What Does Dual Diagnosis Mean?
When addictions and other mental health challenges intertwine, experts consider them co-occurring conditions, and you will need a dual diagnosis treatment program. They can’t be treated in isolation, as they will reinforce one another and block healing. But when they are treated at the same time, you could experience true recovery.
Addiction isn’t a moral failing. It’s a disease that’s sparked by changes in brain chemistry. Researchers, doctors, and therapists all agree that addiction is a mental illness. But it’s not the only one you can have at one time.
When Two Conditions Combine
The National Institute on Drug Abuse (NIDA) reports that about half of all people with an addiction will also have mood and anxiety disorders, such as depression, bipolar disorder, or schizophrenia. The reverse is true too. If you have a mental health issue, you’re at a higher risk of developing an addiction.
Many of these incidents arise from individuals attempting to self-medicate to try to manage the symptoms of a mental health disorder, and each condition can get worse if left untreated.
Which Condition Occurs First?
When people have a dual diagnosis of mental illness and substance use disorder, either one can happen first and often occur at the same time. But one does not directly cause the other. When people dealing with mental issues turn to alcohol or other drugs to relieve the distress, it only makes the condition worse.
Substance use disorders are sometimes mistaken for psychiatric disorders. There have also been diagnoses for substance-induced mood and anxiety disorders, which further complicates the issue. Due to this complication, the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders has advised that diagnoses of primary psychiatric disorders not be made until the patient is sober for a period that is long enough for the substance withdrawal symptoms to fade away.
Every mental health challenge is a little different. But how they intersect with addiction can be remarkably similar.
For example, someone with PTSD may experience difficult nightmares that punctuate sleep. Alcohol can deaden sleep and produce sedation that blocks dreams. Someone might start drinking in the evenings to keep the night’s thoughts clear. But in time, the person may be drawn to drink even when it’s not bedtime.
For others, the addiction comes first. For example, a person may develop a physical affinity for marijuana. That person may enjoy the distortion in perception the drug brings, and daily use may become the norm. That use can tinker with the brain and make latent schizophrenia symptoms come to the fore. When that happens, marijuana and mental health perception changes blur.
Commonly Occurring Dual Diagnoses
- Alcohol and Bipolar disorder—People who struggle with bipolar disorder tend to turn to alcohol to ease their symptoms.
- Substance abuse and stress—For people who can’t manage their stress, substance abuse feels like the quickest way to get relief.
- Benzodiazepines and anxiety—Benzodiazepines are medications that help manage anxiety, but they are often misused. When the patient takes more than prescribed, it only makes the anxiety worse.
- Alcohol and depression—People with depression tend to believe that drinking helps take the edge off their symptoms. In fact, it only makes the symptoms of depression worse.
There is no limit to which substance coincides with which mental disorder, certain pairings happen more often than others.
Common Co-Occurring Conditions
Common co-occurring conditions include depression, anxiety, bipolar disorder, schizophrenia, obsessive-compulsive disorder, personality disorders, and PTSD.
According to the National Institute of Mental Health (NIMH), people with depression have severe symptoms that interfere with the way they feel, think, and tackle daily tasks, including working, sleeping, and eating. Significant symptoms must be present for two weeks for a diagnosis to apply. This mental health problem is more than a sad mood.
In the United States, anxiety disorders are common, says the Anxiety and Depression Association of America. More than 18 percent of the population has an anxiety disorder.
Periods of unusually intense emotion, sometimes punctuated by extreme shifts from happiness to depression, characterize this mental illness. The moods are extreme, so they’re far beyond what a person might experience during a normal day. Four types of bipolar disorder are recognized, NIMH says. While all of them involve mood changes, they can vary in severity.
This is a severe mental illness that can change the way you think and feel about yourself and the world around you. It’s associated with considerable disability, as many people with the disorder mistrust those trying to help them. They may resist treatment, even though it could help them.
This disorder causes intrusive thoughts and unusual behaviors. Sometimes they’re linked, as someone engages in a behavior (like washing their hands) in response to a thought (like a fear of germs). But they don’t always go together. The condition can be severe. NIMH says some people with OCD engage in repeated behavior for an hour per day or longer.
There are more than 10 types of personality disorders, says the American Psychiatric Association. They are all defined by unusual behavior and inner experiences. People with an antisocial personality disorder, for example, may repeatedly lie or deceive others. People with a histrionic personality disorder may do anything to be at the center of attention.
Close to 4 percent of Americans have this disorder, says the American Psychiatric Association, and it’s more common among women than men. Those with the disorder have disturbing memories of an event that intrude on the present day, even when they’re not actively trying to remember anything about their experiences. It’s often associated with wartime, but PTSD can be triggered by interpersonal violence (like rape) or natural disasters (like earthquakes).
There are many types of mental health issues, and any of them could be associated with addiction. Researchers focus their work on a handful of issues that are most common, and that work has helped us understand just why addiction and other mental health problems often come together.
