Dual diagnosis is a peculiar situation, where two mental health problems are diagnosed at the same time for a patient. Patients who have dual diagnosis always suffer from psychological problems (psychosis) and substance addiction, such as drugs or alcohol. Dual diagnosis complicates the whole process of assessment, diagnosis, treatment & recovery.
A dual diagnosis condition can occur as a result of one or more of the following:
- A substance use disorder that results in a psychiatric problem
- A psychiatric problem that leads to or is associated with chronic alcohol or drug use
- The use of alcohol and other drugs which lead to the alteration of the course of mental illness.
PREVALENCE OF DUAL DIAGNOSIS
Dual diagnosis is common among people with severe psychiatric problems. Population health research points out that about 50% of people with critical mental issues are involved in alcohol and drug use.
Anxiety and depression are the most prevalent psychiatric disorders that co-occur with alcohol and drug misuse. The rates of drug abuse among psychotic patients are, however, higher.
CHARACTERISTICS OF DUAL DIAGNOSED PEOPLE
Mental illness and substance misuse are prevalent among young people across the universe, although it is not exclusive to them. People who are mentally ill are known to use alcohol and other drugs continuously or periodically.
Some people with mental illness can also use certain substances to reduce the symptoms or unpleasant effects of their medications. Psychotic patients are prone to have drug and alcohol issues.
The complexity and treatment of dual diagnosis can be affected by the following factors:
- Age of the individual
- The type of drug used
- The intensity and frequency of use
- The social and physical impacts of the co-occurring illness on the individual.
HOW TO MANAGE PEOPLE WITH DUAL DIAGNOSIS
There is a need to apply an integrated approach to the assessment and treatment of people with a dual diagnosis. It is necessary to respond positively to the needs of persons living with dual diagnoses while providing mental health and drug services.
This means that health practitioners must manage such individuals according to the illness they present through the use of a risk framework. Health providers must also understand the preferences of the patients and their relatives. To effectively manage people with dual diagnosis, staff need to undergo appropriate training.
WHAT ARE THE IMPACTS OF DUAL DIAGNOSIS?
There are several complex impacts of dual diagnosis on affected individuals. When people with a single disorder are compared with people with dual disorders, people with dual diagnosis have higher rates of:
- Anti-social behaviour
- Violence
- Suicidal behaviour
- Infections
- Systemic diseases and relapse
- Service use
- Incarceration
IMPORTANT FACTORS FOR MANAGEMENT
During the screening, treatment, and management of people with dual diagnosis, the following factors need to be taken into consideration:
- Young people who live with dual diagnoses are at higher risk of experiencing poor outcomes. This is because they become more vulnerable because of their age and physical, psychological, neurological, & social development.
- Aboriginal people who experience substance misuse are likely to face specific challenges with a dual diagnosis.
- Age, type, and pattern of drug and alcohol used should be observed in different social settings, gender, culture, and peer group.
Based on a survey by the National Survey on Drug Use and Health (NSDUH), 45% of people with drug addiction have a co-occurring psychiatric condition. A fulfilling, healthy life can be achieved by seeking treatment for co-occurring mental health disorders.
COMMON MENTAL HEALTH DISORDERS THAT CO-OCCUR WITH ADDICTION
There are quite a few mental health disorders that repeatedly co-occur with addiction. These mental health disorders usually lead to addiction; this is the basis upon which dual diagnosis is formed. This is the main reason why symptoms of psychiatric or behavioural disorder should not be ignored when it surfaces during a person’s long term addiction recovery plan.
The following mental health disorders have been linked to substance abuse:
- ATTENTION DEFICIT HYPERACTIVE DISORDER (ADHD): People with ADHD are usually more inclined to misuse or abuse certain substances to cope with their symptoms. Stimulants are generally prescribed to many people to treat their Attention-Deficit Hyperactive Disorder (ADHD). These stimulants are addictive and can make the individual develop a toxic pattern of substance abuse.
- BIPOLAR AFFECTIVE DISORDER: About 50% of people with Bipolar disorder also struggle with substance abuse. Self-medication is common among people with bipolar affective disorder. This can be linked to the temporary relief that is derived from the use of drugs and alcohol.
