Dual Diagnosis Treatment For Addiction And Mental Health Disorders

A dual diagnosis occurs when a person has both a mental health and substance use disorder. Dual diagnosis programs work to treat both disorders.

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Dual Diagnosis Addiction Treatment

Of the 20.2 million adults who had a substance use disorder in 2014, 7.9 million had a co-occurring mental health disorder.

In order for a person to recover from a dual diagnosis, rehabilitation must treat both conditions. The most effective treatments blend behavioral therapy, medication, and support groups and promotes healing on a physical, mental, and emotional level.

What Is A Dual Diagnosis?

A person with a dual diagnosis (also called co-occurring disorder) is someone who struggles with a mental illness and a substance use disorder (SUD) at the same time.

Either of these disorders can develop first, and they may not always be related to the other. However, the two disorders are frequently connected to each other.

Drug and alcohol abuse may worsen the symptoms of an existing mental illness. In some cases, a substance use disorder may actually cause emotional or mental problems. In the worst case, a SUD may trigger the development of a mental illness. In other instances, mental illness may lead to drug addiction or alcoholism.

Many people use drugs or alcohol as a way to cope with symptoms of their mental illness. But as this self-medication continues, it often aggravates the mental illness, and may result in addiction and a more disabling form of the mental illness.

Each mental illness has its own set of symptoms. Along with the signs of a SUD, certain warning signs may point to a co-occurring mental illness.

General signs of a co-occurring disorder may include:

  • confusion
  • difficulty concentrating
  • severe mood changes
  • social isolation
  • thoughts of suicide

Mental Illnesses That Can Become A Dual Diagnosis

Any mental illness may be linked to addiction, however, the conditions which most frequently accompany SUDs are depression, anxiety disorders, schizophrenia, and personality disorders. The following are common mental health conditions which can lead to a dual diagnosis.

Anxiety Disorders

Anxiety disorders are the most frequently experienced mental illness in America. A person with anxiety struggles with persistent and extreme feelings of fear and worry which compromises their quality of life.

Generalized Anxiety Disorder (GAD)

GAD causes a person to become consumed by uncontrollable worry about their day-to-day life. This happens even when there’s little to no reason to worry. A person with GAD may experience physical and mental symptoms which disrupt their daily routines and impair their health.

Social Anxiety Disorder

A person with social anxiety disorder (also called social phobia) experiences a sense of anxiety and dread when confronted with social interactions or the expectation to perform in public. People with this disorder are fearful of acting in a way which humiliates them, often leading to panic attacks. A person with this disorder may avoid these situations so often that they become isolated.

Panic Disorder

A panic disorder causes severe and unexpected panic attacks marked by a sense of overwhelming fear and physical distress. These attacks may not have an obvious trigger. To avoid these, many people isolate themselves in a way which causes problems with work, school, or relationships.

Phobias

For a person with a phobia, an event, object, or place triggers an extreme sense of fear and panic. In most cases, the trigger doesn’t place a person in any real danger. A person’s life may be structured around avoiding these triggers, to the extent they become isolated and their relationships suffer.

Attention Deficit Hyperactivity Disorder (ADHD)

ADHD is a brain disorder that causes a person to be inattentive, hyperactive, and/or impulsive. These characteristics make it difficult for a person to concentrate, pay attention, and stay on task. This disorder begins in childhood and may continue into adulthood for some individuals.

Autism Spectrum Disorders (ASD)

ASDs are developmental disorders which change the way a person is able to interact with people and communicate on a social level. This disorder may be marked by repetitive or restricted behaviors. Symptoms of ASD may cause impairment ranging from mild to severe.

Bipolar Disorder

Bipolar disorder, also called manic-depressive illness, is marked by extreme shifts in activity levels, energy, mood, and thought. This may happen during manic episodes (energized activity and elevated mood) or depressive episodes (sense of hopelessness). Bipolar disorder is sometimes considered a form of depression.

Delusional Disorder

A person with a delusional disorder has difficulty recognizing reality. Instead, a person believes a delusion or false belief about their body, life, or surroundings. Types of delusions include: erotic, grandiose, jealous, persecutory, or somatic (delusions about the body).

Depressive Disorders

Depressive disorders cause a person to experience a persistent and disabling sense of sadness and worthlessness. These symptoms affect a person’s thoughts, behaviors, and ability to carry out tasks and responsibilities. A depressive episode may only happen once, but most people experience recurrent episodes.

Major Depression

Major depression is also called major depressive disorder or clinical depression. This disorder is characterized by intense sadness and a sense of emptiness for two weeks or more. These feelings limit a person’s desire to take part in pleasurable experiences. During a depressive episode, a person may experience changes in their appetite or weight, difficulty sleeping, or low energy.

Persistent Depressive Disorder

Symptoms of depression continue, at minimum, for two years. Symptoms may be manageable or include those of major depression. A person may feel joyless, hopeless, and struggle with their self-esteem.

Seasonal Affective Disorder (SAD)

This form of depression most commonly happens during winter and ends when the season is over. Most people experience it winter after winter. Symptoms include low energy, an increased need for sleep, weight gain, and social withdrawal.

