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What Is a Dual Diagnosis?

A dual diagnosis also referred to as a co-occurring disorder, is when a person is diagnosed with both a mental health disorder and a substance use disorder.

An example of a dual diagnosis is having an alcohol or drug use disorder and a mental health condition such as a mood or anxiety disorder.

You're not alone if you or a loved one have a dual diagnosis. In 2020, 17 million adults in the United States experienced a mental health condition and substance use disorder.

Having a dual diagnosis often isn't a coincidence. "Mental illness is about twice as prevalent in people diagnosed with an addiction." The National Institute on Drug Abuse (NIDA) notes that approximately half the people who experience a substance use disorder also experience a mental illness at some point during their lifetime, and vice versa.

This article explores the causes, diagnostic process, and treatment options for dual diagnosis, as well as some coping strategies that might be helpful.

Causes of a Dual Diagnosis

Listed below are some reasons why substance use disorders co-occur along with mental health conditions, according to the National Institute on Mental Health (NIMH).

Common Risk Factors

Both substance use disorders and mental health conditions have common risk factors, such as stress and trauma. Genetic factors may also play a role, as mental health conditions and substance use disorders tend to run in families.

Mental Health Conditions Can Lead to Substance Use

Mental health conditions can change a person's brain, making them more susceptible to the rewarding effects of alcohol. This can make them more likely to continue using the substance and develop an addiction.

People with mental health issues may use alcohol or substances to self-medicate their symptoms.

For instance, someone with anxiety, depression, or post-traumatic stress disorder (PTSD) may turn to substances such as alcohol or drugs to feel better. However, while substances can offer a temporary escape, they worsen the symptoms of these conditions over time.

Substance Use Can Lead to Mental Health Conditions

Similarly, substance use can change the brain, making a person more likely to develop a mental health condition. A person using alcohol or substances may be more susceptible to mental health issues, and the longer they use substances, the greater the risk of developing mental illnesses.

Though substance use disorders and mental health conditions may occur together, it can be challenging to determine which came first or caused the other. The etiology of co-occurring disorders is sometimes difficult to ascertain.

Diagnosing Co-Occurring Disorders

The National Alliance on Mental Illness (NAMI) notes that the symptoms of co-occurring disorders can vary considerably depending on which conditions the person has.

A dual diagnosis is identified when a professional, usually a psychiatrist or psychologist, conducts a thorough patient evaluation, asking about the symptoms of various conditions and understanding the onset of symptoms and their evolution over time.

Often, it is challenging to untangle the symptoms because mental health symptoms may be related to a pattern of substance use, intoxication effects, or even withdrawal associated with a particular substance. For example, a person may stop using cocaine, and the acute effect may be a depressed mood.

Therefore, it is also essential to ask about symptoms that may or may not have been present before substance use and whether the substance use exacerbated the mental health symptoms. Recognizing psychosocial triggers such as significant stress or trauma history that may underlie both disorders is also important.

Treating Co-Occurring Disorders

Treating co-occurring disorders requires an integrated approach.

Dual diagnosis treatment must simultaneously address mental illness and substance use since both impacts a person's life. Treatment, therefore, consists of integrating the two disorders rather than focusing on each separately.

These are some of the treatment approaches healthcare providers may recommend for a dual diagnosis:

  • Detoxification: The first step, which can be a significant hurdle, involves stopping the substances and flushing them out of the system. The detox process is often undertaken in an inpatient setting, so healthcare providers can monitor the patient and provide medication and care in case of the person experiences withdrawal symptoms.

  • Psychotherapy: Therapy is often a significant part of the treatment plan. Cognitive behavioral therapy (CBT) is often helpful in changing unhealthy thought patterns that contribute to substance use. Some people may need intensive therapy initially, but once they get their symptoms under control and learn valuable coping skills, they may be able to reduce the frequency of their treatment sessions.

  • Medication: In addition to helping with withdrawal symptoms, medication can also help reduce cravings for drugs and alcohol and help with the symptoms of mental health conditions.

  • Inpatient rehabilitation: People with co-occurring disorders may benefit from inpatient rehabilitation, receiving continuous monitoring and mental healthcare.

  • Support groups: Grappling with a dual diagnosis can be challenging. Support groups offer an avenue for people to share advice, celebrate successes, vent frustrations, find resources, and offer help and inspiration.

A dual-diagnosis treatment plan needs to consider that co-occurring disorders may be more persistent and severe than having only one disorder, and you can't treat one without assessing the risk factors for the other.

For example, you wouldn't want to treat anxiety with medication that may have abuse potential; you wouldn't want to treat a substance use disorder without understanding the circumstances in which the person uses the substance and what effect it has on them.

A 2018 study notes that an integrated approach is critical because a lack of improvement in either disorder can lead to a relapse of both conditions.

Coping With a Dual Diagnosis

Some strategies that may help cope with a dual diagnosis are:

  • Seek help: The first step to helping someone cope with a dual diagnosis is to convince them to seek help. Finding a compassionate provider who is willing to listen and understand how the diagnoses are affecting their physical well-being, emotional health, and social life is necessary for a successful intervention.

  • Participate actively in treatment: Talking to a professional is just the beginning of the recovery process. Active participation in treatment is critical. Fully engaging in therapy with adequate support from within and outside the treatment program is very beneficial.

  • Focus on feeling better: Any mental health or substance use disorder can create a variety of challenges for the patient, their friends, and their family. A dual diagnosis may complicate the treatment plan, but education, support, therapy, and medication can help individuals recover and lead productive lives.

Remember that people can and do get better with the proper treatment. It's essential to keep an open mind, find a support team, and not give up on the recovery.

Coping with a substance use disorder can be challenging and even more complex with a dual diagnosis since co-occurring disorders can worsen both conditions. To start feeling better, seek help for these conditions, get an accurate diagnosis, and participate in treatment.

If you or a loved one could be suffering from a substance use disorder along with a mental health complication and might need help, you can call Another Solution for help. We will provide cost-free evaluations and formulate a comprehensive recovery plan.

Article courtesy: Sanjana Gupta Sanjana is a health writer and editor. Her work spans various health-related topics, including mental health, fitness, nutrition, and wellness.

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