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What is dual diagnosis?

Dual diagnosis is the term used when a person with a substance use disorder (SUD) is also suffering from a co-existing mental health disorder.

It is also commonly referred to as co-morbidity or co-occurring mental health and substance use disorder.

While these disorders frequently occur together, dual diagnosis is still a relatively new and ever-evolving field. Researchers are still learning about the complex relationship between substance addictions and mental health disorders – and which treatments are most effective for prevention, treatment and recovery.

Current research suggests the relationship between the two disorders can be due to three possibilities:

  • A mental health disorder contributes to a substance use disorder
    For example, people dealing with a mental health disorder may self-medicate with drugs or alcohol to find temporary relief from their symptoms. Using this coping mechanism for an extended period is known to alter brain function, making addiction more likely.
  • A substance use disorder directly causes a mental health disorder
    For example, substance use is known to cause changes in the brain in ways that can make some people highly susceptible to developing mental health problems. It can also trigger or worsen underlying/existing mental health disorders. The effects of withdrawal from many substances are also known to produce or mimic symptoms of mental health problems.
  • Common risk factors
    Both conditions share some common risk factors, including trauma, high-stress environments, and genetics.

It is also understood that the type and pattern of dual diagnosis vary with age, gender, culture, peer group and social settings – and every person’s experience will be different. A lot will depend on the type of mental health problem, the kind of substance(s) used, and how the two interact.

While addiction treatment and mental health treatment still tend to be separate systems of care, research now shows that people with co-occurring disorders need specialised treatment forms. These are referred to as integrated services or dual diagnosis treatment. The two conditions significantly impact each other and, unless treated together, a high incidence of relapse is likely.

With the right support and professional care, those suffering from dual diagnosis complexities can overcome both conditions and learn to manage their wellbeing effectively.

What are the most common examples of dual diagnosis?

There is an endless range of combinations in dual diagnosis, but some of the most common co-occurring conditions include:

  • depression and alcohol addiction
    Individuals who suffer from depression are more likely to abuse or become dependent on alcohol, using it as a coping mechanism to suppress symptoms, such as anxiety, insomnia and irritability. Unfortunately, this form of self-medicating often makes the problem significantly worse. For many, depression is the primary condition, with alcohol addiction developing over time. For others, alcohol addiction is the starting point with symptoms of depression arising over time due to the physical effects of alcohol abuse. 
  • anxiety disorders and prescription drug addiction
    Anxiety disorders can come in many forms, including social anxiety disorder, specific phobias, panic disorder and obsessive-compulsive disorder. The anxiety symptoms can be so intense and unbearable that people often resort to taking some form of medication to find relief. Unfortunately, many of the prescription medications used to treat anxiety disorders, such as benzodiazepines, are highly addictive. Long-term use can cause changes in brain structure, resulting in increased tolerance, which ultimately leads to addiction.
  • bipolar disorder and cocaine or alcohol abuse
    Symptoms of bipolar disorder (manic depression) are typically related to extreme changes in behaviour, mood and energy levels. The substance of choice to manage symptoms will often depend on which symptoms are present – whether the person is in a depressive or manic cycle. For example, during a low period, a person with bipolar disorder may use stimulants, like cocaine, to feel increased energy, focus and sociability. Stimulants are highly addictive if used over an extended period. In addition, long-term use sees symptoms of the mental health disorder worsen rather than improve.
  • borderline personality disorder and poly-drug abuse
    Research shows that borderline personality disorder (BPD) and addiction frequently occur together. Over 75% of people living with BPD have a substance use disorder at some point in their lifetime. They will use a variety of substances to self-medicate, to relieve the symptoms of intense emotional pain. While it is believed that substance abuse alone cannot cause BPD, it is known to aggravate and hasten its progression.
  • PTSD and opioid or alcohol addiction
    Post-traumatic stress disorder (PTSD) develops after a person has experienced one or more traumatic events. The condition affects millions of people each year, but most do not seek the professional support required to manage their symptoms effectively. Many people with PTSD self-medicate, turning to prescription painkillers or alcohol to relieve the intensity of their symptoms, including flashbacks, insomnia and recurring disturbing thoughts. Over time, the use of opiates or alcohol may result in the development of addiction.
  • schizophrenia and cannabis abuse
    Studies show that cannabis (marijuana) is one of the most commonly abused substances by those living with schizophrenia. People with schizophrenia often have difficulty coping with highly disruptive symptoms, turning to self-medication for temporary relief. However, if a person has schizophrenia (or a predisposition to it) and uses cannabis to experience a short-term ‘high’, their symptoms will only worsen over time, with more psychotic episodes likely to result.

