Dual diagnosis refers to a person diagnosed with an alcohol or drug addiction who 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.
Chemical dependency often co-occurs with Eating Disorders , such as Anorexia or Bulimia. Research has proven that dually diagnosed individuals must receive treatment for both issues in order to achieve long- term sobriety.
Causes of Dual Diagnosis
For some, the psychiatric disorder emerges first, with the person’s drug or alcohol abuse developing at a later date. 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 potential worsening of symptoms and emergence of chemical dependency.
Addiction experts note that many individuals have a mere predisposition to a particular psychiatric disorder. In some cases, the disorder only emerges as a result of the physiological, psychological and social stressors related to addiction. For example, a Methamphetamine addict with no psychiatric symptoms prior to abuse may experience manic episodes after years of using the drug.
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 health disorder. Of all Americans diagnosed with a mental disorder, 29% abuse drugs or alcohol. A recent study suggests that only 12% of dually diagnosed people actually receive treatment for both chemical dependency and mental illness.
Experiencing a mental health 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:
Dual Diagnosis Treatment
Depending on which substance the individual is dependent upon, detoxification may be recommended. Detoxification is 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 the effects of drugs and alcohol often mask, exacerbate or mimic the symptoms of psychiatric disorders.
A psychiatrist may make a preliminary evaluation and diagnosis but until the substance completely leaves the system, an accurate assessment is impossible. Psychiatrists needs to determine whether the individual is stable with regard to their co-occurring psychiatric disorder and able participate and benefit from dual diagnosis treatment.
Continued psychiatric evaluation and simultaneous treatment of chemical dependency is typically commonplace throughout the treatment process. Generally, this takes the form of individual and group counseling as well as education regarding both addiction and psychiatric issues. Nutrition, exercise and 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.
Establishing an aftercare plan is recommended for the highest chance of success. 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. However, with consistent psychiatric care and longer-term sobriety, the odds that these periods will occur less frequently is greater.