Dual Diagnosis

  • What is Dual Diagnosis Disorder? +

    Dual Diagnosis treatment is a relatively new innovation in the field of addiction recovery. Until the 1990s, people who were experiencing symptoms of a mental health disorder — anxiety attacks, depressive episodes, delusional behaviour or mood swings — were treated separately from those who sought help for drug or alcohol abuse. When these conditions overlapped, clients were often denied treatment for a mental illness until they got clean and sober. Unfortunately, because substance abuse is often driven by an underlying psychiatric disorder, this meant that many people with a Dual Diagnosis of addiction and a mental disorder never got the help they needed.

  • Causes +

    Does Mental Illness Cause Substance Abuse? While some think that mental illness is a potential cause for substance abuse, there is no key relation between the two. The only real relation, is in the fact that many people turn to drugs or alcohol as a means of self-medicating a substance abuse problem. For instance, an individual may already suffer from anxiety and they may drink or use drugs to calm their anxiety. The problem with self-medication is that it often makes matters worse, escalating the anxiety or mental illness problem.

    Does Substance Abuse Cause Mental Illness? In some cases, mental illness can result from substance abuse, but for the most part, substance abuse is not likely the actual cause for mental illness. In fact, most of the time, when mental illness is present in addition to substance abuse, the illness was already a factor long before the drugs were used it just went unnoticed until a substance abuse problem escalated the situation.

  • Signs & Symptoms +

    To get an official Dual Diagnosis, you must be evaluated by a mental health professional or addiction specialist. But you don’t have to be a psychologist or a primary care doctor to know that something’s not right with you or someone you care about.
    These red flags may indicate that someone in your life has a problem with addiction:

    Abandoning friends or family in favor of new activities or a new crowd
    Struggling to keep up with school or work
    Lying or stealing in order to continue an addictive behaviour
    Staying up late at night and sleeping during the day
    Trying to quit using drugs, drinking, gambling or having unsafe sex, but relapsing repeatedly
    Expressing feelings of guilt or regret about a compulsive behaviour
    Seeking out larger doses of drugs, more alcoholic beverages or more extreme high-risk behavior in order to get the same high
    Experiencing withdrawal symptoms after trying to quit a harmful substance or cutting down the dose.

    The only way to know for certain if a Dual Diagnosis exists is to consult an addiction treatment specialist with a background in psychiatric care. At Dual Diagnosis rehabilitation facilities, intake counsellors and evaluation specialists will review your psychiatric history and evaluate your substance use patterns before helping you develop an individualised treatment plan. Reaching out for help may be the hardest part of getting the support you need to begin the recovery process.
  • Who Is At Risk? +

    Dual diagnosis can stem from a range of factors, including:.
    Family History — both addiction and mental health disorders have a strong genetic component. If your family members have struggled with depression, anxiety, addiction or other mental health issues, you have a higher risk of developing these conditions yourself.

    Environment — Your current living environment and the environment you grew up in can affect your mental health and coping skills.

    Trauma — Traumatic events such as abuse or loss of a loved one can trigger mental health and substance abuse disorders.

    Self-Medication — Some people begin to use drugs or alcohol in an attempt to cope with the symptoms of depression, anxiety and other mental health disorders. Others use drugs and alcohol to counter the side effects of medications for mental illness. Drugs and alcohol inevitably make the symptoms worse over time and put the individual at greater risk of addiction.

    According to a report in the Journal of the American Medical Association:
    Roughly 50 percent of individuals with severe mental health disorders struggle with substance abuse.
    Thirty-seven percent of alcohol abusers and 53 percent of drug abusers also have at least one serious mental illness.
    29 percent of people diagnosed with mental illness abuse alcohol or drugs.

    Having a dual diagnosis puts people at greater risk of other problems, such as:
    Family conflict or relationship problems
    Financial problems
    Employment or school problems
    Risky behavior such as driving under the influence and unsafe sex
    Chronic relapse
    Legal problems and incarceration
    Unstable home environment or homelessness
  • Diagnosis +

    Assessing and treating a comorbid condition can be especially difficult due to the co-occurring nature of the disorders. One can often proliferate the other or, in some cases, both the substance abuse and the mental illness can occur separately from one another. Determining which illness is primary to the other can be problematic and troublesome. After a period of detoxification, physicians may have a better chance of diagnosing a patient with one of the above types of substance-related comorbidities. Many substance use disorders have symptoms that will rapidly decline after use discontinues, making a proper diagnosis more feasible.

    So what then? After substance use stops, how to physicians know how to diagnose a mental health disorder? For that, a variety of illness-specific models have been established to help doctors, psychiatrists, and physicians better determine what disorders are present within an individual.

    Perhaps one of the most widely used interview models for clinical assessment is the PRISM-IV. The PRISM-IV stands for Psychiatric Research Interview for Substance and Mental Disorders, and is a structured set of questions that help the interviewer assess mental illness and its relation to substance abuse. With a structured set of interview questions and measures for illness severity, an interviewer can better identify one or more of many mental illnesses. Over 10 major mental health disorders are targeted in this questionnaire including personality disorders, PTSD, obsessive-compulsive disorder (OCD), panic disorder, social phobias, specific phobias, major depression, manic depression and schizophrenia. Typically, questions relating to substance use precede those relating to mental illness so as to best serve as a benchmark for possible mental health disorders, and to understand how the two relate in an individual.