Perinatal Depression

Perinatal depression is unique to mothers. It causes both minor depressive episodes and major depression. It can happen during pregnancy or for up to 12 months after the child is born. Symptoms can become so extreme as to prevent a mother from taking care of herself or her new child.

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Premenstrual Dysphoric Disorder (PMDD)

PMDD is unique to women. It’s the most severe form of premenstrual syndrome (PMS). Symptoms of PMDD start just after a woman ovulates and continue until her cycle starts. Symptoms include irritability, severe depression, and tension.

Psychotic Depression

Psychotic depression occurs when severe depression is accompanied by some type of psychosis. Psychosis may include delusions or hallucinations. These symptoms usually have a depressive undertone, such as delusions of guilt, illness, or poverty.

Dissociative Disorders

A person with a dissociative disorder encounters an involuntary escape from reality. Approximately two percent of Americans suffer from a dissociative disorder. This disorder causes a disconnect between a person’s actions, consciousness, identity, memory, surroundings, and thoughts.

Dissociative Amnesia

This disorder causes a person to have difficulty remembering important details about themselves or people and events within their life. The amnesia may be specific to a traumatic event or revolve around a person’s identity or past. This loss of memory may happen suddenly and last anywhere from minutes to years.

Depersonalization Disorder

This disorder causes a person to feel as if the world around them isn’t real. A person may become detached from their own actions, feelings, and thoughts, almost as if they are watching a movie. People and places may seem unreal as well (derealization).

Dissociative Identity Disorder

A person with dissociative identity disorder “switches” to alternate identities. Each identity may have a unique name, characteristics, voices, mannerisms, and personal history. This disorder more frequently impacts women.

Early Psychosis And Psychosis

A person’s thoughts and perceptions become altered in a way which makes it difficult for them to tell the difference between what is real and what is not. This “break from reality” may include delusions and/or hallucinations.

Eating Disorders

A person’s thoughts and actions are increasingly preoccupied with food and weight to the point that their daily life and health suffer. Roughly one in 20 Americans will experience an eating disorder at some point within their life. Without proper treatment, a person may experience severe medical complications from their eating disorder.

Anorexia Nervosa

A person with anorexia has a debilitating fear of gaining weight or getting fat. Because of this, a person doesn’t eat enough or get enough calories. Some people may even starve themselves to achieve a desired weight.

Bulimia Nervosa

A person experiences a loss of control as they compulsively binge eat. To rid themselves of these calories, a person may make themselves vomit, abuse laxatives or diuretics, exercise excessively, and/or fast.

Binge Eating Disorder

A person undergoes recurrent episodes of binge eating, which is defined as a loss of control while eating an excessive amount of food in two hours or less. A person may eat this way once they’re full or even when they’re not hungry.

Avoidant/Restrictive Food Intake Disorder

Due to an issue with eating, a person is not able to consume enough calories or get enough nutritional basics through their diet. This may cause a person to lose weight or have stunted growth.

Other Specified Feeding Or Eating Disorder

A person meets some, but not all, criteria of an eating disorder. Examples include: atypical anorexia nervosa, purging disorder, night eating syndrome, and an unspecified feeding or eating disorder.

Pica

For one month or longer, a person eats non-food items that hold no nutritional value. Examples include clay, hair, or dirt.

Rumination Disorder

For one month or longer, a person regurgitates their food. This includes re-chewing, re-swallowing, or spitting out food.

Impulse Control Disorders

These disorders are characterized by impulsivity which impairs a person’s social and occupational functioning. Much like addiction, a person loses control over their problematic behavior and experiences cravings or urges for it. Examples include compulsive shopping, intermittent explosive disorder, internet addiction, kleptomania, pathological gambling, pyromania, and sexual compulsion.

Obsessive-Compulsive Disorder (OCD)

A person with OCD struggles with repetitive, unwanted, and uncontrollable intrusive thoughts, or obsessions. They also encounter repetitive, irrational, and uncontrollable behaviors or compulsions. OCD may cause significant anxiety and distress within a person’s life.

Personality Disorders

A personality disorder creates inflexible and harmful patterns of thinking, functioning, and behaving. These characteristics make it difficult for a person to understand and relate to people. There are three clusters of personality disorders, grouped by similar symptoms.

Cluster A Personality Disorders

This group of people exhibit bizarre and eccentric thoughts and actions.

Paranoid Personality Disorder

A person with this disorder is deeply distrustful and suspicious of others. They frequently believe that harmless actions and words are personal attacks meant to cause them harm. This mistrust extends to a person’s close loved ones and family members, making it difficult to have meaningful and close relationships.

Schizoid Personality Disorder

A person with this disorder purposely isolates themselves from the world. An individual may have little interest in creating relationships with others and struggle with physical intimacy. This disorder makes it difficult to understand common social cues and to express emotion.

Schizotypal Personality Disorder

A person with this disorder acts in strange, particular ways. These individuals may have social anxiety and have trouble expressing an appropriate emotional response. Some individuals with this disorder believe they can change a person’s actions or an event by only their thoughts (“magical thinking”).

