A dual diagnosis means someone has a psychiatric condition and a substance use disorder involving drugs or alcohol. These conditions often occur together, and around half of the people with a mental disorder will also have a substance use disorder at some point in their lives, and vice versa.
The interactions between psychiatric symptoms and addiction can worsen both conditions if they aren’t properly treated. According to the Mental Health Services Administration, integrated treatment for addiction and mood disorders or mental health disorders can help facilitate long-term recovery.
What is Dual Diagnosis?
According to the National Alliance on Mental Illness, 21 million people in the U.S. are estimated to have an alcohol or drug addiction. Eight million also have a mental illness.
The term dual diagnosis isn’t a diagnosis in and of itself—it’s a reference to a combination of diagnoses. It’s a broad term that can refer to something like mild depression developing after binge drinking or someone having severe symptoms of bipolar disorder when misusing an illicit drug like heroin or methamphetamine.
Either co-occurring mental health disorder can appear first. Someone with a mental health disorder might turn to drugs or alcohol to self-medicate their symptoms. Someone with a substance use disorder can also be at a higher risk of developing a mental health disorder because of its effects on the brain. Drugs and alcohol make symptoms of mental health conditions worse, and without appropriate diagnosis and treatment, the cycle becomes severe.
Common Dual Diagnosis Disorders
Some of the most common dual diagnoses or co-occurring disorders include:
- Depressive disorders and cocaine addiction: Around 10% of the population of America struggles with major depression, and at least one-third misuse substances, including cocaine. Cocaine is a highly addictive stimulant that spikes the production of dopamine, the reward neurotransmitter, leading to euphoria. Artificial stimulation alters the brain’s chemistry.
- Anxiety disorders and alcohol addiction: It can be somewhat common for someone with anxiety disorders like generalized anxiety disorder, panic disorders, or social anxiety disorder to develop a problem with alcohol, often because of a desire to self-medicate. Obsessive-compulsive disorder can also co-occur with alcohol addiction.
- ADHD and alcohol use disorders: Attention-deficit hyperactivity disorder (ADHD) and alcohol misuse can be dual disorders for many reasons. One is that alcohol has a depressant effect on the brain and central nervous system. Someone with ADHD might rely on alcohol to help calm them down. Unfortunately, alcohol and ADHD affect the frontal lobe of the brain, so when someone consumes alcohol, it can lead to out-of-control behaviors and emotions if they also have ADHD.
- PTSD and opioids: Post-traumatic stress disorder (PTSD) can occur with various trauma exposure, including abuse, military combat, or accidents. People with PTSD have higher rates of opioid prescriptions, and that exposure raises the risk of addiction.
- Bipolar disorder and alcohol: When someone has bipolar disorder, they experience both manic and depressive episodes. When someone feels like they don’t have control over their life, they might use alcohol as an escape. People with bipolar disorder may be seven times more likely to have an addiction than individuals without this mental health disorder.
- Eating disorders and stimulants/appetite suppressants: Tens of millions of people may suffer from an eating disorder, and around 64% misuse prescription and over-the-counter medications. Someone with a food-related mental health disorder might misuse cocaine, heroin, or amphetamines, for example.
It’s important to remember that addiction is in and of itself a mental illness. Substance use disorders are complex chronic diseases stemming from brain function and structure changes. They lead to compulsive cravings and the use of substances, no matter the consequences. The changes stemming from addiction affect the same brain areas impacted by psychiatric disorders such as anxiety, bipolar disorder, and depression.
Mental health conditions don’t necessarily have to cause a substance use disorder or vice versa, but it’s possible.
Common risk factors can contribute to both substance use and mental health disorders. These risk factors include stress, trauma, and genetics. Mental disorders can contribute to substance use disorders through self-medication.
Symptoms of a Co-Occurring Disorder
When someone has a simultaneous mental health condition and a substance use disorder, symptoms can vary quite a bit between individuals but may include the following:
- Social withdrawal from friends and family
- Sudden behavioral or mood changes
- Using substances in dangerous situations
- Risk-taking behaviors
- Loss of control over substance use
- Developing tolerance and withdrawal symptoms
- Feeling like you need to use the substance to function “normally.”
Dual Diagnosis Treatment Programs
When someone has a dual diagnosis, they need the care to treat both conditions. If someone has a substance use disorder and only receives treatment for that, not an underlying mental health condition, they’re at a much greater risk of relapsing.
Dual diagnosis treatment centers specialize in screening for co-occurring disorders and treating both, including within the context of how they affect one another.
Dual diagnosis treatment often includes what NAMI calls “integrated intervention.” Integrated intervention means that someone receives care for substance abuse and a particular mental illness.
The first step of dual diagnosis treatment for someone with an addiction may be detoxification. This is when the substances leave their body, which can be done on your own or in a medically-supervised facility.
A person with a severe addiction or mental illness might need inpatient rehab following detox. An evidence-based approach to treatment might occur along on continuum of care. While everyone’s path is different, it could look like the following:
- A dual diagnosis program could start with medical detox in a supervised environment. This is often the highest level of care in a comprehensive treatment plan.
- After detox and when ready, patients could move into inpatient treatment in a residential setting. Inpatient rehab will include evidence-based treatment such as individual therapies, group therapy, family therapy, and medication management. Inpatient treatment might include holistic therapy such as art therapy, music therapy, trauma therapy, and nutritional guidance.
- After someone completes an inpatient program, effective treatment plans might include an intensive outpatient program or, if they’re ready, a more flexible outpatient program.
- An individualized treatment plan for co-occurring disorders could include an aftercare program, such as recommendations for 12-step programs like Alcoholics Anonymous and referrals for physical health care providers. Aftercare planning may include referrals for ongoing psychiatric care and mental health programs as part of a continuity of care. If relevant, an aftercare plan might include recommendations for family programs too.
Again, everyone’s recovery journey is unique when they have a co-occurring disorder or co-occurring condition involving alcohol or drug abuse and a psychiatric illness.
Regardless of whether treatment is received inpatient or outpatient, it will likely include a combination of medication and psychotherapy.
Medications are valuable tools for mental health treatments and can play a key role in recovery. Some medications can help with substance abuse disorders. For example, certain medicines can reduce alcohol or opioid withdrawal symptoms and cravings. This is known as medication-assisted treatment.
Psychotherapy or behavioral therapy is almost always part of a dual diagnosis treatment plan. During talk therapy, you work with a professional therapist who helps you understand more about how your beliefs and behaviors influence your thoughts. You can simultaneously work to improve the symptoms of your mental illness and substance addiction. One of the most commonly used approaches in dual diagnosis treatment is cognitive-behavioral therapy.
Faith Based Substance Abuse Treatment in Orange County, CA
Having substance abuse issues along with other mental health-related issues can feel overwhelming and isolating, a treatment team might recommend that you participate in a support group for other people with similar diagnoses or in group therapy. Social support is an integral part of recovery, especially social support from people who are like minded in their faith.
Covenant Hills Treatment offers faith-based and traditional treatment programs for people struggling with addiction in Orange County, CA. Please contact our team today at 844-268-8412 to learn more about what taking the next step toward recovery looks like.