Dual Diagnosis: Mental Health Conditions and Substance Abuse

Dual Diagnosis: Mental Health Conditions and Substance Abuse

doctor with female patient

Research shows that as many as half of all psychiatric patients also struggle with addiction, but less than 1 in 10 eligible patients receives treatment. Substance abuse and mental health problems such as depression, schizophrenia, bipolar disorder and anxiety disorders are challenging to treat individually, but when a person suffers from both, the difficulties from a treatment perspective are multiplied. The two elements of dual diagnosis feed into one another, and for this reason “integrated treatment”—as opposed to addressing the elements separately—seems like a promising solution. However, current options when it comes to this type of treatment are limited, and some experts believe that they aren’t doing enough for patients suffering from the combination of conditions.

What Is Dual Diagnosis?

Dual diagnosis can mean any combination of psychological conditions and substance abuse problems. The relationship between the two is seen in both human patients and in rodent models, and experts assume that the cause of the link is the common regions of the brain involved in the problems. Schizophrenia, for example, affects the nucleus accumbens, the hippocampus and the frontal cortex, and these same regions are associated with an increased likelihood to develop a drug or alcohol addiction.

Research into the issue has revealed that dual diagnosis isn’t related to a specific drug—just addiction on the whole—and that it spans across a wide range of mental health issues. According to Dr. R. Andrew Chambers from the Indiana University School of Medicine, it’s been established that those with a more serious mental illness are at even greater risk for substance abuse. The impulsiveness common to both addictive behavior and mental illnesses is assumed to be an important factor in the link, but it’s also noted that some drugs (such as marijuana) have been shown to increase the risk of psychosis and some people with mental health problems may use drugs as a means of “self-medicating.” The combined effect is that substance abuse and mental health problems mutually exacerbate each other.

Challenges of Treating Dual Diagnoses

An example of the issues often encountered by people with dual diagnoses comes from Matthew Peters, who suffers from major depressive disorder and was a regular drinker by the age of 13. He recounts stories of treatment centers prescribing him Valium (a commonly abused, addictive drug) for his depression-related insomnia and many treatment centers focusing on one issue or the other, rather than both.

The problem is that many treatment providers don’t address both issues simultaneously. People struggling with two conditions concurrently have unique needs; if the substance abuse is successfully treated, for example, the mental health condition still persists and the drive to self-medicate can easily lead to a relapse. The use of the term self-medication also irks some experts, because of the fact that drug use is practically the opposite of “medicating,” but it’s clear that many patients do so regardless. Addressing this myth is an important part of helping people with dual diagnoses, but it’s essential that effective treatment for the mental illness is also provided to nullify the perceived “need” to self-medicate.

Integrated Treatment—Are We Doing Enough?

Integrated treatment is the best solution to dual diagnosis, providing patients with a program—ideally conducted in a single facility—capable of dealing with both elements of the condition to a high standard. Drug-related psychological symptoms may disappear or at least be reduced in severity after the addiction is tackled, but some of the symptoms will continue. When the individual has pre-existing mental health problems, the symptoms will not go away with abstinence, so in either case it’s likely that some additional psychological treatment—other than that ordinarily offered for addiction—will be needed. Unfortunately, despite many centers claiming to deal with dual diagnosis, the reality is that the historical separation of mental health and drug abuse treatment and research has led to most providers being unable to treat both under one roof.

As well as going to greater lengths to truly integrate treatment, some argue that further efforts should be made to identify cases of dual diagnosis. Because of the notable overlap between mental health conditions and substance abuse, it’s suggested that when one is present, healthcare providers should take decisive steps to determine whether the other also has a role to play.

Importance of Post-Treatment Support

Integrating our treatment approach and helping identify people in need is vital, but it’s also important to remember that continuing support may be needed in many cases of dual diagnosis. “Completing” treatment—whether for one condition or both—is a misleading notion, because cravings and psychological symptoms can continue for a long time after the main period of treatment. Continuing, post-treatment support—as provided by 12-step groups—has been shown to improve outcomes for patients, so it’s vital that those with dual diagnoses are offered such additional care, especially if psychological symptoms are ongoing. It might not be the easiest task, but if we take steps to account for the unique factors in dual diagnosis, the proportion of eligible patients receiving appropriate and effective treatment can be significantly increased.

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