Dual Diagnosis Treatment Approaches
There are several approaches to treating dual diagnosis:
- Partial—Partial treatment means only treating the disorder that is considered primary (occurring first).
- Sequential—Sequential treatment entails first treating the primary disorder and then the secondary condition, but only after the first one is stabilized.
- Parallel—Parallel treatment involves the patient receiving substance abuse treatment from one provider and mental health treatment from another.
- Integrated—Integrated treatment is a combination of interventions into a single treatment plan.
Clients with co-occurring conditions often face challenges in getting treatment. They may be blocked from mental health treatment because of the substance use issue and excluded from substance use treatment because of the psychiatric problem. In 2011, it was estimated that only 12.4% of people with addiction and psychiatric disorders obtained treatment for both addiction and mental health.
The NIDA reports that integrated strategies work best. You’re more likely to get better when you address both problems with one program at the same time. The Substance Abuse and Mental Health Services Administration of the United States says that the integrated approach is in the best interests of the patients, programs, funders, and systems.
Dual Diagnosis Treatment Programs
A dual diagnosis treatment program helps the patient understand how their mental health and addiction connect and influence each other. Along with the treatment, patients learn the coping skills necessary to manage their mental health properly without the need to use illicit drugs.
A program like that includes elements you’re accustomed to seeing in traditional addiction treatment settings, such as:
This is the process of removing toxins from your body. It is the period of time that the body needs to process any drugs or alcohol and clear it out of your system. This is usually done in a hospital or treatment center with round-the-clock medical supervision. Some experts advocate a detox program before beginning any mental health treatment.
This provides 24-hour a day treatment services that take place on-site. The patient is removed from outside pressures and triggers to use substances again. Programs may be short-term or long-term.
This is a highly structured program for people that don’t require 24-hour medical supervision and is considered an optimal outpatient program for individuals suffering from dual-diagnosis. PHP can also be used as a step-down program from residential treatment.
The patient can live at home but continues an intensive regimen of therapy sessions at the treatment center every day. This form of treatment can also be used as a step-down program from residential treatment.
An outpatient program allows the individual to carry on with work, school, and family obligations while attending a modified course of therapy at the treatment center 3 to 5 days a week.
Basic outpatient programs are generally geared towards individuals who are only having minor struggles with co-occuring disorders. Someone who is having severe issues would most likely benefit more from a more intense treatment regimen.
You will live in a safe, structured situation with other people in recovery. This helps prepare you to transition into a life without using substances.
Common Therapies Used in Dual Diagnosis Treatment
Multiple forms of therapy are used, including individual, group, and family therapy, as well as some specialized treatments like EMDR, DBT, and ACT. Your treatment counselors will work with you to decide what options work best.
Individual Counseling. You work one-on-one with a counselor to understand your addiction’s roots.
Group Counseling. You work with other people in recovery as your counselor guides all of you through lessons on addiction.
Family Counseling. Your family will take part in therapy sessions with you and a licensed therapist.
Eye Movement Desensitization and Reprocessing (EMDR). This therapy is generally used for those suffering from PTSD and substance abuse.
Dialectical Behavioral Therapy (DBT). DBT is the practice of learning emotional regulation and self-management. This is done by identifying negative thinking patterns and destructive behaviors and working to transform them.
Support Group Work. You meet with others in recovery, and you learn from one another in an informal setting.
Medication Management. This is when you use prescription drugs to amend changes in brain chemistry.
Alumni Work. When the program is through, you stay connected through periodic meetings and activities.
Each element includes features you’ll need to heal from both addiction and mental illness. You won’t deal with just one problem in these sessions. Everything you do will be designed to help you gain control over both issues.
Where Should You Get Treatment?
Private treatment facilities often specialize in care for people with co-occurring conditions. They offer more exclusive settings and several different options in therapy and treatment types.
The most important part of picking a facility is finding a place that is right for you. You will need to find a program that addresses both disorders individually and offers you a customized approach.
Are There Any Federally Run Programs?
But if you lack even minimal resources or access, you might be interested in a nonprofit or state-run option.
You could start your search by looking into:
- State health departments.
- State mental health authorities.
- U.S. Department of Veterans Affairs.
- Dual Recovery Anonymous.
Get the Help You Need For Dual Diagnosis Today!
Whether you look into state-run programs or private care, it’s critical that you get the help you need. Addictions and mental illnesses don’t tend to get better in time. They usually worsen exponentially without help. Treatment does work, and there are plenty of programs that can help you. Reach out and get the care you need.
At Footprints to Recovery, we have several payment options to help you get started. Footprints to Recovery has the qualified and caring medical professionals you will need to care for your dual diagnosis. We believe every person is unique, and we can develop a program to address your needs. Contact us here. We have specialists waiting to talk to you.