Sometimes when someone is deeply addicted to a substance, it is either a cause or a symptom of one or more underlying mental health issues. This condition is referred to as co-occurring disorders or a dual diagnosis. It’s not always the case where the mental health disorder appears first, but it’s almost indefinitely true that alcohol and drug addiction tends to exacerbate mental health problems.
For rehabilitation to be successful in these cases, it’s crucial that both be treated simultaneously. This typically takes a long time and is much more extensive than a normal addiction treatment plan.
How common is dual diagnosis?
Dual diagnosis situations are quite common. A 2014 Substance Abuse and Mental Health Services Administration (SAMHSA) report on drug use revealed that 7.9 million American adults have co-occurring disorders, with a slight majority of these being males.
In general, people with mental illnesses are more likely to become addicted to drugs because they may be more biologically prone to self-medicating – either to feel “more” or feel “less.” Some use it to comfort themselves and connect with others; others use it to numb chronic emotional pain.
The basic idea behind this is that people who have mental illness may already have a chemical imbalance which leads to feelings like anxiety or depression, or to certain types of behavior, and the seemingly “positive” effects of the drugs are felt deeply, but of course only temporarily.
Chronic use of any drug has the potential to exacerbate psychological symptoms as well as increase the chances of psychotic behavior in the most extreme cases.
Mental Health and Addiction
Mental illness often leads to substance abuse because essentially a person, whether they know it or not, is often trying to “treat” their illness via the substance. For instance, if they feel social anxiety, they may feel that using alcohol makes them feel less inhibited.
Sometimes people may already have diagnosed mental health conditions which they are taking prescription medication for, and they turn to drugs to manage the side effects of medication. For instance, those with schizophrenia may smoke marijuana to handle depression that sometimes comes alongside prescribed drugs for the disease.
On the other hand, it’s also possible for the drugs themselves to cause mental illness because they change the structure of the brain and the way the brain naturally regulates mood. So someone who does not have a mood disorder and repeatedly turns to a drug like ecstasy, which can alter serotonin levels, may face depression or anxiety after long-term use.
People who are exposed to drugs and alcohol before their brain is fully developed also may be predisposed to addiction.
Most major psychiatric disorders will be worsened via regular drug and alcohol use, but alcohol and drug abuse may also prompt the emergence of latent symptoms. It can also temporarily mask symptoms which are then revealed in later phases of addiction. Even withdrawal can prompt severe psychological symptoms that may be a part of a bigger issue.
Common Co-occurring Disorders
Certain co-occurring disorders are more common than others. Here are a few examples.
Alcoholism is often accompanied by drug addiction, Schizophrenia, Bipolar disorder, and Antisocial Personality Disorder (APD) as reported by the National Institute on Alcohol Abuse and Alcoholism. APD describes a disorder where people behave in such a way where people disregard the feelings of those around them, and at its most severe is sociopathic.
Cocaine and anxiety often exist together, since cocaine can give the user a feeling of confidence. But over time, cocaine use tends to make anxiety worse, resulting in symptoms like paranoia and even violence.
Opioids and PTSD are two more that tend to go hand-in-hand. Veterans, in particular, are in a high-risk category for this type of co-occurring disorder.
Heroin addiction can actually lead to long-term, permanent depression because it changes the way the brain regulates moods. Basically, the brain becomes dependent on the opioids to produce certain neurotransmitters. This also is the case for other types of drugs.
Why Dual Diagnosis can be Hard to Treat
Sometimes these cases are extremely difficult to treat, even for the most experienced professionals. This is because addiction and mental health can have complex relationships, with each influencing the other in ways that will vary from patient to patient.
In this way, medical professionals may not know whether a mental health symptom is exacerbated by the addiction or vice versa. This is why it often requires extensive and integrated inpatient treatment plan.
The point of dual diagnosis treatment is highly specialized in that it is set up to manage each issue separately, taking into account the treatment of the initial health issue first. Where it used to be that the addiction was managed first, professionals now realize that it’s often the underlying mental issues that make people more likely to use, so addressing mental health is key.
Anyone going into dual diagnosis treatment has a thorough understanding of how each disease must be treated separately but concurrently, and this often involves the use of medication such as antidepressants. Treatment should take a supportive and compassionate approach and be inclusive of loved ones.
It’s important that people with co-occurring disorders be treated via an integrated channel that offers extensive and detailed care in a facility with the capacity to address all angles of these often-complex cases. Typically, this means long-term residential care.
If you or someone you love is dealing with mental health issues or you suspect that this may be the case, it’s crucial that they get in touch with a dual diagnosis treatment center as soon as possible.