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One of the most troublesome problems in addiction treatment is dual diagnosis. Addiction is a challenging chronic disease that’s currently plaguing the United States and the world abroad, killing tens of thousands every year. One of the roadblocks to treating this growing problem is co-occurring mental disorders alongside substance use disorders. The two often feed off of one another, creating a problem that resists most conventional attempts to solve. Still, responsive treatment options for dual diagnosis exist, and more are on the horizon. The challenge now is getting people the help they need, and the first step is to learn about dual diagnosis, its causes, and what you can do.

What is Dual Diagnosis?

Dual diagnosis is defined as “the condition of struggling with a mental illness and a co-morbid substance abuse problem” at the same time. As a relatively new method of treatment, dual diagnosis treatment has been crucial in helping those with disorders or disabilities. Until the 1990s, those who struggled with mental health disorders such as depression, anxiety, delusion, or mood swings went through entirely different treatment than those who struggled with substance abuse.

When drug addiction and mental health disorders overlap, treatment centers used to deny most clients from enrolling in mental health treatment until they were sober. Eventually, this was seen as counterproductive seeing that many cases of drug addiction were fueled by underlying psychiatric disorders.

Thus, those with a dual diagnosis of substance abuse and mental health disorders almost never got the proper treatment they need.If you or someone you know meets the criteria for being diagnosed with a mental health disorder, from depression to bipolar disorder to schizophrenia, as well as an addictive disorder, dual diagnosis would be the most effective and beneficial course of action.

Seeing as dual diagnosis treatment can help both your mental and addiction disorder, there are little to no downsides of seeking dual diagnosis treatment as long as you meet the criteria.

Potentially half of people being treated for substance use struggle with a co-occurring mental illness.

Potentially half of people being treated for substance use struggle with a co-occurring mental illness. Facilities and programs that aren’t equipped to deal with dual diagnosis may not have the resources to diagnose and treat co-occurring disorders.

In many cases, dual diagnosis treatment takes longer to complete. Treatment plans (including timing) should be tailored to the individual and responsive to needs.

Alcoholism and depression, PTSD and opioid addiction, and dozens of other combinations exist that all require unique treatment.

Relapse prevention is a major part of any successful treatment program, but dual diagnosis needs more robust sobriety maintenance.

Responsive, personalized treatment exists for people with an SUD and a mental illness.

Despite the challenges, researchers and addiction specialists have identified the problem of dual diagnosis and are working on ways to treat it effectively. Today, there are many treatment options for co-occurring disorders of different types.

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How Common is Dual Diagnosis?

Despite the fact that it’s often underdiagnosed, dual diagnosis isn’t rare at all. Dual diagnosis between substance abuse and mental health disorders is fairly common. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), millions of people struggle with a mental health issue and addiction. People who struggle with mood and anxiety disorders are twice as likely to struggle with addiction and vice versa when compared to the overall population. Adolescents with significant behavioral problems are seven times more likely to have used or abused substances like drugs or alcohol in the past month.

Though there are greater numbers of people who struggle with substance abuse disorders without any diagnosed second disorder, substance abuse dramatically raises risk factors for developing other mental health disorders.

According to the Journal of Clinical Psychiatry, it’s so common that it should be expected. “The co-occurrence of a severe mental illness and a substance abuse or dependence disorder is common enough to be considered the expectation more than the exception.” For this reason, many treatment facilities have incorporated mental health checks into normal intake procedures to place clients into the best possible treatment programs.

According to the SAMHSA, over 39 percent of adults who had an SUD in 2014 also had a mental health issue. That totals at about 7.9 million people with co-occurring disorders. Other estimates are higher, especially when you take undiagnosed mental illness into account.

While 39 to possibly 50 percent isn’t the majority of cases, the prevalence of co-occurring disorders is enough to warrant extra precautions. Treatment centers should expect the possibility in order to treat clients correctly.

What Causes Dual Diagnosis?

Dual diagnosis may not always occur because one disorder caused the other, but it is clear that one disorder can often exacerbate the other. According to NIDA, drug abuse can bring out mental disorder symptoms in individuals with increased risk.

Depending on a variety of factors like family life, heredity, stressful occupations, chronic medical conditions, and isolation, some people are at a greater risk of developing a mental illness. Because drug and alcohol abuse is a risk factor for mental illness, according to the Mayo Clinic, it can be what tips the scales towards developing a disorder.

Mental illness can also lead to substance abuse by means of self-medication. People struggling with anxiety or depression often use alcohol or other drugs for a brief period of relief. However, these substances ultimately exasperated mental disorders and can develop into substance abuse disorders.

According to NIDA,dual diagnosis can often be difficult to determine which disorder came first. It can also be that shared risk factors for both disorders caused both independently. For instance, environmental triggers like stress and trauma can contribute to a substance abuse disorder and a mental health issue.

