Adult and Adolescent Mental Health Blog

The team at Fifth Avenue Psychiatry aims to help both adults and adolescents with substance abuse and mental health issues.

Understanding Dual Diagnosis And Co-Occurring Disorders In Addiction Treatment

Understanding Dual Diagnosis And Co-Occurring Disorders In Addiction Treatment

Addiction is primarily a mental health condition, and the chemical dependency a drug creates often pales in comparison to the strength of the psychological hold an addictive substance can have on a person. When a person suffers from a mental health disorder, there is always a risk of the person developing a substance abuse disorder in response. Self-medication is a dangerous path, and many people who struggle with substance abuse also suffer from co-occurring mental health disorders.

Effective substance abuse treatment hinges on addressing the underlying causes of an addiction. Some people develop addictions in response to consistent everyday stress while others may turn to illicit substances in response to trauma or major life events like the death of a loved one or loss of a job. Treatment must acknowledge these issues and help patients move past them and learn to process them with healthier coping techniques. Dual diagnosis, or the presence of a co-occurring mental health disorder with a substance abuse disorder, makes effective treatment an especially complicated undertaking.

What Is Dual Diagnosis?

Dual diagnosis describes an individual suffering from a substance abuse disorder and a co-occurring mental health disorder. Regardless of whether the individual has a natural mental health disorder or developed one in response to trauma, the mental health issue creates a dangerous symbiosis with substance abuse. These two issues effectively feed off one another, creating a very deep-seated cycle of dependency that can be extremely difficult to break without specialized, individualized treatment for both issues simultaneously.

As many as 70% of the people struggling with substance abuse in the United States also suffer from co-occurring mental health disorders*. Of the nearly nine million Americans struggling with dual diagnoses, only about 8% receive appropriate treatment. Unfortunately, mental health treatment and substance abuse treatment largely exist in separate systems of care in the U.S. Many substance abuse treatment centers have started to adopt dual diagnosis care, but it is still generally harder to find than standard substance abuse treatment or mental health treatment.

Dangers And Challenges Of Dual Diagnosis

Unfortunately, many people who have struggled with dual diagnosis effectively had to bounce back and forth between different systems of care, sometimes receiving conflicting treatments for their co-occurring mental health disorders and/or substance abuse disorders. For example, some medications used to treat mental health disorders carry high risk of abuse and dependency, and some medications used in substance abuse treatment to help curb cravings and withdrawal symptoms may interfere with preexisting mental health conditions or prescription medications taken for mental health disorders.

Effective dual diagnosis treatment must address both issues simultaneously because it is essentially impossible to treat one issue without addressing the other. Some people develop mental health disorders and self-medicate and some develop mental health disorders after years of struggling with substance abuse. Regardless of how co-occurring disorders manifest, overcoming them is only possible with comprehensive treatment.

Links Between Mental Health Disorders And Addiction

Many mental health disorders carry significant risks of contributing to addictions or worsening from them:

  • Depression. Clinically diagnosed depression can be extremely difficult to overcome, even with prescription antidepressants and consistent counseling. People with depression face a very high risk of falling into substance abuse out of a desire to self-medicate. Additionally, some substances like alcohol and stimulants like cocaine can interfere with antidepressant prescriptions, causing potentially fatal interactions in some cases and exacerbating depression symptoms in others.
  • Anxiety. Many anti-anxiety medications, typically those made with benzodiazepines, carry very high risks of dependency and addiction. People who take these medications with legitimate prescriptions must only use them for short-term relief and speak to their doctors about proper cessation. Suddenly stopping these medications can cause an intense resurgence of anxiety symptoms, compelling the individual to take more benzodiazepines to compensate and accelerate the cycle of dependency.
  • Post-Traumatic Stress Disorder (PTSD). This very complex condition affects everyone who experiences it differently. Manifesting in response to acute trauma, PTSD sufferers can experience a wide range of negative symptoms that make everyday functioning difficult or impossible. These individuals may attempt to cope by abusing alcohol and illicit drugs to aid sleep, quell flashbacks, and fight symptoms of anxiety and depression. However, abusing substances in this manner quickly escalates to full-blown addiction.
  • Personality disorders. Some people who struggle with psychological conditions like bipolar disorder, schizophrenia, and borderline personality disorder also face significant risk of developing substance abuse disorders.
  • Eating disorders. Many people who struggle with bulimia, anorexia, and binge eating also struggle with substance abuse. Drugs and alcohol impact appetite in different ways. Some of these individuals may use drugs to cope with the stress an eating disorder causes or to specifically control aspects of his or her diet. For example, stimulants like cocaine tend to reduce appetite, leading to weight loss but also several negative medical issues like diminished immune system function.

These are just a few examples of how substance abuse and mental health disorders can intertwine in dangerous ways.

Risks Of Untreated Dual Diagnosis

The major risk of a dual diagnosis is for the two co-occurring issues to escalate each other to dangerous levels. A person struggling with depression may use alcohol to cope and numb his or her pain, causing significant health and personal issues that exacerbate his or her depression symptoms. This in turn encourages more alcohol abuse, creating a very dangerous symbiotic cycle of dependency.

Left untreated, an individual struggling with a dual diagnosis will suffer the ill effects of both the substance abuse disorder and the mental health disorder. Untreated depression increases the risk of suicide, untreated anxiety can make it impossible to function in normal life, and an unchecked addiction will continue to escalate to fatal levels. It is essential for anyone with a substance abuse disorder and a co-occurring mental health condition to seek comprehensive treatment for both issues simultaneously.

Treating Dual Diagnosis

An effective dual diagnosis treatment program must include extensive treatment considerations for both the substance abuse issue and the mental health issue simultaneously. Additionally, treatment providers must ensure close communication among all members of the treatment team to avoid potential conflicts between treatments for these issues. They can also collaborate to develop well-rounded treatment plans that fully explore a patient’s dual diagnosis, address the root of it, and provide effective treatment.

The Need For Comprehensive Care

There is no one-size-fits-all solution to dual diagnosis, nor is there any one treatment that will work for everyone struggling with addiction and a co-occurring mental health disorder. An effective dual diagnosis treatment plan must start with a close review of the patient’s mental health history and his or her history with substance abuse, identify the damage done by both problems, and develop an individualized treatment plan that helps both issues simultaneously.

Virtually all addiction treatment programs include a mixture of individual counseling, behavioral therapy, group therapy, and medical treatment. These same measures apply to many mental health disorders, but a dual diagnosis demands treatment for both issues together. Patients forced to bounce between mental health treatment and substance abuse treatment may find relief from one issue for a time and then quickly devolve back into a destructive cycle before long. Patients who receive individualized, coordinated dual diagnosis treatment stand much better chances at overcoming their addictions and achieving lifelong sobriety.

Dual diagnosis patients also need more comprehensive ongoing support and relapse prevention treatment than standard addiction patients do. They need to learn new coping mechanisms for their mental health disorders, and some may require safe pharmaceutical treatments that do not pose a risk of addiction. Ultimately, dual diagnosis presents an enormous challenge to anyone working in the substance abuse treatment field, and individualized, comprehensive treatment is the only method that can hope to achieve positive results.

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