It’s difficult to have a substance use disorder or a mental illness. Having both at…
Dual Diagnosis: Everything You Need to Know
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It isn’t easy to live with addiction or mental illness. Life is challenging enough on its own. So it’s even more difficult to try to navigate life while managing symptoms of a psychiatric disorder or without turning to the thing you’re addicted to. Now imagine living life with both addiction and mental illness. That’s what people who have a dual diagnosis have to work through every day.
They have to manage the symptoms of their mental illness without turning back to the substance or behavior they used to use for relief. Thankfully, dual diagnosis-focused treatment facilities exist. These locations treat both mental illness and addiction simultaneously to achieve the best results.
What exactly is dual diagnosis disorder? How do you know if you qualify as having the condition? What can you do to treat dual diagnosis? Can it be cured? Continue reading to learn everything you need to know about dual diagnosis.
What is Dual Diagnosis Disorder?
Dual diagnosis disorder describes a person who lives with both addiction and a mental health disorder. There are no requirements for the specific types of addictions or psychiatric disorders a person must have to receive a diagnosis. They qualify for the condition as long as they experience both simultaneously.
In terms of dual diagnosis conditions, addiction doesn’t necessarily refer to only substance or alcohol use. They may struggle with their drug or alcohol use, or they might have another type of behavioral addiction such as:
Similarly, any kind of psychiatric disorder can qualify someone for a dual diagnosis. Common conditions seen in individuals with dual diagnosis include:
- Major depressive disorder
- Generalized anxiety disorder
- Post-traumatic stress disorder
- Bipolar disorder
- Obsessive-compulsive disorder
- Borderline personality disorder
- Panic disorder
Additionally, co-occurring disorders is another name used to refer to dual diagnosis. Dual diagnosis was the original term used to describe the condition. Co-occurring disorders are a newer term but they’re often used interchangeably today.
Some people also use the term comorbid disorders when talking about dual diagnosis, but comorbid disorders are more generic. They refer to any combination of physical or mental disorders or diseases. Dual diagnosis and co-occurring disorders refer to addiction and psychiatric disorders specifically.
Definition of Dual Diagnosis
There is no requirement for which disorder comes first when diagnosing someone with dual diagnosis. Clinicians usually don’t consider whether their client’s mental illness or addiction came first when diagnosing them.
For example, some people turn to substances or sex as a way to cope with the symptoms of their mental illness. Those who eventually develop an addiction to their coping mechanism then qualify as having co-occurring disorders.
Another example is people who drink heavily or use large amounts of substances. Excessive drug and alcohol use sometimes lead to lasting psychiatric disorders, which qualifies the user for a dual diagnosis.
Regardless of which disorder came first, dual diagnosis is a serious condition. It’s difficult to live with and it’s also difficult to treat. While clinicians don’t consider which disorder came first while diagnosing a client, it sometimes helps to know when treating them.
There are both addiction treatment facilities and mental health treatment centers. Some facilities offer dual diagnosis treatment that specializes in working with these types of clients. What does it mean to have a dual diagnosis, though?
What Does It Mean to Have a Dual Diagnosis?
Ultimately, addiction and mental illness or psychiatric disorder must be present for someone to be diagnosed with a dual diagnosis. Dual diagnosis is a serious condition because both mental illness and addictions are difficult disorders to cope with on their own.
Treating addiction and mental health cannot be covered by a one-size-fits-all treatment approach. There are some practiced methods for working with specific types of conditions, though. But the wide range of disorders covered by dual diagnosis makes it an extremely complicated condition to work through.
Some people believe their addiction helps them manage their mental health condition. They find relief from their symptoms in drugs, alcohol, gambling, or other behaviors. In reality, though, their addiction only makes the symptoms of their disorder worse.
It might help them over the short-term but it creates a vicious cycle of worsening symptoms and deeper addictions. This cycle, although harmful, becomes a normal way of life and becomes increasingly difficult to escape from as time goes on.
How Common is Dual Diagnosis?