The origins of dual diagnosis cases are often debated. Addiction and other mental health disorders seem to have a close relationship and there are several theories as to why. Some posit that psychoactive substance use leads to psychological disorders. However, others suggest that drugs merely trigger secondary, co-occurring disorders.

According to the Journal of Clinical Psychiatry, “Causes of this comorbidity may include self-medication, genetic vulnerability, environment or lifestyle, underlying shared origins, and/or a common neural substrate.”

There are many possible causes for dual diagnosis (also called comorbidity) and they are not mutually exclusive. Risk factors can work together to increase the likelihood of developing dual diagnosis.

Glowing brain in hands

Poor Coping Mechanism

One of the most likely causes of dual diagnosis is using drugs or alcohol to cope with an existing mental illness. Depression is common in the United States and 1.5 percent of the population struggles with persistent depressive disorder (PDD) alone. Anxiety disorders are even more common. As the most prevalent mental illness in the US, it affects 40 million people, which is slightly over 18 percent of the population. Still, millions of people don’t get the treatment they need; only a minority (36 percent) of people struggling with anxiety get treatment.

Instead, people will often look for other, unhealthy ways to cope with stress. Using drugs to alleviate the symptoms of a psychological disorder is called self-medication.

Alcohol is frequently used as a form of self-medication because of its effects on mood and memory. Other central nervous system depressants, especially benzodiazepines, can act as an anti-anxiety medication. However, if abused or taken beyond what’s described, drugs and alcohol can make mental disorders much worse.

Overlapping Risk Factors

Both substance use disorders and mental health issues have a set of risk factors that increase your likelihood of developing a disorder. Many of the risk factors for SUDs and mental disorders overlap, which can contribute to the high amount of people who struggle with a dual diagnosis. Overlapping Risk Factors include:

Mental illness isn’t always a product of random chance or even outside influences. Some disorders can be passed down from generation to generation. Likewise, evidence suggests that biological influences affect your likelihood of developing a SUD.

Military servicemen and women have a high instance of both post-traumatic stress disorder and SUD. Because veterans have a greater risk of experiencing head injuries and high stress, traumatic scenarios, they also have an increased risk of developing a dual diagnosis. Likewise, people who experience traumatic events like car accidents, sexual assault, and violent crimes are more likely to experience.

Environmental factors can play a role in the development of dual diagnosis as well. For instance, stressors in your home life can cause depression that leads to coping with drugs. If parents use drugs or alcohol, studies show that children are more likely to have behavioral problems and children of alcoholic parents report higher rates of depression and anxiety.

Certain biological factors can cause both addiction and mental health problems. For instance, imbalances in your neurochemistry can lead to depression and then to poor coping strategies. The National Institute on Drug Abuse reports that people with schizophrenia have higher rates of abusing alcohol, tobacco, and other drugs. Research has shown that abnormalities in areas that are known to increase your predisposition to schizophrenia may also increase the rewarding effects of drugs like nicotine.

Damage Leading to Co-Occurring Disorder

It’s possible that instances in which a SUD occurs before a co-occurring mental illness, the substance use is triggering a latent mental illness. For example, a person may have a genetic abnormality that could potentially lead to a mental health issue that hasn’t yet manifested in noticeable symptoms. When heavy use of a psychoactive substance is introduced into the brain, it can begin to leave damage that triggers the underlying issue.

For instance, if you have a genetic predisposition to schizophrenia and you start regularly smoking marijuana, you may start to develop symptoms of the mental disorder. While marijuana shows no evidence of causing schizophrenia, studies show that it could cause it to precipitate in people who are vulnerable. For this reason, it’s generally more dangerous for people who have a personal or family history to take drugs like psychedelics and hallucinogens, even though many have very low risk of overdose and addiction.

Signs of a Dual Diagnosis Disorder

If you are worried that you might have a co-occurring disorder, there are several signs that you may be able to recognize. Unfortunately, identifying a dual diagnosis by its symptoms is difficult. If you believe that you do have a co-occurring disorder, it’s even more difficult to properly self-diagnose mental illness. If you have any suspicions, talk to a doctor or call the addiction specialists at Ocean Breeze Recovery for further guidance. That being said, there are some basic warning signs you may be able to recognize:

Chemical substances are often used to feel high. However, people using them to cope with mental illness might be using it to feel “normal.” If you feel anxious or unsatisfied without drugs, it could be a sign of physical or psychological dependence. If you can’t remember ever feeling satisfied without drugs, it could be that you are using them as self-medication.

If you’ve started using drugs or alcohol heavily, consider your family’s experience with mental disorders. If your parents or grandparents have had depressive disorders, anxiety disorders, or another mental issue, it’s possible that your substance use also has an underlying cause in mental illness.

