnosis treatment is a serious issue and requires professional guidance and help. If you or a loved one is experiencing a co-occurring disorder, help is available. Seek help today.