What is Dual Diagnosis?

Learn about dual diagnosis (co-occurring disorders), statistics, symptoms, and available treatment options.

Understanding Dual Diagnosis

Treating and managing a mental illness or substance abuse disorder can be quite complicated, especially when the disorder has existed for quite some time. Sometimes these conditions occur independently of one another; however, often, they have been commonly associated with each other, especially in terms of dual diagnosis.
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If you would like to learn more about what dual diagnosis is and the different causes, risks, and symptoms, read on in this article. Treatment options are always available for co-occurring disorders as well, and you can learn more about treatment with Essence Health and Wellness.

Dual Diagnosis

Questions About Treatment?

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Dual Diagnosis

Questions About Treatment?

Our team is standing by to address your questions. Your call is confidential and no obligation is required.

A Closer Look at Dual Diagnosis?

In simple terms, dual diagnosis is when an individual has a mental illness and a substance abuse problem at the same time.2 Generally, a dual diagnosis condition may include one of the following:

  • A mental health issue or disease that is linked to problematic drinking and substance usage
  • A drug abuse problem or condition that is linked to a mental health issue or disorder. 2
 
Dual diagnosis is a severe medical condition, and it should be treated as such. This is because the co-occurrence of these two conditions usually results in treatment complications and worsens the individual’s health condition. 2

Dual Diagnosis: The Link Between Mental Health and Addiction

Dual Diagnosis vs. Co-Occurring Disorders: What is the Difference?

Dual diagnosis and co-occurring disorders are two very similar yet quite different medical conditions. Due to their close similarity, they have been used interchangeably. Some people even consider one a more recent term with essentially the same meaning as the other. In both cases (dual diagnosis and co-occurring disorder), the individual is diagnosed with two medical conditions, usually a mental illness and a substance abuse problem. However, the main difference between these two conditions lies in the nature of the diagnosis. 3
In dual diagnosis, the diseases/conditions are treated as two separate medical conditions even though they may have the same cause. In co-occurring disorders, however, what happens is usually that one of these illnesses, over time and with the “right” conditions, leads to the other medical condition. As such, the two conditions are closely linked and must be addressed jointly. Generally, however, these two terms refer to the same thing, so they are commonly used interchangeably. 3

How Common is a Dual Diagnosis?

The co-occurrence of mental illness and substance abuse problems is quite common. A considerable body of evidence suggests that mental disorders are closely linked to drug use disorders. According to a population health study, individuals with serious mental health issues have high alcohol and drug usage rates (up to 50%). 4

Dual Diagnosis Statistics

There are some important facts to consider when analyzing the overall impact of dual diagnosis. Relevant facts include:
  • According to a national survey on drug use and health in 2018 by SAMHSA, 9.2 million individuals in the US have a co-occurring condition. 5
  • In Canada, estimates of co-occurring illnesses in persons with severe and chronic mental illness are considerably high (as high as 40-60 percent). 

What Comes First: Substance Abuse or Mental Health Issues?

Substance abuse and mental health disorders are very closely linked, and as such, they often co-occur. There are several reasons why this can occur, some of which include:
  • Certain illicit substances can trigger one or more symptoms of a mental health condition in users.
  • Mental illness (such as depression) can occasionally lead to the overuse of alcohol or drugs since some persons with mental illnesses utilize these substances as self-medication.
  • Substance abuse disorders and mental illnesses share several causative factors, including changes in brain makeup and early exposure to stress or trauma. 6

Co-Occurring Disorders: A Precursor for Substance Abuse?

Due to these reasons, it’s quite challenging, if not impossible, to say with any measure of certainty that substance abuse occurs before mental illnesses and vice versa in co-occurring disorders. However, it should be noted that people with substance abuse disorders are very likely to develop mental illnesses. The reverse is also the same since these two conditions have been known to serve as “precursors” for each other.

Introduction to Co-Occurring Disorders

Common Co-Occurring Disorders

As mentioned earlier, co-occurring disorders include both substance abuse and mental illnesses co-occurring. Some common dual-diagnosis disorders include the following.

Generalized Anxiety Disorder (GAD)

Generalized Anxiety Disorder is a mental health condition characterized by extreme, persistent worry over daily life events. People with GAD often exhibit increased irritability, have concentration problems, and are generally very restless. GAD can and is usually managed with medications such as benzodiazepines (e.g., diazepam and alprazolam), fluoxetine, etc. However, these medications have a high abuse profile due to their effects, so the possibility of developing a substance abuse disorder from this mental illness is somewhat high. 7

Schizophrenia

Schizophrenia is a severe mental illness that impairs a person’s ability to think, act and express emotions. It also affects an individual’s perception of reality. Those who suffer from schizophrenia struggle in society, education, and relationships. They are also usually withdrawn because they have lost contact with reality. All these factors make schizophrenia the most persistent and devastating of the major mental diseases, despite its rarity. 15