    Other assessment models include the Young Mania Rating Scale (YMRS) for manic disorders and bipolar disorder, the Inventory of Depressive Symptoms (IDS), the Montgomery Asberg Depression Rating Scale (MADRS), the Structured Clinical Interview for DSM-IV for Axis II personality disorders (SCID-II), and the Angst Hypomania Check List (AHCL) that assesses hyperactivity and hypomania (useful for bipolar disorder evaluation).

    These targeted assessments, along with detoxification, can dramatically help a physician determine what mental illness or illnesses remain comorbid with a substance use problem. While a 100 percent accurate diagnosis may be difficult all the time, achieving the best diagnosis possible is the goal.

  • Treatments +

    The best treatment for co-occurring disorders is an integrated approach, where both the substance abuse problem and the mental disorder are treated simultaneously.

    Recovery depends on treating both the addiction and the mental health problem. Whether your mental health or substance abuse problem came first, recovery depends on treating both disorders. There is hope. Recovering from co-occurring disorders takes time, commitment and courage. It may take months or even years but people with substance abuse and mental health problems can and do get better. Combined treatment is best. Your best chance of recovery is through integrated treatment for both the substance abuse problem and the mental health problem. This means getting combined mental health and addiction treatment from the same treatment provider or team.

    Relapses are part of the recovery process. Don’t get too discouraged if you relapse. Slips and setbacks happen, but, with hard work, most people can recover from their relapses and move on with recovery. Peer support can help. You may benefit from joining a self-help support group like Alcoholics Anonymous or Narcotics Anonymous. They give you a chance to lean on others who know what you’re going through and learn from their experiences.

  • Living With +

    Why is it important to treat both the mood disorder and the alcohol/drug use? When neither illness is treated, one illness can make the other worse. When only one illness is treated, treatment is less likely to be effective. When both illnesses are treated, the chances for a full and lasting recovery are greatly improved, and it is easier to return to a full and productive life. Why is it important to stay clean and sober when getting treatment? Mixing alcohol or drugs with medication can have serious and dangerous effects. Many medications, including over-the-counter medications, interact with alcohol or drugs in harmful ways. It is also unlikely that you will benefit from talk therapy if you are under the influence.

    What should I expect from treatment?

    You may need to go to more than one doctor and attend more than one support group. All of your treatment providers should be aware that you have a dual diagnosis. Treatment for your mood disorder may include counselling or psychotherapy, medication and DBSA support groups where you can share your experience living with depression or bipolar disorder. Treatment for your alcohol and/or drug use may include some type of recovery group. If you are drinking or using every day, you and your doctor may decide that you need to check into a hospital or treatment center so you can be treated for physical withdrawal symptoms. After treating the withdrawal, you will need to treat the addiction. This may include a residential or outpatient alcohol/drug treatment center, a 12-step group or another group that focuses on living without substances. In these groups, you will learn how others stopped drinking or using, how to cope with cravings and urges to drink or use, and how to live comfortably without the use of alcohol or drugs.

    Talk therapy (psychotherapy) can help you learn to cope with symptoms of depression and/or mania, and change the patterns of thinking that may be making them worse. Therapy can also help you look at your drinking/using habits and work on staying clean and sober. You may get therapy from a psychiatrist, a psychologist, a social worker, a therapist, a counsellor, a nurse or another health professional.

    Medication to help with symptoms of depression and mania may be prescribed by a physician or psychiatrist. You and your doctor will work together to find the right medication(s) for you. Different people have different responses to medication, and many people need to try several before they find the best one(s). Though it may not be easy, be patient when starting new medications and wait for them to work. Don’t lose hope. Some can take four to eight weeks before you feel their full effects.

    Keep your own records of treatment—how you feel each day, what medications and dosages you take and how they affect you, and any alcohol or drug use.

    Medications that affect the brain may also affect other systems of the body, and cause side effects such as dry mouth, constipation, sleepiness, blurred vision, weight gain, weight loss, dizziness or sexual problems. You might feel the side effects before you feel the helpful effects of your medication. Many times, these side effects will go away in a few weeks. If they don’t go away immediately, don’t be discouraged. There are ways to reduce or get rid of them.

    Change the time you take your medication to help with sleepiness or sleeplessness.

    Take it with food to help with nausea.

    Your doctor may change your dosage or prescribe another medication.

    Tell your doctor about any side effects you are having. You and your doctor should work together to make decisions about medication.

    Never stop taking your medication or change your dosage without talking to your doctor first.

    Am I still clean and sober if I take medication?

    Absolutely. Taking medication as prescribed by a doctor is not the same as using alcohol or street drugs to feel better. Medications affect the same brain chemicals that alcohol and street drugs do. But medication balances the levels of these chemicals instead of making them rise and fall. Medications help keep your brain chemicals, and your moods, more predictable and stable. They can help you to be yourself.

    Medications do not impair your judgment. They do not give you a false sense of courage. They do not cause you to crave another pill soon after you’ve taken the first. They are not mixed or “cut” with other dangerous chemicals. They have been tested and found to be safe and effective.

    The goal of medication treatment is to help you become stable and healthy. Medications manage your symptoms, rather than masking them. They help you take control and work toward positive changes in your life. Your doctor also monitors your medications, and if you have any problems, s/he can help you decide what changes need to be made. Some drug and alcohol recovery groups may believe that you can’t be clean and sober if you take medications prescribed by a doctor. This belief is just plain wrong. Medication for your mood disorder is no different than medication for another illness such as asthma, high blood pressure or diabetes. If your recovery group challenges your use of medication, it is probably best for you to become part of another group that understands the concept of dual diagnosis. The good news is there are many different recovery groups to choose from. Don’t give up hope. If you keep looking, you will find other people who are dually diagnosed and receive treatment for both illnesses.

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