The Substance Abuse and Mental Health Services Administration (SAMHSA) conducts annual surveys to gather data on substance use and mental health nationwide. They compile their findings into the National Survey on Drug Use and Health (NSDUH).
The survey offers a look into the prevalence of many disorders, including co-occurring disorders that involve substance use disorder specifically. In 2018, there were 46.7 million adults throughout the United States aged 18 and older who lived with some type of mental illness. Additionally, 19.3 million adults lived with an active substance use disorder that same year.
9.2 million of those adults had both a mental illness and a substance use disorder, or dual diagnosis. In other words, 3.7 percent of the adult population in the United States has co-occurring disorders. These numbers are similar to the results from the 2017 NSDUH but higher than those in 2015 and 2016. The rates of dual diagnosis among specific age groups are:
- 2.4 million between the ages of 18 and 25 (or 7.2 percent of this population group)
- 5.0 million between the ages of 26 and 49 (or 5.0 percent of this population group)
- 1.7 million ages 50 and older (or 1.5 percent of this population group)
It’s alarming to see that rates of mental illness, substance abuse, and dual diagnosis are rising. Hopefully, the upcoming report for 2019 will reveal the trend declining. Until then, there is a growing need for specialized dual diagnosis treatment facilities to help these individuals.
Why is Dual Diagnosis Important?
People with dual diagnosis differ from those who have only addiction or mental illness. That isn’t to say addiction and mental health disorders are not difficult diagnoses to live with. But co-occurring disorders compound on one another and make life even more challenging.
Living with both addiction and mental illness often results in a complicated cycle of symptoms and addictive behaviors. People turn to their addiction of choice to relieve or distract from the symptoms of their mental illness. This may help in the short-term but it tends to lead to more symptoms as time passes.
Dual diagnosis needs to look at a person’s addiction and mental illness both individually and cohesively. Clinicians cannot only treat their conditions separately or together as a co-occurring disorder. Effective dual diagnosis treatment requires an individualized treatment plan that addresses each aspect of a person and their conditions.
You start to realize the importance of a specific diagnosis for people with co-occurring disorders as you understand the intricacies of the condition. It’s important to address these specific individuals rather than grouping them in with people who have only one part of dual diagnosis.
Which Disorder Came First: Mental Illness or Addiction?
When diagnosing a person with co-occurring disorders, clinicians do not look at whether mental illness or addiction came first. All that is necessary is the active presence of both conditions. If they simultaneously have an addiction to something, as well as a mental illness, they qualify as having dual diagnosis.
Treating someone with a dual diagnosis is different, though. It’s important to know which disorder came first when creating a treatment plan because the order affects how clinicians should work with the client.
People who start with a mental illness and develop an addiction require a different approach than those who developed a mental illness from their addiction. But both require separating the person from substances to more accurately determine which disorder came first.
Clinicians cannot provide effective treatment until they know the extent of a client’s mental illness. Some experience relief from their mental illness symptoms after separating from their addiction. Others are forced to face the symptoms of their mental illness without turning to the solution they used before treatment.
Again, though, there is no requirement for mental illness or addiction to come first. If someone experiences both conditions they will benefit from specialized dual diagnosis treatment.
Dual Diagnosis vs. Co-Occurring Disorders
Dual diagnosis was the original term used to describe people with simultaneous addiction and mental illness disorders. Co-occurring disorder is a newer term than dual diagnosis but the two are now used interchangeably.
Some claim co-occurring disorders refer to those who developed mental illness as a result of their addiction. According to the National Alliance on Mental Illness, though, dual diagnosis and co-occurring disorders both refer to the presence of simultaneous illnesses.
Comorbidity is another word used to refer to dual diagnosis or co-occurring disorders. This term is more general, though, and doesn’t specifically refer to someone with mental illness and addiction.
Instead, comorbidity refers to a person who experiences two disorders or illnesses at the same time. While dual diagnosis and co-occurring disorders refer to addiction and mental illness, comorbidity does not refer to any particular kinds of illnesses or disorders.
