Edited By: Juanita Wells, CADC-II, ICADC. Clinically Reviewed By: DeAnna Crosby, M.A., LMFT, LAADC, Psy.D (C).
Dual diagnosis is a relatively new term to describe an individual with a drug dependency and an underlying behavioral health disorder.
According to a study funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), about 23 million Americans suffer from some form of a co-occurring disorder associated with a substance use disorder (National Institutes of Health, 2015). These comorbid disorders are considered dual-diagnosis disorders, and the survey reveals that most of these disorders are left untreated.
People with mental illnesses are twice as likely as the rest of the population to engage in substance abuse. At the same time, people who struggle with substance abuse are also more likely to develop a mental illness or behavioral disorder. It’s an accepted fact that mental illness can lead to substance abuse and that addiction can cause other mental illnesses.
Dual diagnosis is far more common now than it used to be. At one point, mental illness and addiction would be treated as separate conditions. A person with depression or bipolar disorder would be referred to a behavioral health facility.
Someone addicted to alcohol or drugs would be referred to an addiction rehab center. The problem with this approach is both conditions often did not receive adequate treatment.
For example, a patient in rehab might be discharged for not responding to treatment due to their mental disorder. Meanwhile, a person in a behavioral health facility might be prescribed medication to treat their disorder, but their addiction to drugs or alcohol ends up interfering.
It’s easy to see why both conditions are now treated at the same time as co-occurring disorders at most addiction treatment centers.
Co-occurring disorders of addiction and behavioral health issues often have overlapping symptoms. Only a behavioral health professional can make an accurate determination on the nature of the behavioral health issue occurring alongside addiction. However, there are some questions you can ask yourself or a loved one if you suspect the presence of co-occurring disorders.
Do you have a history of mental illness in your family? If you have family members diagnosed with mental illness, you’re more at risk. All mental illnesses have a genetic aspect along with other factors.
Can you remember the last time you felt happy or satisfied with life without using drugs or alcohol? Think back to before you started using drugs or alcohol. Were you happy or unhappy? If you can’t remember being happy before substance abuse, you may have an underlying mental illness.
Did you start using drugs or alcohol to overcome negative feelings? If you started using drugs or alcohol to cope with stress, anxiety, or depression, this might indicate the presence of an underlying behavioral health issue.
Have you experienced trauma in the past? Trauma increases your risk for mental illness and addiction, especially in your early years. Trauma alters brain chemistry and causes people to experience undue stress daily.
Untreated addiction and behavioral health disorders usually make each other worse and make treatment more difficult.
A dual diagnosis has to be done by a professional. However, here are some signs of substance abuse:
The sign of a mental disorder can be hard to understand, especially when a person shows symptoms of drug abuse. However, here are some of the characteristics to look out for in mental disorders:
If you already suspect a loved one is using drugs, try and keep track of the symptoms listed above. If the individual shows three or more of these symptoms, an integrated treatment program can help.
Clients are often treated for one disorder while the other one goes undetected. Several major factors contribute to the treatment of one without the other:
Diagnosing a person with Co-Occurring Disorders of Substance Abuse and Behavioral Health Disorders can be difficult. The symptoms of a behavioral health disorder can be enhanced or masked by a substance use disorder. Depending on the particular behavioral health disorder and the substances being used, a person’s symptoms can be present as very atypical compared to other people with a similar diagnosis.
Denial often plays a large role in clouding a diagnosis. A person who has become dependent on drugs or alcohol will typically minimize the effect that the addiction has on their life and well-being. Similarly, many behavioral health disorders carry an unfair stigma that can lead a person to ignore or hide their issues.
At dual-diagnosis treatment centers like New Method Wellness, individuals with substance use disorders receive client-centered integrated treatment in the context of their co-occurring behavioral health disorder. Listed below are some common treatment approaches used for various comorbidities:
Major depression is the most common co-occurring disorder associated with drug and alcohol addiction. Clinicians must differentiate between depressive episodes induced by substance use versus depressive episodes that were not caused by another medical condition, psychiatric illness, or chemical dependency.