Recovery from any combination of co-occurring disorders requires a treatment plan that targets both the mental health disorder and addiction to ensure effective, long-term results.

What are the signs and symptoms of dual diagnosis?

It can be challenging to identify the signs and symptoms of dual diagnosis for several reasons, including:

  • they present themselves in unique ways with each individual
  • they vary enormously depending on the combination of mental health disorder and substance(s) used
  • some mental health disorders and addictions have similar biological, psychological and social components, which means they can look the same and often overlap. 

While signs and symptoms are complex and vary in severity, there are common indicators of dual diagnosis, which include:

  • sudden changes in behaviour (e.g. engaging in violent or risky behaviours)
  • changes in sleep patterns (e.g. insomnia or excessive sleep)
  • inability to concentrate and confused thinking
  • social withdrawal: isolating from friends, family, and those who offer support
  • dramatic shifts in moods or energy levels and an inability to control emotions
  • intense feelings of hopelessness, despair and/or worthlessness
  • anxiety that can only be relieved by certain behaviours or rituals
  • difficulties meeting daily responsibilities, including employment
  • trouble maintaining relationships due to erratic behaviour or mood swings
  • use of alcohol or drugs as a way of coping with any of the above symptoms, despite being aware of the dangers.

Due to the complexities of both conditions, dual diagnosis disorders can be challenging to diagnose. For example, addictions can present symptoms of mental health disorders and mental health disorders can present symptoms of addiction. A full diagnosis of co-occurring disorders needs to be made by trained professionals, so that an effective treatment plan can be devised for recovery from both conditions.

Can dual diagnosis be treated?

It is common for people with dual diagnosis to only receive treatment for one disorder while the other remains untreated. This can happen if an incomplete diagnosis is made, due to the symptoms being so similar and/or overlapping. 

If one of the co-occurring disorders goes untreated, both usually worsen, and additional complications can often arise. A combination of disorders can result in poor response to traditional treatments – as symptoms tend to be more persistent, severe and resistant – and increase the risk for other serious medical problems.

Research suggests that co-occurring conditions must be treated at the same time, through an integrated treatment program. Specialised dual diagnosis treatment provides intensive care for both diagnoses and is key to a full recovery.

Early detection and treatment greatly improve recovery and significantly reduce the risk of relapse. 

Highly effective dual diagnosis treatments will include:

  • integrative treatment for mental illness and addiction at a single location
  • close collaboration between the professionals involved in treatment
  • staff of psychiatric professionals and addiction therapists, with specialised training in co-occurring disorders
  • individual counselling and peer group support
  • access to medications to manage craving and withdrawal symptoms during detoxification and/or to relieve the symptoms of some mental health conditions
  • complementary, holistic therapies, such as acupuncture, equine-assisted therapy, hypnotherapy, massage and mindfulness therapy
  • aftercare recovery support.

Dual diagnosis treatment at Centres for Health and Healing

At Centres for Health and Healing, our multi-disciplinary team can provide a holistic, individualised treatment program for dual diagnosis that addresses any addictions and mental health disorders simultaneously.

Combining psychiatric evaluation, intensive therapy, medical management, exercise options, healthy eating and nutrition – our approach ensures deep transformational healing to restore balance to your mind, body and soul.

To find out more about our dual diagnosis treatment plans, please contact us to begin your health and healing journey. 

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