Dual Diagnosis vs. Comorbidity
Sometimes people use the word comorbidity to refer to people with dual diagnosis. Unlike dual diagnosis or co-occurring disorders, comorbidity is not as specific of a term. Dual diagnosis and co-occurring disorders only describe someone with an addiction and mental illness. Comorbidity, on the other hand, is a more general diagnosis.
Comorbidity describes the presence of any two or more disorders in the same person. They don’t necessarily have to be addiction or mental illness; the term covers many different kinds of disorders.
Still, even though it isn’t as definitive a disorder, comorbidity can be used to refer to people with co-occurring disorders. Comorbidity does cover dual diagnosis, or co-occurring disorders, underneath its umbrella. While it isn’t as descriptive as the two other diagnoses, it does imply that the conditions tend to worsen one another over time.
What Are Dual Diagnosis Issues?
It’s difficult to determine whether someone has dual diagnosis outside of a clinical setting. Sometimes it might seem like someone has both an addiction and mental illness when they really only have one or the other.
For example, what might look like mental illness may simply be the side effects of a drug or alcohol addiction. Clinicians are able to tell whether a person also has mental illness after they are separated from their substance of choice. There are also those who you might think only struggle with mental illness while they keep their addiction hidden from everyone.
Still, dual diagnosis causes many different issues depending on the specific type of mental illness a person has. Someone who has bipolar disorder will show different signs than someone with major depressive disorder. What are some of the most common dual diagnosis issues?
Depression is one of the most common mental illnesses in adults throughout the United States. The NSDUH revealed that over 7 percent of Americans ages 18 and older had a major depressive episode in the last year.
People with depression have a higher likelihood of developing a substance or alcohol use disorder. Some studies estimate as many as one-third of people who have depression also have a drinking or substance use problem as well.
Drugs and alcohol seem to provide relief from the sadness and hopelessness that are characteristic of depression. Over time, though, they only make the person’s depression worse and may lead to their developing an AUD or SUD, and dual diagnosis.
Generalized Anxiety Disorder
Many people feel nervous or worried before a presentation at work or a date. There are many situations where these feelings are normal. Generalized anxiety disorder, or GAD, is another level of anxiety, though. People with GAD have a difficult time navigating their daily lives as a result of severe and debilitating anxiety.
Drinking or using drugs might seem like an easy solution to relieving the overwhelming anxiety caused by GAD. It removes the person’s ability to learn to manage their symptoms on their own, though, which makes their anxiety worse over time.
Bipolar disorder is a complicated disorder on its own. There are two main types of bipolar disorder: Type I and Type II. The condition is comprised of manic episodes and depressive episodes that range in severity and length depending on the person.
It’s difficult to manage life with bipolar disorder, especially when it goes undiagnosed. About half of people with bipolar disorder turn to drugs or alcohol as a way to relieve their symptoms. This only leads to more extreme manic and depressive episodes, and it may cause someone to take more drastic measures.
Borderline Personality Disorder
Borderline personality disorder, or BPD, is a condition that describes people with a distorted self-perception, extreme emotions, impulsivity, and unstable relationships. People with BPD tend to have other disorders like anxiety or depression in addition to their borderline personality disorder.
BPD symptoms are overwhelming, erratic, and difficult to control, so the majority turn to drugs and alcohol for relief. Rates of substance and alcohol use disorder are high among individuals with BPD. An estimated two-thirds of individuals with borderline also struggle with their drug and alcohol use.
Post-Traumatic Stress Disorder
Post-traumatic stress disorder is a debilitating condition that results from unprocessed trauma. People who experience a traumatic event, from combat to assault, have a chance of developing PTSD.
Some people with PTSD turn to drugs and alcohol as a way of coping with their symptoms. Using substances is not a helpful way of dealing with PTSD, though, especially over a long time. The condition is a result of unhealed trauma and drinking or using drugs doesn’t work to heal the impact of that event.
Dual Diagnosis In Mental Health
Dual diagnosis and mental health go hand-in-hand. It’s difficult to pursue a path of mental wellness while living with active co-occurring disorders. It is imperative for people with dual diagnosis to seek treatment so they can address both their mental illness and addiction effectively.
