Dual diagnosis simply means a person has been diagnosed with both a substance addiction and a serious mental health issue like depression, bipolar disorder or an anxiety disorder. Other names for dual diagnosis include co-existing disorders, co-occurring disorders and co-morbid disorders. They all mean the same thing, which is having two kinds of problems at the same time. It also means having to struggle with both issues and often makes the road to sobriety and mental health more difficult. However, having a dual diagnosis is not to say recovery from addiction or the mental health diagnosis is impossible. With the right help, rehabilitation and a sober, stable life are very possible.
Many addiction programs already have trained staff who deal with both mental health and addiction disorders regularly. This is an important question to ask when seeking treatment if you suffer from both mental health and addiction issues. You need to know that staff at the facility support and understand your mental health concerns and the need to stabilize and recover from those, including addressing medication issues, as you deal with addiction issues. Not every treatment program is equipped for such complications. Failing to treat both problems simultaneously and effectively almost always causes one or both to worsen.
When substance abuse increases, it makes mental health issues much more difficult to manage. The reverse is also true. Also, having both addiction and mental health problems makes both issues more difficult to diagnose, because the symptoms and behaviors associated with each disorder often mask or complicate the symptoms of the other. It takes highly-trained specialists, as well as a motivated and honest client, time to untangle the conditions. It is not necessarily important to determine which issue came first – the mental health problem or the substance abuse problem. Both still need to be resolved through proper care and treatment.
Unfortunately, denial is common to both addiction and mental health problems. Addicts frequently have a hard time admitting how pervasive the effects of their drug or alcohol use have become. Often, the stress of trying to hide the consequences of addiction causes people to feel ashamed, anxious or depressed. The effects of the substances themselves also can lead to depression, panic attacks and mood swings, among other symptoms.
The same holds true for people with mental health issues. Most people find the symptoms of anxiety, panic attacks, mood swings or depression to be frightening, shameful or signs of weakness. They might try to ignore them and hope they go away, or they might use drugs or alcohol to seek to make them go away. It is hard to admit having a problem with either substances or mental health problems.
Problems do not go away when they are ignored or when a person tries to medicate them with drinking or using drugs. This makes them worse. The first step towards getting better in both cases is admitting there is a problem and seeking help to solve the problem.
Frequently, people who have either addiction problems or mental health problems or both find that family members also suffered similar problems. Science has found these issues tend to run in families. We don’t know the exact role of genetics vs. upbringing in this regard, but in a sense, it doesn’t matter. People with addictions and mental health problems still need to get professional help to overcome their problems and live a productive, fulfilling life.
Addiction does not usually cause mental health problems, nor do mental disorders cause addiction. However, they still often occur together because people try to self-medicate their symptoms, and substance abuse certainly increases the risk for mental problems to develop
Dual diagnosis occurs when any addiction is paired with any mental health disorder. Some of the more common mental health disorders seen with addiction include:
Frequently, people use drugs and alcohol to cope with life stresses, including the symptoms of mental health issues. Substances offer a way to relax and feel a sense of escape from problems, even if it is only temporary. However, when the person continues to use drugs and alcohol to cope, they never learn real coping skills and they usually do not take the necessary actions to address whatever underlying problems are causing the symptoms of their mental health problems.
Substances make the symptoms worse in the long run, and can sometimes trigger new symptoms due to the way drugs and alcohol alter the way the brain and its chemicals operate. Interactions between illicit substances and prescribed mental health medication like antidepressants, anti-anxiety medications and mood stabilizers also cause more problems. The interactions often make the medications far less effective.
According to reports in the Journal of the American Medical Association, about half the people diagnosed with severe mental disorders also struggle with substance abuse. Around 37 percent of alcoholics and 53 percent of other drug addicts also have at least one serious mental illness diagnosis. The Journal of Addiction Medicine reports that about, 60% of people with Bipolar Illness also have some kind of addiction. Around 44 million people in America have been diagnosed with some form of mental illness.
The number of individuals who suffer from mental illness but who have never sought help is unknown. It is estimated that about 7 million adults over the age of 18 in the US cope with both addiction and mental health disorders, or have a dual diagnosis. Unfortunately, estimates show only about 16 percent of the people with co-occurring disorders seek treatment.
Treatment for co-occurring disorders has changed a great deal over the past three decades. Until the mid-1990s, people with addictions and mental health disorders were often denied treatment for their mental illness until they were clean and sober. This was problematic because substance abuse is very often a driving force for the psychiatric disorder. The result was that many people with dual diagnoses never got the treatment they needed.
Today, treatment focuses on addressing both the addiction and the mental health issues at the same time. This is a growing area of therapy, as it is more comprehensive and effective in achieving long-term success for people struggling with both issues. Dual diagnosis treatment must be practiced in an evidence-based program, where they use a combination of cognitive-behavioral therapy (CBT), motivational enhancement therapy, group and individual counseling, family counseling and helping clients get thoroughly engaged with community support groups like 12-step programs.
Dual diagnosis treatment should include counseling to help clients learn to cope with their mental illness without turning to drugs and alcohol to manage their symptoms. Clients need to learn how substance use actually worsens their mental health disorder. They need to be regularly seen by a psychiatrist familiar with the dual diagnosis and addiction medicine and treated with appropriate psychiatric medication for their disorder.
Clients often need to learn about medication compliance, or why it is important to take prescribed medication every day as prescribed, to stay well. Cognitive therapy programs and individualized treatment plans tailored to address the needs of each client are essential to the success of this part of the program.
