Dual Diagnosis in Mental Health

If a person has a substance abuse problem and a mental health issue, it’s a dual diagnosis. It’s very common for someone to have a dual diagnosis. 

Around half of the people with a mental disorder will have a substance use disorder in their life at some point, and vice versa. When the two conditions interact with one another, it can worsen the symptoms of both, according to the Mental Health Services Administration. 

For someone with a co-occurring disorder, dual diagnosis treatment is best. Below, we explore a dual diagnosis and how to find the right type of treatment.

What is a Dual Diagnosis?

Substance use disorders and mental health disorders affect people from all age groups. Both mental health disorders and addictions are chronic but are also treatable.

• When you have a psychiatric illness or psychological issues, they lead to changes in how you think and behave. Mental health disorders affect your mood and functionality in your daily life. Having a mental illness can impact your decision-making and relationships with other people.
• A serious mental illness is when someone has a diagnosable mental or emotional disorder within the past year that significantly interferes with their life and limits their ability to do at least one major activity.
• A substance use disorder is a condition with uncontrolled substance use, even though the usage leads to known negative consequences. If someone has a substance use disorder, they’re preoccupied and intensely focused on using drugs or alcohol. The most severe type of substance use disorder is addiction.

As is the case with mental illnesses and mood disorders, it can distort your thinking and behavior if you have an addiction to drugs or alcohol. The use of substances alters the brain’s structure and function resulting in personality changes, powerful cravings, and abnormal movements and behaviors.

• We know from imaging research that substances affect brain areas that control decision-making, judgment, learning, and memory.
• With repeated substance exposure, your brain’s function changes, and these impacts are seen well after the immediate effects of the substance go away.

Mental health or healthcare professionals can diagnose a mild, moderate, or severe substance use disorder. Symptoms of a SUD can fall into one of four general groups—impairment of control, social impairment, high-risk use, and pharmacological criteria such as tolerance and withdrawal.

The severity of a SUD is diagnosed based on how many of the 10 or 11 diagnostic criteria you experience in 12 months. If you have two or three of the criteria, it’s a mild disorder. Four or five is moderate, and the condition is severe for people with six or more symptoms.

These criteria are:

• Taking the substance, whether it’s drugs or alcohol, in larger amounts or for longer periods than you intend
• There is an ongoing desire to stop or cut down on using the drug, but your efforts aren’t successful.
• Spending a lot of time on the activities required to get the substance, use it or recover from the effects.
• Having cravings or urges to use the substance.
• Ongoing substance use leads to declines in performance at work, home, or school.
• Continued substance use despite relationship problems.
• Giving up other activities due to using the substance.
• Using the substance in dangerous situations or engaging in risky behavior, such as drinking and driving.
• Continuing the use of the substance even though you know it’s causing or worsening psychological or physical problems.
• Tolerance means you need higher amounts of the substance to get the desired effects or prevent withdrawal symptoms.
• Withdrawal, when you try to stop or cut down, leading to uncomfortable symptoms.

Common Mental Health Disorders Associated with Substance Use Disorders

Some of the more commonly diagnosed dual diagnoses include:

• People with attention-deficit hyperactivity disorder (ADHD) might misuse substances to deal with their symptoms. The medicines doctors prescribe to treat ADHD, including stimulants like Adderall, are addictive and habit-forming.
• Bipolar disorder is linked with addiction, often because people turn to drugs or alcohol to manage the symptoms of mania and depression that characterize the disorder.
• Around 1 in 10 adults in the U.S. says they’ve suffered from depression. Again, a depressive disorder can lead to someone’s desire to self-medicate with alcohol abuse or drugs. Unfortunately, substances worsen depression.
• Generalized anxiety disorder (GAD) is one of the most commonly diagnosed specific types of anxiety. With GAD, you may have wide-ranging anxieties about various things in your life, contributing to a desire to use drugs or alcohol to reduce your anxiety and feel better.

Personality disorders such as borderline personality disorder (BPD) are also often related to higher drug and alcohol addiction rates. 

Why Is There a Relationship Between Addiction and Mental Illness?

There are a couple of ways that addictions and psychiatric disorders interact with one another, leading to a dual diagnosis.

First, we talked about this one above—often, someone with a mental health disorder, particularly when they’re not receiving treatment or it’s not well-managed, can have the desire to self-medicate. Self-medicating might temporarily reduce mental health symptoms but almost always worsens them over time.

There’s some evidence that addiction and mental disorders are caused by some of the same factors, which can explain the relationship. For example, mental illnesses and addiction can be caused by genetic factors, environment, and brain deficits. There are also areas of the human genome associated with a higher risk for mental illness and substance abuse disorder. 

Drug abuse can also occur first and cause someone to experience mental illness symptoms.

If you have a history of trauma, you are at a much higher risk of a substance use disorder. If you have post-traumatic stress disorder or were the victim of physical or sexual abuse, this raises your risk of addiction and other mental health disorders.

What is Dual Diagnosis Treatment for a Co-Occurring Disorder?

If someone has co-occurring disorders, they need a dual diagnosis program. At dual diagnosis treatment centers, you receive a care plan that addresses all of your needs, including substance abuse treatment and intensive mental health care for your psychiatric disorder. 

You can’t treat just the substance use disorder without treating your mental health disorder. In doing so, you’re not getting to the root causes of the issue.

You have a much higher risk of relapse if you don’t go to a dual diagnosis treatment center specifically equipped to provide this type of care for your mental health condition. You’re much less likely to have a long-term recovery process without integrated treated approaches. 

Dual diagnosis treatment will be holistic therapy, looking at all of your needs as a full person to help your recovery journey. 

The individualized treatment plans for mental health disorders and addictions often overlap anyway. For example, your treatment plan might include behavioral therapies, family therapy, and medication management. Dual diagnosis programs can include inpatient treatment or outpatient programs and sober living homes with varying levels of care. 

If you’d like to learn more about mental health treatment options and dual diagnosis disorders, we’re here to talk and answer questions. The experienced mental health professionals of the Mental Health Center of San Diego can provide more information about dual disorder treatment and integrated treatment approaches; just call (858) 258-9883.