Dual diagnosis

What is the connection between mental health and addiction?

Mental health disorders and addiction is a bit of a chicken and egg story. Which one comes first? The chicken or the egg? Mental illness or addiction?

When someone is living with a mental illness and an active addiction, it’s important that they receive treatment for both at the same time. This is known as dual diagnosis and it plays a vital role in choosing the right treatment plan for lasting recovery.

What is dual diagnosis?

Dual diagnosis is a term used to describe a person who is experiencing both substance use disorder and one or more mental disorders. It’s also referred to as co-occurring disorder (COD).

There are two types of dual diagnosis:

  • a substance use disorder that leads to or worsens a mental illness
  • a mental illness that leads to or worsens an addiction

What causes dual diagnosis?

If you have a mental illness, you may use alcohol, drugs or engage in risky behaviour to feel better or cope with symptoms such as depression, anxiety and rage. Frequent and sustained use of drugs and alcohol then leads to addiction.

On the other hand, abusing prescription drugs or street drugs may trigger or worsen a mental disorder such as bipolar or schizophrenia. Several drugs are known to activate a mental illness or at least, deepen anxiety or depression that already exists.

For some people, addiction and mental health issues are triggered by the same factor and start at the same time. For others, they start separately and get progressively worse if the dual disorders aren’t treated.

Dual diagnosis depends on the type of mental disorder and its symptoms, drugs and alcohol used and the severity of substance use disorder, and how mental health and addiction alters the course of a person’s overall well-being.

What mental illnesses co-occur with addiction?

Dual diagnosis patients often have one or more mental disorders (depression, anxiety disorder, bipolar, schizophrenia, personality disorders) and addictions (alcohol, drugs, gambling, Internet, sex). In fact, the statistics show that at least half of people with a mental illness have a co-occurring drug or alcohol addiction and vice versa.

Mental illnesses that commonly occur with addiction include:

  • depression
  • anxiety disorder
  • bipolar disorder
  • attention-deficit hyperactivity disorder (ADHD)
  • schizophrenia
  • borderline personality disorder
  • anti-social personality disorder

Can drugs trigger serious mental illness?

Yes, certain drugs can trigger serious mental illness and they can change how the brain works and functions. Psychiatric symptoms such as chronic anxiety, depression and paranoia commonly occur from acute intoxication as well as withdrawal. The side effects may be short-term or permanent.

Drugs that are known to trigger serious illness include:

  • cocaine
  • inhalants
  • ketamine
  • kratom
  • LSD
  • marijuana
  • MDMA
  • methamphetamine
  • PCP
  • prescription drugs
  • steroids (appearance- and performance-enhancing drugs)

If I have a mental disorder, will I develop an addiction? And vice versa?

According to the National Institute of Drug Abuse (NIDA); compared with the general population, people addicted to drugs are roughly twice as likely to suffer from mood and anxiety disorders, with the reverse also true. Likewise, those living with mental disorders are often twice as likely to become chemically dependent on prescription drugs or addictive substances.

Now, this does not mean that you will develop an addiction if you have a mental disorder. Or develop a mental disorder if you have an active addiction. There are other environmental factors that affect dual diagnosis as well as a complex interplay of genetics.

Why is it difficult to treat dual diagnosis?

It is difficult to treat dual diagnosis because it isn’t always easy to tell what symptoms are coming from what condition. It takes time to work out what might be a mental health disorder and what might be a drug or alcohol problem. This is because mental disorders and addiction share many of the same symptoms, such as depression, anxiety, aggression, irritability, paranoia etc.

Someone who abuses marijuana or crystal meth may experience prolonged psychotic reactions, while someone with alcohol use disorder may experience chronic depression and anxiety. This does not necessarily mean they have a co-occurring mental disorder.

To treat symptoms of dual diagnosis, you need to find the root causes and treat them. A person with a possible co-occurring mental illness and addiction needs to be evaluated by a mental health professional and they need an integrated recovery treatment plan that’s tailor-made to their unique needs.

Warning signs of dual diagnosis

Dual diagnosis is not something that can be self-diagnosed because it’s a complex condition. However, there are a few signs that point to the likelihood you may have a co-occurring disorder

You use alcohol or drugs to cope with unpleasant memories or feelings, to stay focused on work or tasks, to improve your mood or to face situations that threaten or frighten you

There is usually a co-dependent relationship with feelings and drugs or alcohol; for example, you drink alcohol or take recreational or prescription drugs when they feel anxious, fearful, agitated etc.

It takes more and more alcohol or drugs to make you feel better, happier, less anxious etc.

A person has been to rehab for drug or alcohol addiction but has relapsed due to their frail state of mind or symptoms of a mental illness

How is dual diagnosis treated?

Dual diagnosis is best treated through an integrated approach where the mental disorder and addiction are treated at the same time. A dual diagnosis treatment plan at an inpatient facility like White River Manor is managed by a multi-disciplinary team that includes a psychiatrist, psychologist, counsellor, addiction care therapists and nutritionist.

The treatment plan for addiction with a co-occurring mental disorder may include the following:

  • medical detox
  • medicine to help cope with substance withdrawal
  • inpatient or outpatient rehab
  • psychotherapy, including cognitive behavioural therapy
  • healthy lifestyle changes; diet, exercise, sleep patterns
  • group support
  • after-care support

What therapy works well for dual mental illnesses and addiction

Research into the link between co-occurring mental illnesses and addiction is advanced, and has led to the development of effective behavioural therapies.

CBT and DBT are two popular behavioural therapies used to treat comorbid patients at inpatient addiction treatment centres or at outpatient facilities.

Cognitive behavioural therapy (CBT)

CBT helps people learn how to identify and change destructive and troubling thought patterns that have a negative effect on how they behave and feel about people and events. CBT is effective because it focuses on changing automatic negative thoughts that fuel depression and anxiety.

CBT helps you identify and challenge negative thoughts and turn them around into more positive, realistic thoughts.

Dialectical behavioural therapy (DBT)

DBT is similar to CBT but the goal is to teach people to live in the moment, manage their moods and emotions, develop healthy relationships and better ways to cope with stress. It’s the practical side to CBT. DBT was designed specifically to treat borderline personality disorder (BPD) but it’s now used to treat addiction and comorbid mental disorders as well as behavioural disorders, eating disorders and PTSD.

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