Experiencing a mental health issue in conjunction with substance abuse is known as dual diagnosis. Dual diagnosis is sometimes referred to as dual disorder or co-occurring disorders.
Dual diagnosis is a condition characterized by the presence of a mental health issue and alcohol or drug abuse. The terms dual diagnosis and comorbidity are often used as synonyms though they are distinct and separate concepts. Comorbidity occurs when a person experiences two or more physical or mental health issues, with the possibility that the interaction between those conditions exacerbates the effects of the other(s). Comorbidity consists of co-occurring conditions of any kind, and dual diagnosis indicates that one of those conditions is a substance abuse problem.
According to the National Institute on Drug Abuse, 17.5% of people experiencing mental health issues have co-occurring drug or alcohol abuse problems, totaling nearly 8 million people. A survey conducted by the Substance Abuse and Mental Health Services Administration found that of those 8 million people experiencing dual diagnosis, only about 12.4% of adults were receiving treatment for both their mental health condition and substance abuse issue.
In many cases, addictive behaviors serve as coping mechanisms to mask mental health issues. In fact, according to the Journal of the American Medical Association, approximately 53% of those who abuse drugs and approximately 35% of those who abuse alcohol meet the criteria for a mental health diagnosis, which indicates a profound relationship between mental health issues and addiction. Some of the most common mental health issues that occur in conjunction with substance abuse include:
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- Obsessions and compulsions (OCD)
- Posttraumatic stress (PTSD)
- Disordered eating
Experiencing symptoms of a mental health issue on this list does not necessarily indicate that a person will also experience substance abuse. Though these mood, anxiety, and personality issues are commonly associated with dual diagnosis, they do not always occur in conjunction with substance abuse.
There are several theories on how dual diagnosis occurs for those experiencing a mental health condition. Two of the most commonly cited include:
- The self-medication theory argues that the use of drug and alcohol serves as a form of self-medication for those experiencing certain mental health concerns. Drugs and alcohol provide temporary feelings of relief, but in the long run, they may worsen the primary issue (for example, anxiety or depression). Furthermore, abusing drugs and alcohol may lead to other mental health issues or worsen symptoms of an existing mental health issue.
- The multiple risk factor theory identifies the existence of shared risk factors that can result in dual diagnosis. Those factors can include poverty, social isolation, lack of structured daily activities or responsibility, living in areas where drugs are easily available, and interacting in a social group with people who use drugs.
Because of its complexity, dual diagnosis requires different approaches to treatment. In general, there are four treatment models for dual diagnois:
- Partial treatment refers to the treatment of the primary mental health issue alone, and not the substance abuse concerns.
- Sequential treatment addresses the mental health condition first, and then the substance abuse issue.
- Parallel treatment focuses on treatment of the mental health concern and alcohol or drug abuse simultaneously, but separately, with different mental health care providers.
- Integrated treatment allows a person to receive mental health and addiction treatment simultaneously, under a single, unified, and comprehensive treatment program.
Historically, partial and sequential treatment were the go-to methods for treating dual diagnosis, as many experts thought mental health care and addiction recovery should be separate endeavors. According to dualdiagnosis.org, a website operated by a company called Foundations Recovery Network that specializes in residential treatment for those experiencing dual diagnosis, partial and sequential treatment have been shown to produce higher rates of relapse. Ongoing research is examining the efficacy of parallel and integrated treatment in comparison to other models, but these are generally recommended as the best approaches by the U.S. Department of Health and Human Services. It should be noted, however, that no one approach to treatment works well for everyone experiencing dual diagnosis. The relationship between a mental health condition and addiction is complicated and the path to recovery should be determined by in collaboration with a qualified health care professional.
Inpatient treatment programs often offer parallel or integrated treatment for those who use drugs or alcohol heavily and experience troubling symptoms from a mental health issue. In a residential treatment setting, a person can benefit from regular care while staying in a safe environment. Outpatient treatment is also available at many treatment facilities for those who cannot access inpatient treatment or for those who need additional help following inpatient treatment.
To facilitate the best treatment for dual diagnosis, some degree of personal transformation is usually required. This may include changing habits, learning stress management techniques, ending relationships with certain friends and forming new ones with others, or addressing issues with stable housing. These issues can be addressed through individual, family, or group therapy, all of which are often parts of inpatient treatment for dual diagnosis. Psychotherapy utilizes various techniques to address a wide range of mental health issues, emotions, and behaviors associated with substance abuse. Cognitive behavioral therapy, for example, is commonly used to teach those experiencing dual diagnosis about the relationship between their emotions and behaviors. In addition, group therapy with similarly affected individuals or support groups like Alcoholics Anonymous or Narcotics Anonymous can play a crucial part in both mental health treatment and relapse avoidance.
Depression and alcohol abuse: Jonathan, 37, experienced his first symptoms of depression not long after losing his wife in a car accident. Months passed, and his condition transformed from complicated grief to depression. He stayed in bed for days, neglecting his other roles. The only way he seemed to be able to find an escape was in drinking alcohol. Feeling depressed and estranged from everything he loved, with the help of his parents, Jonathan decided to enter a rehabilitation clinic. After some time and many tearful group therapy sessions, Jonathan acknowledged his grief from losing his loving wife, the feeling that he was abandoned by her, and his misplaced anger toward her for leaving him and their children. Gradually, his therapy included his children and parents and created a safe space for sharing the experiences they went through, which Jonathan found very helpful long after he had left the clinic.
- Drake, R.E., and Mueser K.T. (2000). Psychosocial Approaches to Dual Diagnosis. Schizophrenia Bulletin. Volume 26, Number 1, 105-118. Retrieved from http://www.psycontent.com/content/9w2u042h31831812/
- Integrated Treatment of Substance Abuse & Mental Illness. (n.d). Treatment Therapies for Dual Diagnosis Patients. Retrieved from http://www.dualdiagnosis.org/treatment-therapies-for-dual-diagnosis-patients/
- National Alliance on Mental Ilness. (2013). Dual Diagnosis Fact Sheet. Retrieved from http://www.nami.org/factsheets/dualdiagnosis_factsheet.pdf
- National Health Service. (2009). Dual diagnosis. Retrieved from http://www.nhs.uk/ipgmedia/national/Rethink%20Mental%20Illness/Assets/DualdiagnosisRET0162.pdf
- National Institute ofn Drug Abuse. (2011). DrugFacts: Comorbidity: Addiction and Other Mental Disorders. Retrieved from http://www.drugabuse.gov/publications/drugfacts/comorbidity-addiction-other-mental-disorders
- Results from the 2011 National Survey on Drug Use and Health: Mental Health Findings. (n.d.). Substance Abuse and Mental Health Services Administration. Retrieved from http://archive.samhsa.gov/data/NSDUH/2k11MH_FindingsandDetTables/2K11MHFR/NSDUHmhfr2011.htm
- Substance Abuse and Mental Health Services Administration. Integrated Treatment for Co-Occuring Disorders: The Evidence. DHHS Pub. No. SMA-08-4366, Rockville, MD: Center for Mental Health Services, Substance Abuse, and Mental Health Services Administration, U.S. Department of Health and Human Services, 2009.