Dual Diagnosis Explained

A dual diagnosis occurs when an individual is diagnosed as having both a mental health condition and a substance abuse disorder at the same time. Many people suffer from co-occurring disorders, and they need in-depth specialist help to recover from both. That’s why it’s essential that people understand the significance of a dual diagnosis and the complexities involved in managing and treating it. Greater awareness makes it easier for those with a dual diagnosis to seek mental health and addiction treatment.

What is Dual Diagnosis?

A person who is identified by healthcare professionals as having a dual diagnosis has both a mental health condition and substance abuse disorder (SUD). The SUD is usually drug addiction or alcoholism, but the mental health condition can be any mental illness or disorder, including depression, anxiety, post-traumatic stress disorder (PTSD), bipolar disorder, or schizophrenia. This is a type of comorbidity, meaning both disorders require treatment at the same time. It’s common for people with mental health conditions to develop SUDs and vice versa. These co-occurring disorders require simultaneous but individual treatments. ^[1]

Dual diagnosis is particularly prevalent due to a number of factors, such as stress, genetics, and trauma. Not every person with a mental health disorder will develop an SUD, although the trauma and stress related to poor mental health can prompt many people to turn to unhealthy coping mechanisms. This negatively impacts them and usually makes their mental state even worse.

The risk factors related to co-occurring diseases mean that it’s better to treat the two at the same time rather than one at a time. This type of medical intervention focuses on both behavioral and medical treatments, tackling the dual diagnosis as one. ^[1]

Common Co-occurring Disorders

There is no limit to which mental health and substance abuse disorders can co-exist, but there are some combinations that healthcare professionals see more than others. Some mental health conditions spur individuals to use particular substances to try and calm their symptoms, whereas others are the result of casual use turning into addiction. ^[2]

Though there is no specific list of definitive combinations, these are some of the most typical co-occurring disorders:

• Anxiety and marijuana
• Depression and alcoholism
• Schizophrenia and cocaine
• Bipolar disorder and cannabis
• Depression and prescription drugs
• ADHD and alcoholism

Depending on the substance that the individual is abusing, some medications cannot be used. For instance, there are dangers related to prescribing certain substances to people who are addicted to prescription drugs. Each case of dual diagnosis is treated uniquely to ensure safe and effective treatment is administered. ^[2]

Signs of Dual Diagnosis

One of the biggest issues in accurately diagnosing two co-occurring disorders is the wide array of signs and symptoms associated with both mental health conditions and substance abuse disorders. There are many symptoms that cross over, which can often lead to one of the disorders being missed.

Furthermore, many patients are hesitant to disclose their substance abuse and related symptoms, and this further complicates making a proper diagnosis. Dual diagnosis treatment relies on medical professionals being able to make a quick and correct assessment of the person’s condition, which requires spending time, paying attention, asking the right questions, and establishing trust between the patient and medical professional to foster openness and honesty.

Some of the most telling signs of dual diagnosis include:

• Increased psychiatric symptoms
• Poor personal hygiene
• Aggressive or risky behaviors
• Social withdrawal
• More frequent hospital visits and medical issues
• A high tolerance for medications and other substances ^[3]

There are many complexities involved with overlapping conditions, and it’s the job of healthcare professionals to treat both without making either worse. The integrated treatment plan for dually diagnosed patients has produced mixed results in the past, with further resources needed to account for the diverse variety of mental health disorders. The criteria for recognizing an individual with co-occurring disorders continues to expand as a result of this specialization. ^[3]

Causes of Dual Diagnosis

Millions of people in the United States have more than one diagnosis, with the coupling of a mental illness and a substance abuse problem becoming a mainstream condition, as opposed to a medical exception. The causes of a dual diagnosis are typically an amalgamation of issues that trigger both poor mental health and a desire to use illicit substances to cope. Often, these intertwine, with one increasing the risk factors of the other, which, consequently, amplifies the burden placed on healthcare providers to treat patients effectively. ^[4]

Some of the leading causes of co-occurring mental conditions and SUDs can include genetic factors, such as mental health disorders that are passed down through familial generations or potentially inheritable substance abuse issues that may be influenced by genetic makeup.

However, environmental factors also have a significant influence, particularly when a person who is abusing one or more substances begins to develop symptoms of mental illness. Self-medication, an unhealthy lifestyle, and continuous exposure to substance abuse (such as parental alcoholism) all contribute to the likelihood of developing co-occurring disorders. ^[4]

In most cases, already having one disorder triggers the development of a second, equally damaging disorder. Prolonged substance use has the potential to cause structural changes in the brain, such as to its emotional processing regions and communicative controls, making the individual more vulnerable to developing mental health problems.

