Dual Diagnosis: The Overlap Between Addiction and Mental Health Disorders
Updated on September 7, 2021 by Amber & The Team
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Addiction and mental health disorders are inextricably intertwined. Data from JAMA (the Journal of the American Medical Association) shows that 50% of individuals suffering from serious mental health disorders also have a substance use disorder. From the same data, we see that 37% of alcohol abusers and 53% of substance abusers also present with one or more serious mental health conditions. Conversely, of all those diagnosed with a serious mental health disorder, 29% also abuse alcohol, drugs, or both.
If you are experiencing either alcohol use disorder or substance use disorder at the same time as a mental health condition, this is known as a dual diagnosis or co-occurring disorder. In the United States, over 9 million adults have a dual diagnosis.
Even more disturbingly, this figure is merely scratching the surface of a problem that’s damaging for individuals, families, and society more broadly. Many people self-medicating with drink or drugs have no idea they also have an underlying mental health condition. Many others abuse alcohol, prescription medications, or illegal drugs without ever being diagnosed with a substance use disorder.
Dual Diagnosis: The Overlap Between Addiction and Mental Health Disorders
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What Is Dual Diagnosis and Why Should You Care?
Given the confusion surrounding dual diagnosis and the closely linked nature of mental health issues and substance abuse, it’s not surprising so many people fly under the radar.
Comorbidity is the umbrella term for more than one simultaneous illness. In the case of a co-occurring disorder, this is a very specific form of comorbidity with a simultaneous substance use disorder and mental health condition.
A dual diagnosis can encompass a broad sweep of substance abuse, including addictions to:
- Prescription medications
In the same way, those suffering from a dual diagnosis present with mental health conditions including:
- GAD (generalized anxiety disorder)
- PTSD (post-traumatic stress disorder)
- Panic disorder
- Bipolar disorder
- OCD (obsessive compulsive disorder)
In the event of a dual diagnosis, it could be the mental health condition that first develops, or it could be the substance use disorder. There are almost infinite permutations of a co-occurring disorder, with no two cases exactly alike.
Fortunately, while unpacking two interlinked conditions like this is challenging, with the right dual diagnosis treatment program, full and sustained recovery is perfectly possible.
How can you tell, then, if you might have a dual diagnosis?
How to Recognize a Co-Occurring Disorder
Whether you’re looking for signs of a dual diagnosis in yourself or in a loved one, it can be tough to pick up on this nuanced issue.
Teasing out the symptoms of a substance use disorder or alcohol use disorder and differentiating them from the symptoms of a mental health condition can be tough. Also, the signs and symptoms of substance abuse vary dramatically depending on the substance being used. The symptoms of anxiety co-occurring with crack cocaine addiction will differ significantly from the symptoms of alcohol abuse and depression.
Common Markers Signifying The Possibility Of a Co-occurring Disorder Or Dual Diagnosis
Ask Yourself These Questions
- Do you turn to drink or drugs when you want to counter unpleasant thoughts and feelings? Do you use substances to control your moods or to deal with pain?
- Have you detected a relationship between the way you abuse substances and your mental health? For example, do you feel depressed after drinking? Or perhaps you drink because you are feeling depressed?
- Do you have a family history of alcohol abuse, substance abuse, or mental health issues?
- Are you often depressed or anxious, even if you’re sober?
- Have you sought treatment for either a mental health disorder or a substance use disorder? If so, did complications from one of these conditions lead to treatment failing?
Common Signs Of Addiction
There are some common signs that indicate the use of alcohol or substances could have strayed into alcohol use disorder or substance use disorder. If you are concerned about your use of drink, drugs, or prescription medications, assess yourself against the following:
- You feel you should cut down on your intake of alcohol or drugs;
- Your substance use has created problems at home, work, or school;
- You have experienced legal issues as a result of substance use;
- After using drink or drugs for some time, you find yourself needing more to achieve the same effect;
- You have tried to cut back or quit without success;
- If you use prescription medications, you use more than prescribed;
- You find yourself lying about how much you drink or use drugs;
- Friends and family have expressed concern about your substance use;
- You feel increasingly ashamed about your drug use or drinking.
While none of these signs mean you are addicted to drinking or drugs, if you feel several of these scenarios apply to your intake of drink or drugs, it’s worth scheduling an appointment with your healthcare provider.
Which Comes First, The Mental Health Condition or The Substance Use Disorder?
The fact that mental health disorders and substance abuse are closely linked does not mean that one necessarily directly causes the other. While the issues undeniably feed into each other, apportioning blame is not that straightforward.
We know that abusing substances like meth and marijuana can trigger sustained psychotic reactions. It is also widely accepted that alcohol can inflame the symptoms of both depression and anxiety disorder.
