What is "Dual Diagnosis"?
Dual diagnosis occurs when a person diagnosed with an alcohol or drug addiction also has another emotional or psychiatric problem. Common psychiatric diagnoses that co-occur with substance abuse & dependence include Depression, Bipolar Disorder, Obsessive-Compulsive Disorder, Schizophrenia and Post-Traumatic Stress Disorder. In addition, chemical dependency often co-occurs with Eating Disorders, such as Anorexia or Bulimia. To establish solid recovery, the dually diagnosed person must receive treatment for both issues, since long-term sobriety and mental health depend on effectively coping with them simultaneously.
How Common is Dual Diagnosis?
Dual diagnosis of chemical dependency and another psychiatric disorder is quite common. The Journal of American Medicine estimates that 37% of alcoholics and 57% of drug abusers have another mental disorder. Furthermore, of all Americans diagnosed with a mental disorder, 29% abuse drugs or alcohol. Unfortunately, a recent study suggests that only 12% of dually diagnosed people actually receive treatment for both chemical dependency and mental illness.
Experiencing a mental disorder seems to raise the individual’s lifetime chance of developing alcohol or drug dependence. The following table shows selected psychiatric diagnoses and the associated increased risk (over the general population) of developing chemical dependency:
|
Psychiatric Diagnosis
|
Increased Risk of Chemical Dependency
|
|
Bipolar I Disorder
|
14.5%
|
|
Schizophrenia
|
10.1%
|
|
Panic Disorder
|
4.3%
|
|
Major Depression
|
4.1%
|
|
Obsessive Compulsive Disorder
|
3.4%
|
|
Phobia (Including Social Phobia)
|
2.4%
|
Does Mental Illness cause Chemical Dependency or Does Chemical Dependency cause Mental Illness?
Confusingly, the answer is “Yes.” For some, the other psychiatric disorder emerges first, with the person’s drug or alcohol abuse developing in an effort to cope with the painful symptoms. For instance, an individual suffering the effects of Major Depression may turn to alcohol or painkillers to numb their mental anguish. Addiction specialists call this process “self-medication.” The net effect leads to a worsening of the disorder’s symptoms, overall functioning, and the emergence of chemical dependency.
On the other hand, addiction experts note that many individuals have a mere predisposition to a particular psychiatric disorder. However, the disorder itself only emerges as a result of the physiological, psychological and social stressors related to addiction. For instance, a Methamphetamine addict with no psychiatric symptoms prior to abuse may experience Manic episodes (dangerously elevated mood swings related to Bipolar I) after years of using the drug.
How does Treatment for Dual Diagnosis Proceed?
The first phase of any chemical dependency treatment is detoxification, a period in which the individual’s body clears itself of alcohol or drugs under qualified medical supervision. Adequate detox is especially crucial for Dual Diagnosis individuals because alcohol & drug effects often mask, exacerbate or mimic the symptoms of the co-occuring psychiatric disorder. Although a psychiatrist may make a preliminary evaluation & diagnosis, until the effects of the drug completely leave the system, an accurate assessment is impossible. In addition, a psychiatrist needs to determine at this time whether the individual is “stable” with regard to his or her co-occurring psychiatric disorder, and therefore able to participate in and benefit from dual diagnosis treatment.
The second phase of treatment involves continued psychiatric evaluation & treatment along with simultaneous treatment of chemical dependency and the additional psychiatric disorder. Generally this takes the form of individual & group counseling as well as education regarding both addiction and psychiatric disorder issues. In addition, nutrition and exercise, as well as medication are key elements of treatment. Many programs introduce the individual to Alcoholics Anonymous or other 12-Step groups. The overall concept is to establish skills for coping with the addiction and psychiatric issues over the long-term so that relapse in one area does not trigger relapse in the other.
Finally, the third phase of treatment involves returning to life beyond the treatment program itself. This entails continued, effective psychiatric treatment and, generally speaking, compliance with medication as directed by a psychiatrist. Sobriety for the dually diagnosed individual may not guarantee a life free from illness on the psychiatric front. A person with Bipolar I may experience a future manic episode, those with Depression may face a recurrence, as well. However, with consistent psychiatric care and longer-term sobriety, the odds are quite good that these periods will prove less frequent and more easily managed.