Inversely, people suffering the effects of poor mental health, particularly debilitating anxious and depressive disorders, are more likely to attempt self-medication via drugs or alcohol. This can provide short-term relief but causes long-term dependency, which actually makes living with a mental health disorder even harder. ^[5]

The longer that people suffer with either a mental illness or an SUD, the more at risk they are of becoming dually diagnosed. The symptoms of both types of disorders affect how an individual behaves and reduce their likelihood of seeking help, particularly if they have come to rely on drugs or alcohol. Society frequently shames people who suffer from mental illness or addiction, so symptoms often fester and become severe before patients seek help, creating a need for more prolonged treatment.

Diagnosing Comorbid Conditions

The similarities between comorbid conditions make it difficult to accurately differentiate and diagnose them. In the case of a dual diagnosis, the behavioral effects of substance abuse, such as fluctuating moods and increased paranoia and agitation, often mask the realities of mental illness because the signs are so similar. The side effects of abusing substances may also be written off as symptoms of poor mental health if the individual does not disclose their addiction.

As a result, healthcare professionals face considerable obstructions when attempting to make a dual diagnosis. There are few resources that specifically target co-occurring mental and substance abuse disorders, meaning smaller amounts of integrated treatment options are available for a growing number of dually-diagnosed patients. Many mental health programs specifically exclude people with substance addictions, so there is little support for the patients in the wider span of healthcare, too. ^[6]

Comorbid conditions have such an integrated relationship that it often becomes difficult to diagnose and treat them individually. The mental health disorder may cause the SUD, or vice versa, or they may both be triggered by independent causes but interact, making the symptoms overlap. In the past, some co-occurring disorders were grouped into the same categories because their symptoms were so similar, which created a misunderstanding of comorbidity. ^[6]

Nowadays, healthcare professionals use more specialized assessment methods to ensure they don’t misdiagnose vulnerable patients. Psychologists and psychiatrists evaluate the patient’s symptoms and behavioral changes, determining the mental health disorder affecting them. Typically, the individual will need to volunteer information about their substance abuse and how it impairs their life, which is one of the hardest steps in the treatment process. Without complete transparency, the professional will struggle to accurately assess the severity of the SUD. Once the mental health and substance abuse disorders have been recognized and diagnosed, the patient can then be referred for appropriate treatment.

Treatment Approaches for Dual Diagnoses

Integrated treatment is essential for a successful recovery from co-occurring mental health and substance abuse disorders. Integrated treatment focuses on treating both co-occurring disorders under one overall plan that comprises several different types of treatment.

Many medical professionals are involved in administering integrated treatment, including doctors, social workers, psychotherapists, and counselors. Every professional must understand the dangers of these comorbidities and work cohesively to manage mental health and substance abuse symptoms, both in and out of hospital settings. ^[7]

The best results usually stem from a combination of medical treatment and behavioral therapy administered via a specific treatment plan tailored to the dual diagnosis. Integrating multiple treatments to medicate both conditions at once has been proven more successful than approaching them separately.

There are many medicines used to treat mental health disorders and substance addictions individually, as well as some that can treat symptoms of both. A doctor will prescribe only the necessary medication(s) to prompt recovery. Different forms of therapy, including residential therapy, talk therapy, and support groups, can be helpful. ^[1]

Unfortunately, the rate of relapse for those who have a dual diagnosis is high. This is because both disorders still need to be monitored and managed after receiving treatment to reduce the risk of symptoms returning. That’s why psychosocial treatment is also necessary for ensuring dually diagnosed individuals are able to continue improving their lives. This type of treatment typically takes place during therapy, either individual or group, and it involves teaching the patient how to lead a healthy lifestyle, maintain their sobriety, and continue improving their mental health. It’s a way to continue treating dual disorders after other medical and behavioral treatments. ^[8]

Living with Dual Diagnosis

Living with a dual diagnosis is challenging, even if the individual responds well to integrated treatment. Managing one disorder is hard enough, so it can be almost impossible to navigate life with two, especially when one makes the other worse. Unlike people who are diagnosed with one condition, those with co-occurring disorders face unique challenges. From complicated treatment plans to specific lifestyle changes to maintaining their recovery long-term, living with a dual diagnosis requires immense mental and emotional strength.

Treatment doesn’t have to end after recovery has begun, and it’s recommended for dually-diagnosed individuals to maintain some sort of therapy afterwards. The psychosocial approach promotes techniques for better self-care, including mindfulness and relaxation, as well as motivation therapy and relapse prevention counseling to keep the individual on track. With this type of support, managing daily life becomes easier, and the risk of relapsing decreases. The family and friends of dually-diagnosed patients are also encouraged to support the recovering person. ^[8]

Comorbidity is insidious, and individuals suffering from the effects of both poor mental health and substance abuse are at risk of psychological and physical harm. For many of them, receiving a dual diagnosis opens up a gateway to a vastly improved life, and the impacts of treatment and sobriety are evident. However, having a dual diagnosis sticks with them for life, even if they never relapse, so it’s essential that they have access to all relevant resources dedicated to accurately diagnosing and treating co-occurring disorders.