Mental Health & Behavioral Addiction – Dual-Diagnosis

Addiction & Mental Health

Substance addiction and mental health disorders are two health issues with a known correlation. Substance use may harm or change parts of the brain. The changes or damage could lead to mental disorders. ⁽¹⁾

Sometimes, mental disorders lead to substance addiction as a person tries to cope with their symptoms. In other words, substance use and mental health conditions are comorbidities, or co-occurring disorders, and may cause or contribute to one another.

Certain mental health disorders create an increased risk factor for substance use disorders. For example, those living with subclinical, mild, or severe disorders might turn to drugs to help self-medicate against their symptoms. One study showed that smoking can potentially reduce or help people cope with symptoms of illnesses such as depression or schizophrenia.

Another study showed that people with ADHD may have changes in the brain that lead to an increased likelihood of drug cravings when dealing with a substance use disorder comorbidity. Evidence has also shown that using cocaine, for example, could lead to worsened symptoms of bipolar disorder.

Addiction and mental health diagnoses that occur at the same time, also known as dual diagnoses, require medical attention and care to prevent them from building on one another.

What Is a Dual-Diagnosis Disorder?

One form of dual-diagnosis disorder occurs when a person has a mental and substance use disorder occurring at the same time. For example, the person could have depression or anxiety and an alcohol use disorder simultaneously. Or, they could have bipolar disorder while dealing with drug addiction. ⁽²⁾

Data shows that around half of the people who develop mental disorders will also develop substance use disorders in their lifetimes. Each disorder can become worse because of the other.

Some reasons why the two conditions are comorbid include:

1. Common risk factors contribute to both. Stress, trauma, and genetics all play a role in their development.
2. Substance use disorders can lead to new mental disorders.
3. Mental disorders can lead to new substance use disorders.

When someone has a dual-diagnosis, it’s vital that they get treatment for both at the same time. Treatment works best when the individual can stop using drugs or alcohol completely and get appropriate care for their mental health concerns. Failing to treat both conditions at once could lead to a relapse, which is when the condition recurs again.

Dual Diagnosis Treatment

Someone with a dual diagnosis must go through treatment for all their comorbid conditions simultaneously. Different kinds of treatments provide support and aid, including behavioral therapies, medications, and other services. ⁽²⁾

The first goal of dual-diagnosis treatment is the cessation of the used substances. Then, often at the same time or shortly after detoxification (the process of eliminating the substances from the body), they’ll begin longer-term mental health treatment.

Some treatment options include: ⁽³⁾

• Inpatient treatment
• Outpatient treatment
• Intensive outpatient treatment
• Partial hospitalization
• Medications
• Supportive housing
• Self-help
• Support groups
• Detoxification

The specific treatment a patient goes through depends on the conditions they present with. For example, someone with an alcohol use disorder may attend 12-step meetings, have talk therapy sessions, and use naltrexone (a medication approved to treat alcohol use disorder) ⁽⁴⁾. They may even decide to do all of this on an outpatient basis. ⁽³⁾

Everyone is different, so the treatment method used will vary based on the patient’s circumstances and needs. For most, however, the process begins with detoxification and moves forward with inpatient or outpatient treatment. Over time, treatments lessen, and the patient may go to therapy or seek support on a more as-needed basis.

Behavioral Addictions

Behavioral addictions are similar to other kinds of addictions in how they form and affect people. ⁽⁵⁾ They include actions that begin to interfere in a person’s life. Also known as process addictions, behavioral addictions follow the same patterns as substance use disorders. That process includes an introduction to the addictive behavior and an inability to step away from it, despite it causing harm in the person’s life.

Process addictions aren’t the same as “problematic behaviors” that aren’t addictions. Behavioral addictions may lead a person to:

• Spend much or all of their time thinking about or participating in the behavior
• Believe they only feel normal when doing the behavior (a sign of dependency)
• Continue to participate in the behavior, despite it causing physical or mental harm
• Have symptoms of withdrawal, such as irritability or anger
• Be unable to cut back, even when they want to
• Hide the severity of the problem from the people who care about them

These behaviors are different from problematic behaviors, as problematic behaviors may cause disruptions but not be persistent or a result of a specific addictive act. For example, problematic behavior might include impulse control problems, but those problems may not tie in with an addiction.

While there are several casually recognized behavioral addictions, such as video game or social media addiction, gambling disorder is the only formally recognized behavioral addiction. Some commonly recognized behavioral addictions include:

• Shopping addictions
• Video game addictions
• Work addictions
• Food addictions
• Internet addictions
• Sex addictions
• Porn addictions
• Tattoo addictions

These and others aren’t in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), but they can still cause problems in a person’s life. ⁽⁶⁾

Behavioral Addiction Treatment

Those with behavioral addictions need support and treatment when the behavior becomes compulsive, has resulted in a loss of control, occurs despite negative consequences, and includes cravings. ⁽⁷⁾ Those four “C’s” indicate the need for an assessment, at the very least, as well as treatments that address the behaviors the person no longer wants to participate in.

The first step of behavioral addiction treatment requires the identification of the behavior and its triggers. The individual and their sponsors, therapists, psychiatrists, or other support team members then have to figure out warning signs and precipitating behaviors.

Treatment of these addictions tends to be through psychotherapy or 12-step programs, but medications may also provide relief. For example, if the behavior is a dual-diagnosis with ADHD, getting the person’s ADHD treated and under control may also help them break the cycle of behavioral addiction. ⁽⁸⁾

Some of the most common kinds of treatment include:

1. Talk therapy
2. Counseling
3. Support groups

Since every person has their own medical background and history, their medical team has to create a treatment plan personalized to their needs.

Addiction & Changes in the Brain

Addiction causes changes in the brain. When a person becomes addicted to a substance or activity, it’s because the brain has become accustomed to that behavior and now rewards it each time it occurs. ⁽⁹⁾

The brain’s reward system reinforces behaviors necessary for survival. Addictions happen because the person’s current behaviors trigger an overwhelmingly positive response that the brain believes helps the person survive in some way. Essentially, the addiction fools the brain into thinking the behavior is necessary when it really isn’t.

With chronic use of a substance or the chronic completion of an activity, the brain becomes less sensitive to it. That change, called a “tolerance,” leads to craving more of the behavior to reach previous “highs.”

Addictions can lead to problems with judgment, decision-making, and memory, as well as issues with focus or the way a person learns. Since changes in the brain result in this kind of persistent, cyclical behavior, addiction is a brain disease.

People can’t simply stop their addictions and need interventions to help break the cycles leading to stronger, more pervasive addictive behaviors. Medication-based treatments and psychotherapies are two options to help people work to break away from addiction and get a fresh start. ⁽⁹⁾