Depression

Depression is an emotional state majorly characterized by feelings of guilt, diminished self-worth, and inability to enjoy life. People with depression usually experience insomnia, reduced activity, low self-worth, and prolonged and intense feelings of sadness. The length of these feelings of sadness is what differentiates depression from simple sadness/grieving. 8

Bipolar Disorder

Bipolar disorder (also known as manic-depressive disease or manic depression) is a mental condition that makes people experience fluctuating mood swings (between depression and mania), causing attention problems and the inability to function properly. 9

Post-Traumatic Stress Disorder (PTSD)

Post-traumatic stress disorder (PTSD) is a disorder that affects certain individuals after they have been through a traumatic, frightening, or hazardous incident. The body has a “fight-or-flight” designed to keep a person safe by ensuring an immediate/instantaneous response to potentially dangerous situations. After a traumatic event, most people experience various reactions, but most individuals eventually heal entirely from the initial symptoms. However, those who don’t are usually diagnosed with post-traumatic stress disorder (PTSD). These individuals often feel tense and afraid even in perfectly normal conditions. 10

Attention-Deficit Hyperactivity Disorder (ADHD)

Attention Deficit Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental disease that occurs mainly in children. Although it’s primarily diagnosed during childhood, ADHD commonly develops into adulthood. People with ADHD may struggle to pay attention, manage impulsive actions and exhibit extremely high activity levels. 11

Borderline Personality Disorder

Borderline Personality Disorder (BPD), also commonly known as Emotionally Unstable Personality Disorder (EUPD), is marked by a skewed sense of self and intense emotionally unstable interpersonal relationships. People with BPD usually exhibit self-harm inclinations amidst other harmful actions. They may also experience constant disconnection from reality. Symptoms of BPD in people who suffer from the disorder might be triggered by experiences that appear to others to be normal. 12

Eating Disorders

Eating disorders are a category of illnesses characterized by a dysfunctional relationship with food. There are several different eating disorders; however, they all usually have a “mental” causative link. Eating disorders are more common in females, and they most commonly develop during young adulthood. 13

Obsessive-Compulsive Disorder (OCD)

Obsessive-compulsive disorder (OCD) is a mental condition characterized by recurrent bothersome thoughts or feelings (obsessions) or a strong need to repeat an action (compulsions). People with OCD are controlled by “strong” impulses to do certain things or think certain ways, and these impulses usually interfere with normal daily functioning. Obsessions and compulsions can also co-occur in some individuals. 14

Dual Diagnosis Causes and Risk Factors

There are several possible causes of dual diagnosis due to the disease’s uniqueness. Because substance abuse and mental illness occur together and are treated as different health conditions, it’s challenging to point out any specific cause of dual diagnosis. However, the occurrence or presence of a substance abuse condition or mental illness condition may serve as pointers to the possible occurrence of dual diagnosis.
One major factor/cause of dual diagnosis is the use of medication. Usually, people suffering from mental health conditions are treated/managed using very effective but highly addictive drugs like benzodiazepines. Unfortunately, these individuals tend to abuse the medications due to their effects and their desire to manage possible symptoms better. Over time, this usually results in the development of substance abuse disorders.

Examples of Risk Factors

Some risk factors could hint at or predispose an individual to dual diagnosis. These risk factors include factors that may contribute to or promote substance use disorders and mental disorders. They are:

  • Brain responses
  • Genetics
  • Environmental triggers (such as trauma)
  • Exposure at an early age

Signs and Symptoms of Dual Diagnosis

Dual diagnosis symptoms and signs can be divided into two main categories: those that accompany mental health issues and those that accompany substance abuse disorders.
Dual Diagnosis

Common Signs and Symptoms of Substance Abuse

Common substance abuse signs and symptoms can be divided into three categories. They include:

Behavioral Symptoms

There are behavioral symptoms that can manifest from co-occurring disorders. Examples of these include:

  • Appetite changes
  • Irregular sleep patterns
  • Frequent mood swings, increased irritability, and aggressive, emotional outbursts
  • Loss of motivation
  • Anxiety, mistrust, and paranoia

Physical Symptoms

Similarly, there are physical symptoms that can manifest from co-occurring disorders, such as:

  • Slurred speech and confusion
  • Poor physical appearance
  • Lack of coordination
  • Sudden weight loss/gain
  • Unusually large pimples

Social Symptoms

The most common social symptom observed in individuals with dual diagnosis is social and emotional withdrawal. People with dual diagnosis usually have problems maintaining their relationships and forging new ones. They also typically have legal and financial issues. 6

Common Symptoms of Mental Health Issues

The common dual diagnosis symptoms of mental illness exhibited by people with co-occurring disorders depend on the mental health illness present. Examples are detailed below.