The high prevalence of major depression and substance use disorder is such that treatment of these disorders is imperative; the integrated treatment model used in dual diagnosis treatment centers is critically important for individuals with this comorbidity.
Also known as manic depression, bipolar disorder is characterized by extreme swings between manic episodes (highs) and depressive episodes (lows) and is generally categorized into Bipolar Disorder 1, Bipolar Disorder 2, Cyclothymic Disorder, Rapid-cycling, and “Mixed features.”
Integrated group therapy is a common treatment approach for individuals who have substance use disorder and bipolar disorder.
Substance-induced ADHD and primary ADHD share symptoms that are strikingly similar, such as impulsivity, impaired concentration, and hyperactivity. Due to the symptomatic overlap, clinicians within dual diagnosis treatment centers are very conservative about their pharmacological approach to addiction treatment.
To assess whether ADHD is the primary disorder in a client, practitioners generally treat the substance use disorder first before making a clinical diagnosis after a period of abstinence.
Various anxiety disorders, such as post-traumatic stress disorder (PTSD), generalized anxiety disorder (GAD), and panic disorder, have been associated with substance use disorder.
In dual diagnosis treatment centers, clinicians use psychosocial interventions in integrated treatment models to target maladaptive learned behaviors such as avoidance, which is very common among individuals with some form of anxiety disorder and substance use disorder.
Post-Traumatic Stress Disorder (PTSD) and addiction can form a powerful and often tragic relationship within an individual. If these patients do not receive concurrent, integrated treatment for their dual diagnosis, they may repeatedly relapse. Studies suggest that as many as 46% of individuals with lifetime PTSD also have a comorbid disorder with Substance or Alcohol Use Disorder.
Like many dual diagnoses, the root of this connection lies with a desire to self-medicate to soothe the symptoms of PTSD. The desire to use drugs and alcohol to overcome intrusive thoughts and re-experiencing symptoms like flashbacks and bad dreams make unraveling these conditions especially complicated.
These are only some of the disorders that are accompanied by drug dependency. You might be wondering if drug dependencies cause these disorders or if a mental disorder is what causes addiction.
For starters, many people with depression will begin to use drugs or alcohol to relieve their symptoms. Unfortunately, over time, this routine causes the mind and body to become dependent on the drug. When dependency occurs in the body, higher levels of depression also begin. In other words, to keep up with the brain’s dependency, the person has to use their choice of drug in higher volumes.
When the brain is not met with these new standards, depression gets worse. Overall, dual diagnosis is like a cat-and-mouse game. The more the person uses, the more depressed they become. That’s why an integrated treatment approach is essential. These programs not only treat the addiction, but they also treat the underlying causes.
A common question for dual diagnosis treatment is: Which one of the co-occurring disorders should be treated first? Addiction is a mental illness, but often the underlying causes of it are due to another behavioral health issue. Many people with undiagnosed behavioral health issues turn to substance abuse as a form of self-medication. Substance abuse eventually leads to addiction.
For example, someone with anger issues or high anxiety might decide to use opiates as they have a calming and sedative effect. Someone with depression might choose stimulant drugs like cocaine or amphetamines in order to feel more energetic and alive. These people might feel like they’re helping themselves by countering their symptoms. Unfortunately, drug abuse or alcohol abuse eventually makes these symptoms worse.
Behavioral Health and addiction are ultimately two sides of the same coin. Integrative therapy after a dual diagnosis means that behavioral health is addressed during and after physical treatments for substance abuse, such as detox. Even when a person’s body is freed of the addictive substance, the underlying reasons for the addiction still remain. If the underlying reasons include undiagnosed mental illness, then that is the next step of behavioral health treatment.
Sometimes people become addicted to drugs or alcohol without prior mental illness, but they may still need therapy to address the trauma or stress that led them to substance abuse.