Cluster B Personality Disorders

This group of people exhibit dramatic, unpredictable, and excessively emotional thoughts and actions.

Antisocial Personality Disorder

A person with this disorder frequently disregards other people’s feelings or safety. They may also violate the rights of others or experience legal troubles. These individuals may exhibit impulsive, irresponsible, aggressive, or violent behaviors. A person with this disorder may have little to no remorse for the results of these actions.

Borderline Personality Disorder

A person with this disorder frequently engages in impulsive and risky behavior. A person may struggle with quickly shifting moods, a sense of emptiness, and a fragile self-image. These individuals struggle to create and maintain healthy relationships.

Histrionic Personality Disorder

A person with this disorder goes to great lengths to obtain the attention of others, often by being dramatic or overly emotional. An individual may be overly sensitive, easily influenced by others, and constantly need reassurance.

Narcissistic Personality Disorder

A person with this disorder is arrogant and convinced they’re more important than others. These individuals constantly seek praise and attention and believe other people envy them. A person with this disorder will ignore people’s feelings and take advantage of others to get what they want.

Cluster C Personality Disorders

This group of people exhibit anxious and fearful thoughts and actions.

Avoidant Personality Disorder

A person with this disorder chronically feels shy, inadequate, and inferior to other people. They may struggle with feelings of rejection and not handle criticism well, or isolate themselves for fear of rejection or because they think they’ll do something wrong.

Dependent Personality Disorder

A person with this disorder is overly dependent on those around them and feels a constant need to receive care from others. These individuals often struggle to be alone and become excessively preoccupied with fear of abandonment. Many individuals with this disorder have very low self-confidence, and may even tolerate mistreatment because of this.

Obsessive-Compulsive Personality Disorder

A person with this disorder adheres to rigid routines and rules. They strive for extreme perfectionism and become distressed when they cannot obtain it. These individuals feel the need to always be in control and struggle to let anyone help them. This disorder is not the same as obsessive-compulsive disorder.

Post-traumatic Stress Disorder (PTSD)

PTSD develops in response to witnessing or experiencing a frightening, traumatizing, or life-threatening event. These experiences may include accidents, personal assault, natural disasters, terrorist events, sudden loss of a loved one, or war (combat). Symptoms of PTSD include crippling anxiety, flashbacks, nightmares, and frightening thoughts about the event.

Schizophrenia

Schizophrenia is a severe, debilitating mental health disorder which disrupts a person’s emotions, thoughts, and behaviors. Some people with schizophrenia may appear to lose touch with reality and experience delusions, hallucinations, and other unusual thoughts.

Schizoaffective Disorder

A person with schizoaffective disorder will have symptoms of both schizophrenia and a mood disorder. This means they may have delusions or hallucinations and also symptoms of depression or mania. Co-occurring substance use disorders are a high risk for individuals with this disorder.

Somatic Symptom Disorder (SSD)

Somatic symptom disorder is similar to an anxiety disorder. A person with SSD experiences acute distress and anxiety over physical health symptoms. Over time, their thoughts, emotions, and behaviors fixate on their symptoms. These reactions can become so extreme that a person suffers emotionally and struggles to function within their life.

Trauma

Traumatic experiences are frequently linked to substance abuse and addiction. They may include events experienced as either a child or an adult. Traumatic events include acts of violence, neglect, abandonment, and abuse (physical, emotional, and/or sexual.)

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Related Conditions

Many mental health disorders can trigger other, damaging behaviors or conditions which can endanger a person’s health or life. These include:

  • Anosognosia: This condition disables a person from being able to see that they have a mental illness.
  • Suicide: It’s reported that approximately 90 percent of people who lose their lives to suicide struggled with a mental illness.
  • Self-Harm: Various disorders, including anxiety, borderline personality disorder, eating disorders, depression, and PTSD may be linked to patterns of self-injury. Examples include cutting, burning, picking at wounds, or pulling out hair.
  • Sleep Disorders: Many forms of mental illness may make it difficult for a person to fall asleep, stay asleep, or get quality sleep.

The most effective treatments for mental illness should identify and treat these concerns as well, especially since substance abuse may aggravate some of these conditions.

Dual Diagnosis Treatment

Dual diagnoses are best treated within a residential, inpatient drug rehabilitation program. Treatment for co-occurring disorders requires intensive therapy, counseling, and support which isn’t as readily available in an outpatient format.

The most successful treatments for co-occurring disorders are based on integrated, individualized care which targets the physical, mental, and emotional impacts of the dual diagnosis. This includes medication-assisted therapies, behavioral therapies, family therapy and support, and support groups.

Certain addictions require a medically-supervised detoxification prior to treatment for the psychological addiction. This is common with alcohol, benzodiazepines, and opioid drugs, like heroin and prescription painkillers. In order for a person’s mind to heal, the body must be granted the opportunity to do the same.

Contact InpatientDrugRehab.org to learn more about dual diagnosis treatment options.


Sources

Harvard Health Publishing — Delusional Disorder, Six Common Depression Types
Mayo Clinic — Personality Disorders, Somatic Symptom Disorder
MedlinePlus — Dual Diagnosis

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