In most cases, co-occurring disorders require at least a 30-day inpatient treatment program followed by outpatient aftercare treatment for success. The best outcomes occur when clients stay in treatment for the longest time. Recovery from dual diagnosis is tough, and takes commitment and courage by the client. It can take months or years to overcome a lifetime of maladaptive behaviors and habits.
Treatment can help teach the basics for sobriety, coping skills and decision making, but clients must commit to making long-term change. In treatment, clients should learn how to recognize and manage stress without resorting to using alcohol or drugs to numb the feeling.
Dual diagnosis patients in treatment should also spend a lot of time in therapy talking about how to prevent relapses of both the mental health and addiction behaviors. It is important to know what triggers the urge to use and the mental health states. Write these down in a notebook, which you can and should have with you at all times.
Know what triggers you and have an action plan to cope with each one. Know what signals your mental illness is having a flare, too. Often, the cause is the lack of sleep, increased stress, unhealthy eating, or significant life stresses. Have plans for how to deal with each situation and a list of phone numbers to call in case something occurs
Treatment of dual diagnosis disorders needs to address all the major effects of both addiction and mental health. Treatment plans must be specific to each patient, based on their needs and wants, and plans need to be monitored and updated regularly. Every aspect of a patient’s life may have been disrupted but the time they seeks treatment, so their job may be at risk or gone, their teeth may need repair, or they may have damaged important family and friendship relationships. A high-quality treatment program addresses these concerns
The goal of treatment for co-occurring disorders is to provide simultaneous mental health counseling with addiction rehab to the point that the person functions well at home, work and in the community. Addiction specialists at dual diagnosis treatment centers will have specific training working with both substance abuse disorders and mental illness.
The program will have a robust, integrated approach to treatment that takes a patient from the initial phases of substance detox and withdrawal and mental health stabilization, through counseling and addiction treatment, through relapse prevention and aftercare. The intake assessment will ask about both the drug and alcohol use history as well as behavior and mental health problems.
Sometimes, the intake specialist will recommend treatment focus on one condition intensely at first, such as when a person needs medical detox to withdraw safely from drug or alcohol use. Some people will require inpatient or residential treatment, where they can receive 24-hour care from specialized care teams until they are stable enough to participate in intensive outpatient care. It all starts with reaching out for help and making the call to find a dual diagnosis treatment facility.
Therapy will often focus on setting goals and identifying motivations for making changes in your life, both around stopping using substances and changing how you cope with your mental illness. Cognitive Behavioral Therapy (CBT) is a standard therapeutic method used in dual diagnosis treatment. It helps patients look at how their behaviors, thoughts and feelings interact, and then making changes to each of these to improve outcomes.
Therapy also involves learning about addictions and how they affect the patient’s life and their mental illness. The patient should learn to identify the triggers to their substance use, and learn better coping skills. They will be able to determine what works for them to prevent substance use in the future.
One of the most important things dual diagnosis treatment provides is help to learning to live without using drugs and alcohol and how to cope with life while managing a mental illness. Clients need to get connected with community support groups, such as 12-step recovery groups and mental health peer support groups.
Families of people with co-existing disorders also need to participate in the therapy process. Learning to support a loved one who struggles with addiction and mental health problems is essential, and families need help, too. There are community support groups for family members, and good therapy programs will help connect spouses, significant others and children of addicts and the mentally ill with these groups.
Every good dual diagnosis treatment program will include relapse prevention as part of their program. Both addiction and mental illnesses are chronic, relapsing diseases, similar to asthma, diabetes and many other medical conditions. At times, especially when the patient lapses in self-care, the illness flares and slips or setbacks occur. When this happens, the patient needs to work harder and get back on their recovery program to regain their health and sobriety. They may even need to return to rehab for a time for “tune-up” to get them back on the road to health. This is a natural part of the recovery process.
The best treatment for dually-diagnosed patients comes from a team of professionals trained to work with both addiction and psychiatric disorders. The National Alcoholism and Substance Abuse Information Center (NASAIC) keeps a database of leading treatment centers in the United States, focused on co-occurring disorder treatment.
Always verify the treatment program is accredited and licensed, and that they use evidence-based treatment methods. The treatment program must have a relapse prevention plan in place that helps patients prevent relapse and deal with relapses when they occur.
Also, ask questions before entering a program to verify that facility has experience dealing with your particular mental health diagnosis. You want to be in a program supportive of your doctor-ordered medication regimen because it is essential you continue those medications as ordered if your mental health symptoms are to subside.
Dual diagnosis patients need to be in a rehab setting that accepts psychiatric medication rather than discourages it. Medication Assisted Therapy (MAT) is the appropriate use of medicines, combined with counseling and other therapies, that provides a complete approach to treating combined substance abuse and mental health disorders. Vast amounts of research support this as the most successful approach.
Any treatment program a dually-diagnosed client considers needs to have licensed staff who have training in the treatment of co-existing disorders. It is essential to ask about these qualifications before deciding on a program.
It is also critical to ask about patient treatment plans. These absolutely must be individualized to the patient, based on the individual needs of the client. Every dually-diagnosed client is unique, and the treatment plan must reflect this. Also, plans need to be reviewed and regularly updated, as patients improve and needs change. Any program that uses a standardized “one size fits all” treatment plan is not appropriate for a client struggling with co-existing disorders.
When dual diagnosis patients seek treatment, they need to ask as many questions as possible and get as much information about every available facility. The more decision that is available lets people judge which facility will best fit their needs. Patients and families also need to consider whether insurance covers the program, or if the program offers a sliding fee scale or other funding options.
Remember that different treatment options work better for some people than others. Due to the wide range of mental health disorders that can combine with addictions, it is important to consider every option. Discuss the options with your doctor or an addiction specialist.