Despite this, for many people struggling with the debilitating symptoms of mental health conditions, self-medicating with drink or drugs is commonplace. While self-medicating is a popular strategy, it’s also wildly ineffective. In the short term, drink or drugs often relieve the symptoms of anxiety or depression. They do nothing, though, to address the root cause. Beyond this, substance abuse will almost inevitably aggravate the symptoms you are trying to soothe, leading to a vicious cycle with the added complication of a substance use disorder.
Another disturbing knock-on effect of substance abuse is the way it heightens your risk of developing a mental health disorder. Again, it’s too simplistic to claim that alcohol or drug abuse directly causes depression and anxiety. Mental health disorders come about through a complex interplay of genetics, social, and environmental factors. It’s clear that for some people already at risk of mental health problems, substance abuse can be the tipping point. To illustrate this, there is some evidence suggesting that heavy marijuana abuse can heighten the risk of schizophrenia, while those abusing opioid painkillers are known to be at increased risk of depression.
Abusing drugs can also exacerbate the symptoms of an existing mental health condition, sometimes even triggering new adverse symptoms.
Ultimately, much more important than what came first is how dual diagnosis can be most effectively treated.
What Is The Most Effective Dual Diagnosis Treatment?
Research shows that the most effective approach to treating dual diagnosis is to adopt a fully integrated approach.
When both the substance use disorder and mental health condition are treated simultaneously, you’ll maximize your chances of beating both the issues plaguing you and holding you back.
Given the wide range of variables, there is no boilerplate treatment program for dual diagnosis. Everything must start from an accurate diagnosis, from which point you’ll be better positioned to formulate a personalized treatment plan.
What To Expect In Your Dual Diagnosis Treatment
Before anything, you’ll need to detox from drinks or drugs. Often, FDA-approved medication is prescribed to help you cope with withdrawal symptoms and cravings. This typically takes place in a residential setting so you’ll benefit from professional medical support on-demand.
With your body purged of toxins, you’ll be ready to engage with treatment properly. This can take place in a residential treatment center, or as part of an outpatient treatment program.
Depending on the scope and severity of your addiction, you may continue with medication-assisted treatment if appropriate. The same applies to your mental health condition. Antidepressants and anti-anxiety medication can be a powerful component of an integrated treatment plan.
Alongside any medication deemed appropriate, a range of psychotherapies can be used to minimize your chances of relapse while strengthening your commitment to recovery.
- With evidence-based psychotherapy like CBT, you’ll learn how to identify the people, places, and things that trigger cravings for drinks or drugs. When applied to mental health disorders, CBT can help you to identify the flawed thinking that leads to poor behaviors.
- There are also other therapies like DBT (dialectical behavioral therapy), MI (motivational interviewing), and CM (contingency management) that can all be effectively applied to treating dual diagnosis.
To maximize your chances of sustained recovery, you need to stick rigidly to your treatment plan. In the event of relapse, liaise closely with your treatment provider. View this as a blip rather than the end of the road, and double down on treatment to get back on track.
Beyond formal treatment for dual diagnosis, though, there is much you can do to help yourself. We’ll round out today with some actionable tips on self-medicating the healthy way, and without relying on substances.
How to Help Yourself Through a Dual Diagnosis with Proper Self-Care
Often, drug and alcohol abuse is triggered by misguided efforts to manage stress. Life ebbs and flows, and stress is an inevitable occurrence.
By better learning how to cope with stress without resorting to a chemical crutch, you should avoid your triggers for substance abuse, even if you’re faced with strong cravings.
- Implement the theory you learn in CBT sessions in the real world. Practice makes perfect.
- Also, consider making some rudimentary lifestyle tweaks. Start the day with a healthy breakfast and eat small meals frequently throughout the day. Eat as many whole foods as possible while limiting your intake of processed foods. Aim for five portions of fruits and veggies daily. If you find this hard to achieve, consider juicing or making a smoothie. Drink water throughout the day to stay hydrated.
- Exercise for at least thirty minutes daily to keep fit and improve your mood.
- Incorporate relaxation techniques into your lifestyle, including yoga and mindfulness meditation.
- Make sure you get the right quantity and quality of sleep.
Making these simple changes to your lifestyle can dramatically improve your mood and state of mind, while making you fitter, stronger, and healthier at the same time.
While a co-occurring disorder might seem intimidating, if you stop self-medicating with drink or drugs, commit to the right dual diagnosis treatment program gives you the strongest chance of achieving sustained sobriety and sound mental health.
Under no circumstances leave a dual diagnosis untreated. Both problems will get worse. Instead, take action and reclaim the life you had stolen by addiction and mental health issues.
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