- BORDERLINE PERSONALITY DISORDER: Studies have shown that Borderline Personality Disorder (BPD) co-occurs with addiction. More than 70% of people with Borderline Personality Disorder have been addicted to certain substances at some point in their lives.
- DEPRESSION: 1 in 10 people suffer from depression. People with depression usually try to involve in self-medication with alcohol or drugs to relieve their symptoms. Unfortunately, self-medication only makes their condition worse. The crash that follows the high state can be really devastating for persons with pre-existing depressive conditions.
- EATING DISORDERS: This can be linked to intense feelings of inferiority. People who experience eating disorders always misuse drugs that suppress appetite.
- GENERALISED ANXIETY DISORDER: Generalised Anxiety Disorder (GAD) affects a large number of the population. Affected persons usually manage their symptoms by abusing alcohol and drugs. Benzodiazepines are prescribed medications for the treatment of anxiety disorders; they have also become substances of abuse.
- OBSESSIVE COMPULSIVE DISORDER: (OCD) involves the manifestation of unnecessary obsessions and compulsions, for instance, the need to clean the environment regularly, irrational phobia for dirt and germs. Anxiety and depression are commonly associated conditions experienced by people with OCD due to their involuntary behaviour. OCD can also lead to substance abuse.
- POST-TRAUMATIC STRESS DISORDER: In individuals with Post-Traumatic Stress Disorder (PTSD), the brain produces reduced amounts of a neurotransmitter called endorphins, consequently increasing the urge to take alcohol or drugs to feel happy.
- SCHIZOPHRENIA: This psychotic condition is characterised by delusion and hallucination. It is very complex to diagnose schizophrenia and addiction. This is because both conditions have the same clinical manifestations.
WARNING SIGNS OF DUAL DIAGNOSIS
The manifestations of dual diagnosis are not the same in individuals. The symptoms are dependent on the type of substance abused, and the severity of the co-occurring mental health condition. The following are the symptoms of a dual diagnosis:
- An abrupt change in general behaviour
- Neglecting personal and environmental hygiene
- Inability to manage daily tasks and responsibilities
- Refusal to comply with treatment
- Suicidal tendencies
- Poor performance at work and school
- Obsessive and compulsive behaviours
DANGERS OF SELF MEDICATION
Self-medication is one of the most common factors that contribute to the occurrence of dual diagnosis. Self-medication involves the consumption of alcohol or drugs to relieve the symptoms of mental health illness. These substances can lead to addiction which would consequently worsen the condition.
Some people attempt to self-medicate to get away from the symptoms of their mental illness; these scenarios explain it better:
- Using marijuana to relieve emotional pain caused by trauma and grief
- Excess consumption of alcohol to reduce anxiety in social situations
- Excessive consumption of benzodiazepines such as valium to curb panic attacks
- Inhaling cocaine for energy surge and increased motivation.
The sad news about self-medication is that the person will eventually build a tolerance to the drug and will have to consume a higher dosage to achieve the desired satisfaction. This harmful lifestyle will lead to dual diagnosis.
GETTING HELP FOR DUAL DIAGNOSIS
It is necessary to follow a tailored treatment plan to manage both mental health disorders and addiction simultaneously. It is best to treat dual diagnosis in a structured, safe inpatient rehab center.
It is ideal while visiting a patient in a rehab centre for the treatment of dual diagnosis because it requires a high level of care and attention. Most persons with dual diagnoses usually arrive at a rehabilitation center in distress and a poor state of health. The expertise of both mental health & addiction practitioners is required for effective management of patients with extensive substance abuse and psychiatric conditions.
Before you choose a rehab center for your treatment, you need to put certain factors into consideration to enjoy effective care. You should ask the following questions to make informed decisions:
- Are the treatment plans individualised for all residents?
- Is the available therapy structured for the treatment of dual diagnosis?
- Will a psychiatrist evaluate me before admission?
- Will my co-occurring disorders be regarded as interconnected mental health issues or as separate illnesses?
- Do you offer aftercare services?
- Do you handle relapse cases?
Once you get admitted into the inpatient rehab center of your choice, your treatment process will begin. Some therapies, medications & activities will be incorporated. You will also go through the group and individual therapy sessions.