Dual diagnosis treatment has a myriad of benefits. When both comorbid disorders are taken into account, this treatment model reduces the likelihood of homelessness, suicide, premature death, and incarceration (SAMHSA, 2016). Not only does it reduce the negative consequences of under-treated disorders, but it also lowers the cost of treatment and optimizes outcomes.
A team of interdisciplinary licensed professionals often works together to assist clients in recovery. Addiction therapists work with social workers who are often on the front lines working with persons suffering from substance use disorders. Through a collaborative network, social workers refer clients to the best dual diagnosis treatment centers for further treatment. (3)
Getting an individual to a behavioral health and addiction treatment center can be a challenge. However, if an individual is open to getting help, here are some steps you could take to ease them into the idea.
Getting an individual to a dual diagnosis treatment center can be a challenge. However, if an individual is open to getting help, then here are some steps you could take to ease them into the idea. If this is the case for you, stay patient. Of course, it would help if you did not push the individual into doing anything they’re not ready for. However, you can encourage them without being too pushy.
For example, you could voice your concerns to the person without using derogatory words. Please do not blame the individual for any wrongdoings; instead, encourage them to become better people.
If the individual struggles with mental illness, relay to them that behavioral health treatment can help solve these underlying issues. Therefore, they won’t need to use drugs to cope. All in all, remember to be kind and gentle when speaking to an individual struggling with a dual diagnosis.
Handpicked by Dr. Phil, New Method Wellness is a premier dual diagnosis addiction treatment center dually accredited by The Joint Commission. It has been singled out as one of the best drug and alcohol rehab centers in America, offering a unique 3:1 staff-to-client ratio that pairs every client with two therapists instead of one.
At New Method Wellness, we add another dimension to dual diagnosis treatment, and that is the integration of holistic therapy, such as massage/acupuncture therapy, equine therapy, and art therapy. As addiction therapists and substance abuse counselors work with clients to treat the substance use disorder and the co-occurring illness associated with it, holistic therapy adds meaning to life after treatment and sustains long-term recovery. Our 3:1 staff-to-client ratio ensures client success after treatment, as evidenced by our Extended Aftercare program.
For more information about New Method Wellness’s treatment programs, call 866-951-1824!
Deanna Crosby is a Licensed Marriage and Family Therapist (LMFT) with over 20 years of experience working with clients in recovery. Her expertise has catapulted her into the spotlight. Featured on several episodes of the Dr. Phil Show as a behavioral health expert, DeAnna is a routine contributor for NBC News, The Huffington Post, Elle Magazine, MSN, Fox News, Yahoo, Glamour, Today, and several other prominent media outlets.
After receiving her bachelor’s degree from the University of California in Irvine, Crosby did postgraduate work at Centaur University where she graduated at the top of her class with a CAADAC certification in Centaur’s chemical dependency program. Following her time at Centaur, Crosby received her Master of Counseling Psychology degree from Pacifica Graduate Institute, where she also attained a Doctoral Degree in Depth Psychology.
From all of us at New Method Wellness co-occurring treatment center, we wish you peace and serenity in knowing that you or your loved one will get the necessary help.
ACCREDITED BY:
(1) Center for Substance Abuse Treatment. Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs. Rockville (MD): Substance Abuse and Behavioral Health Services Administration (US); 2005. (Treatment Improvement Protocol (TIP) Series, No. 43.) Chapter 12. Treatment of Co-Occurring Disorders. Available from: https://www.ncbi.nlm.nih.gov/
(2) Minkoff, Kenneth (2006). An Integrated Treatment Model for Dual Diagnosis of Psychosis and Addiction. Psychiatric Services https://doi.org/
(3) Kelly, TM & Daley DC (2013) Integrated Treatment of Substance Use and Psychiatric Disorders. Soc Work Public Health. 2013; 28(0): 388–406. doi: 10.1080/19371918.2013.774673
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