If you have dual diagnosis that does not mean you’ll never find a path to wellness, though. You can learn to prioritize and work on your mental health with proper intervention and treatment. It requires consistent and intensive work but you can escape the cycle of mental illness symptoms and addiction.
Dual Diagnosis Issues | Infographic
Dual Diagnosis and Substance Abuse
The key aspect of dual diagnosis is the presence of substance abuse. If someone has a mental illness that co-exists with any other condition aside from addiction, they do not have a dual diagnosis. Substance abuse makes the difference between someone with co-occurring disorders and someone who only has a mental illness.
There is no requirement on which type of substances a person must abuse. They may struggle with alcohol, opiates, heroin, cocaine, psychedelics, or any other kind of substance. As long as they have an addiction to drugs or alcohol, they qualify as having a dual diagnosis.
What qualifies as substance or alcohol use disorder? The Diagnostic and Statistical Manual of Mental Disorders outlines the 11 common symptoms seen in those with a drug or alcohol use disorder:
- Drinking or using larger quantities or for a longer time than initially intended.
- Wanting to stop or cut back on drinking or using drugs but not being able to.
- Spending a lot of time drinking or using drugs, or being sick as a result of it.
- Finding that drinking or using drugs, or being sick as a result, interferes with daily responsibilities at home, work, or school.
- Continuing to drink or use drugs despite the problems it causes.
- Cutting back on or giving up activities that were once important in order to drink or use drugs.
- Getting into risky or dangerous situations as a direct result of drinking or drug use.
- Continuing to drink despite the development or the worsening of physical or mental health problems.
- Needing to drink or use more in order to achieve the desired effect.
- Continuing to drink or use even if it’s causing problems with family or friends.
- Experiencing withdrawal symptoms when the effects of the drugs or the alcohol wear off.
If someone has a mental illness and their drinking or drug use fits some of the categories above, they likely have co-occurring disorders. What are some different examples of dual diagnosis and substance abuse?
Dual Diagnosis and Alcohol Abuse
Alcohol is a substance that many people turn to for relief. Plenty of people have a drink in the evening to relax after a long day. It’s widely accessible, available at almost every grocery store, convenience store, and restaurant you walk into.
Now imagine living with the stress you experience at the end of a long day constantly. Although the symptoms of mental illness differ depending on the specific condition, the resulting difficulties and stress they cause are essentially universal.
Sometimes these individuals use alcohol as a quick and easy way to cope with symptoms of mental illness. It helps them mask their struggles and escape from the pressure of their condition for a few minutes or hours at a time. And it’s easy for alcohol use to shift from casual drinking and into the disordered territory without realizing it right away.
It might seem like drinking is a great way to manage their symptoms or avoid thinking about their condition. All it does, though, is place a band-aid over the issue and potentially lead to a bigger problem.
If you have a mental illness, drinking alcohol is not a long-term strategy for managing your disorder. Once you’ve started, though, your condition becomes a multifaceted problem to work on.
Dual Diagnosis and Drug Addiction
Dual diagnosis and drug addiction is the second combination of conditions. Drug abuse is not as common a problem as alcohol because drugs aren’t as easily accessible. But the problems that result from the combination of drug addiction and mental illness are often worse than those with alcohol.
For example, benzodiazepine and opiate abuse are two common drugs used by people who experience extreme cases of anxiety or depression. These substances provide calming, euphoric effects that relieve symptoms of anxiety and soften the edges of depression.
At surface level, it’s understandable why some people turn to drugs for relief from their mental illness. Substances offer a quick fix for a problem that may have plagued them for years of their life. Once they discover what appears to be a reliable solution, they lean wholly into it.
Although substances provide short-term relief, using these types of drugs leads to detrimental long-term effects on mental health. When someone turns to drugs as a way to relieve their symptoms, they aren’t really learning how to work through or live with their illness.
The longer someone uses drugs to avoid their illness the more difficult it becomes to heal it. And once they find themselves addicted to their substance of choice, they have an even more difficult problem to address.