Dual Diagnosis

Dual Diagnosis
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Mental disorders and addiction often go hand in hand. According to the National Institute on Drug Abuse (NIDA), people who are diagnosed with a mood or anxiety disorder are twice as likely to struggle with addiction. Unfortunately, people who have both mental illnesses and addiction tend to slip through the cracks of the modern medical world, and they may not get the help they need. They may see their doctors for their medical condition and see addiction counselors for their addiction. Until the two forms of therapy are united, however, the person is unlikely to see any real relief.

A Question of Influence

Researchers have been digging into the question of Dual Diagnosis for many years, trying to determine if addiction influences mental illness, or if mental illness somehow causes addiction. The results of these studies have been mixed.

Dual Diagnosis Addiction and the BrainOn one side of the coin, chemicals in the brain seem to influence both addiction and mental illness. A neurotransmitter in the brain called dopamine is responsible for much of the euphoria caused by drug use. When a user takes in a drug such as heroin, the body converts the heroin to dopamine the person feels a rush of feel-good chemicals as a result. When the drugs leave the body, the person is left with no dopamine, and some people develop an inability to produce dopamine themselves. They might feel crushing depression or other metal problems without dopamine. It’s possible, according to the NIDA, that people with a genetic propensity for mental illness could be on a fast track to mental health issues when they are deprived of dopamine due to drug use. In other words, their drug use changed the chemical makeup of the brain, and this made their underlying condition more prominent.

Many researchers believe that people with mental illness turn to addiction to help ease their symptoms.

A study in the Journal of Affective Disorders looked closely at the relationship between mood disorders and alcohol and drug use among a large group of people. Researchers found that 24.1 percent of people used drugs or alcohol to relieve their symptoms. In essence, the people knew they had mental illnesses, and they took drugs and alcohol in order to make those symptoms less palpable. By taking drugs and adding dopamine to their systems, they were able to mask their mental illness symptoms.

The Risks

Whether the addiction comes first or the mental illness comes first, the results are much the same. People who have both conditions at the same time face significant risks, including:

Significant Risks

  • Arrests and incarceration
  • Violent behavior
  • Homelessness
  • Unemployment

Struggling with both conditions at the same time can just be too overwhelming for the person, and a complete breakdown of the person’s life can result. According to a study published in the Journal of Mental Health, people with a Dual Diagnosis “tended to have more crises and pose a greater risk to themselves and others.” This is clearly not a safe situation for the addicted person or the community, making the treatment of Dual Diagnosis patients all the more urgent.

Counseling for Co-Occurring Disorders

Dual Diagnosis Counseling and TherapyAs stated, people who have both mental illness and addiction issues need treatments that address both topics at the same time. According to an article published by the Substance Abuse and Mental Services Administration, traditional modes of treating mental illness and addiction can be at odds with one another.

In a traditional addiction therapy program, the therapy can be confrontational. The addict is shown the behavior, asked to take ownership of the behavior and required to make significant changes. In some older forms of therapy, the addict was asked to break down his or her defenses, and the therapist could use severe methods to get the addict to stop denying a problem and think in a new way.

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In a traditional mental health program, by contrast, the patient is encouraged to build up trust with one therapist, slowly becoming more and more open about what is occurring with the patient and then moving toward accepting the diagnosis and agreeing to make changes. This is a soft approach, built on trust and respect.Dual Diagnosis programs must combine a soft and a hard approach in order to be successful. The addicted person is encouraged to participate in therapy, even if he or she doesn’t agree that a substance abuse problem exists. Slowly, the therapist introduces the concepts of addiction and mental illness, accepting the thoughts and feelings of the patient and allowing the patient to set the pace for therapy. As the patient gains information, he begins to accept the statements and put them into use in his life.This can be a slow process, and some patients need many months of therapy in order to feel the full effects. In order to ensure that people participate in the program and don’t relapse into drug use, most patients are asked to live in a treatment facility for a specific period of time. A study in Psychiatric Services suggests that some patients need treatment in an inpatient setting for six months or longer in order to stay sober. Patients who did participate in longer stays stayed clean for longer periods of time than people who participated in short programs.

The Role of Medications

People with mental illness and addiction often need several types of medications during their treatment programs. Some medications focus on the addiction issues the person is facing, while other medications focus on the mental issues of the client.

Patients who use alcohol, opiates or other drugs often need medications during the detoxification process of addiction rehabilitation. Paying for detox should not be painful to families, Obamacare can help. Detoxification involves cleaning all of the drugs out of the person’s system, allowing the person to have a clear head so she can participate in the other aspects of therapy. Commonly used drugs include:

Common Meds

  • Buprenorphine, which can help reduce withdrawal symptoms for people who have been taking heroin or prescription drugs
  • Neurontin, which can help reduce seizure risks for people who have been abusing alcohol
  • Methadone, which is a synthetic form of opiate given in smaller and smaller doses, to wean the user from the drug
  • Suboxone, which can block the user from taking drugs and feeling a rush from them

In addition to these medications, the patient often works with a therapist in order to choose medications for mental health needs. For patients who have never had their mental health issues addressed before, this can provide real and necessary help.

Group Counseling

As people begin to improve and their symptoms begin to ease, they may find that meeting other people recovering from addiction might be helpful.

Patients in an inpatient treatment program might participate in group sessions with other people who have a Dual Diagnosis. These programs might be harder to find when the person moves into the community when the inpatient program is complete.

Many communities provide 12-step programs on a regular basis, and meeting times are often published in the local paper. Alcoholics Anonymous and Narcotics Anonymous are the most common programs, but there are many other forms of 12-step programs available. Often, there are different meetings available each week, and since the meetings aren’t regulated by a central committee, the person might be able to find several different sorts of meetings and choose between these different forms. For example, some meetings are designed for veterans of wars while others are designed for gay/lesbian addicts in recovery.

By shopping for the proper group, taking care to select a meeting group that makes the addict feel welcome and comfortable, the addict has the best chance of success.

After all, the more meetings the addict attends, the more likely it is that he will take the lessons to heart and choose to stay clean for a longer period of time.

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A Word About Relapse

Addiction is considered a chronic disease, and often, mental illnesses function in the same manner. It might be easy to criticize a person for returning to an addiction where people might feel uncomfortable criticizing a person for a mental health relapse. It’s important to remember, however, that these conditions do tend to act upon one another, and the person should be treated with respect no matter what happens.

People who are dually diagnosed often relapse into drug use, as a study performed by Dartmouth University makes clear. In this study, two-thirds of people with Dual Diagnosis relapsed during the follow-up period. It might seem depressing, but it’s also just common. It’s difficult for people with a Dual Diagnosis to heal quickly. When a relapse occurs, either of the mental health condition or the addiction, it’s important to react and provide the patient with help. But it’s also important not to overreact and blame the patient or act in a hostile or threatening manner.

Families sometimes need help walking this delicate line, and they may benefit from attending counseling sessions on their own. Here, they can learn more about how mental illnesses and addiction work upon one another and they can learn how to deal with a relapse should it occur.

At Michael’s House, we can help patients and their families come up with treatment programs to assist with Dual Diagnosis therapies and relapses. The help we provide is real, and it’s just a phone call away.