  • Common anxiety symptoms include increased irritability, muscle tension, sleep disorders (like insomnia), restlessness, and concentration problems.16
  • Common symptoms of depression include fatigue, lack of motivation, reduced activity, suicidal thoughts and tendencies, inability to concentrate, irritability, restlessness, prolonged and recurrent feelings of sadness. 17
  • Common symptoms of bipolar disorder include mania, depression, insomnia, restlessness, poor decision making, inability to concentrate, and even high sex drive. 18

Other symptoms of mental health conditions that could manifest in dual diagnosis include drug and alcohol abuse (substance abuse), stress, and violence.

Dual Diagnosis Treatment

Because each of the co-occurring illnesses in dual disorders is considered a separate disease, dual diagnosis therapy involves the treatment of these disorders separately. So, a typical dual diagnosis program for treatment will include mental health and substance abuse treatments to effect complete dual diagnosis recovery.

Substance Abuse Treatment Options

Several different factors eventually combine to determine the substance abuse treatment option employed to effect dual diagnosis recovery. The dual diagnosis program treatment option may depend on the substance of abuse, financial capacity, duration of abuse, etc. Some of the most effective substance abuse treatments that have been used to affect sobriety in individuals include the following. 19

Detoxification

Detoxification allows you to safely clear your body of toxic chemicals at a healthy and safe rate. This is advantageous because substance withdrawal can occasionally result in mild to severe health effects. Detox is usually used in conjunction with other dual diagnosis therapy because it does not deal with the underlying causes of substance abuse. 19 Withdrawal symptoms that accompany detoxification can be life-threatening. Therefore, substance withdrawal symptoms are treated/managed by co-administration of appropriate medications. Proper management of these symptoms at a dual diagnosis treatment center helps prevent drug use relapse. 19

Behavioral Therapy

Behavioral therapy has successfully treated and managed several mental health and substance abuse issues. 20 There are several types of behavioral therapy, but fundamentally, these therapies aim to help individuals identify underlying causes and triggers (habits and thinking) of their substance abuse problem, reinforce “positive” attitudes, and get rid of the negative ones. 19

Support Groups

Support groups also play an important role in dual diagnosis treatment. They serve as sources of support and strength for individuals. They also provide an environment of stability and encouragement.

Mental Health Treatment Options

As mentioned earlier, several different mental health conditions may be present in dual diagnosis. However, for the most part, they have similar treatment approaches. These treatment options include the following.

Medication

Medications are usually used in dual diagnosis rehab to manage mental health disorder symptoms.21

Individual or Group Counseling

Dual diagnosis psychology (also known as psychotherapy or counseling) involves the examination of a person’s thoughts, feelings, and actions to identify, examine “problem points,” and propose solutions that help improve individuals’ overall health condition. Psychotherapy (dual diagnosis group therapy and individual therapy) is mainly used with medications for the best effect. 21 Other dual diagnosis treatment programs include lifestyle changes and peer support (either via groups or informal settings).

Dual Diagnosis Self-Medication

The best treatment option for individuals with a co-occurring disorder is at a dual diagnosis treatment center. However, people prefer to self-medicate and do “in-home treatment” for several reasons. However, dual diagnosis residential treatment or self-medication is quite dangerous and should be discouraged. This is because dual diagnosis consists of two separate yet severe medical health conditions (addiction and mental health illness). Each of these illnesses on its own is challenging to deal with effectively, and the challenge only becomes more serious when they co-occur.

There is also the problem that the treatment of these illnesses is usually accompanied by severe withdrawal symptoms that, if not managed properly, may result in even more severe health conditions/complications. Another problem to consider is that people generally lack the necessary skills to make accurate diagnoses. They also lack the required knowledge for appropriate treatment and monitoring.

Dual Diagnosis

How to Help a Loved One with a Dual Diagnosis?

Living with someone who has a mental health condition or addiction problem can be challenging. This challenge is somewhat doubled when your loved one has a dual diagnosis. However, although interacting with that loved one may be rather tricky, there are a couple of things you can do to help them. These things include:
  • Seek support
  • Set boundaries
  • Educate yourself: This is important because you need to know what to expect to prepare yourself properly. Knowing the signs and symptoms of dual diagnosis will help you understand what to expect so you won’t feel offended if, for example, you’re unable to communicate with your loved one effectively.
  • Be patient: Recovery takes time, and it’s not going to happen any faster because you want it to. You will also want to avoid making your loved one feel pressured, as this might lead them to slip up and leave them feeling uncomfortable.
Dual Diagnosis

Being an Asset to Someone With Mental Illness or Substance Abuse

Get Help for a Dual Diagnosis

As was mentioned earlier, the best treatment option for dual diagnosis is to seek help at a dual diagnosis treatment center. As far as co-occurring disorders treatment centers go, Essence Health and Wellness is one of the best. This treatment center has several treatment programs available, so you will be able to find one that is a perfect fit for your therapy needs.

Healing at Essence Health and Wellness

Essence Health and Wellness Center has well-trained and highly skilled caregivers. You can rest assured that licensed and capable medical practitioners will handle every step of your treatment/therapy.

Get in touch today through the supplied contact lines and begin your journey to full recovery from dual diagnosis.