Think about the time before you began using heavily. Was it a way to connect with friends? Were you looking for entertainment? Were you looking for relief from depression, stress, or anxiety? Again, this is difficult to assess. You may have started drinking at parties as a supposed form of entertainment, while the underlying reason was that it was a way to overcome intense social anxiety.

Trauma is a common cause for mental health problems and substance abuse issues. If you have recently gone through a traumatic event like a car accident, an injury, or a violent attack, you may be at greater risk for both.

If you have a personal history with mental illness and you are worried that you are also developing a substance use disorder, there are several signs that are bit easier to notice. If you are worried about a friend or family member, you may also be able to observe the following signs in others. Signs of addiction include:

  • Strange bursts or lack of energy.
  • Irritability
  • Sudden change in weight
  • Change in sleep patterns
  • Missing work or school
  • Lower performance in work or school
  • Strains in relationships
  • Isolation
  • Financial problems
  • Dilated pupils/ red eyes
  • Lack of personal hygiene

If you’ve been using drugs or alcohol to cope with anxiety, depression, or another mental illness, there are three basic signs that your drug use is turning into dependence: a loss of control over the amount and frequency of use, drug cravings that compel you to use, and continuing to use despite consequences. If you have experienced this kind of drug use and you have a personal or family history of mental illness, it may be a sign of dual diagnosis. To learn more, call the addiction specialists at Ocean Breeze recovery for more guidance as to what you can do next.

Common Mental Illnesses with Dual Diagnosis

Dual diagnosis can occur with a number of mental health issues and psychological disorders. However, a few conditions frequently occur with drug and alcohol abuse. Here are some mental issues that are commonly found in dual diagnosis cases:

  • Depression
  • Anxiety disorders
  • Schizophrenia
  • Personality disorders

Both disorders can occur simultaneously or one can lead into the other. The depressant nature of substances like opioids or alcohol can cause or worsen depression symptoms. However, co-occurrence does not always mean one disorder causes the other. Mental disorders and addiction have a number of possible causes, many of which overlap like heredity, family life, and environment.

Dual diagnosis comes in a wide variety of combinations, which makes it very difficult to diagnose and treat in many cases. However, there are a few mental illnesses that commonly accompany SUDs. Recognizing common co-occurring disorders can help you identify possible underlying causes of substance abuse. It can also help clinicians offer a more complete range of treatment options.

Trauma is a common factor in addiction and therapists often uncover that a client with an SUD has had a past experience that led to substance abuse. In some cases, trauma can become its own psychological disorder.  Post-traumatic stress disorder (PTSD) is a common psychological issue that’s caused by a traumatic event or the circumstances surrounding a high-stress situation. PTSD is most common among military combat veterans, which are often experience dual diagnosis because of trauma or head injuries leading to self-medication with drugs or alcohol. However, many people can develop PTSD after experiencing trauma including victims of violent crime, sexual assault, and accidents and injuries.

Post-Traumatic Stress Disorder symptoms include:

  • Reliving the traumatic event
  • Flashbacks
  • Nightmares
  • Panic attacks
  • Anxiety
  • Depression
  • Mistrust
  • Loss of interest in normal activities
  • Loneliness
  • Guilt
  • Insomnia
  • Emotional detachment

Trauma can prove to be a significant barrier to addiction treatment as PTSD can cause a variety of symptoms that lead to high stress and triggers. If the addiction is treated but the trauma is ignored, the underlying problem will continue to occur, making it more difficult to maintain abstinence. Under normal circumstances, a substance use disorder trains the brain to turn to your drug of choice as a response to negative emotions like anxiety, anger, boredom, or sadness. When PTSD is involved, the negative emotions that may trigger that self-medication response are much more intense. When fear and panic set in, your brain will automatically come in with learned solutions, like saying “alcohol has made you feel better in the past; try that.”

Resolving and working through traumas while you go through addiction treatment is the best option for this particular dual diagnosis. Fortunately, there is a treatment that is available at a number of addiction treatment facilities around the country, including Ocean Breeze Recovery.Eye movement desensitization and reprocessing (EMDR), is a type of psychotherapy that’s specifically intended to help people work through trauma. The treatment involves talking through traumatic events while focusing on a secondary stimulus, like following someone’s hands with your eyes.

The original principle was conceived when it’s inventor, Francine Shapiro, noticed that eye movements in a certain pattern removed some of the intensity of a traumatic memory. By talking through a traumatic experience while the intensity is lessened, you can ideally reprocess those memories in a healthy way. EMDR practitioners posit that PTSD occurs when an event overwhelms a person and isn’t properly processed. Through EMDR, the memory is discussed and reprocessed in a healthy way.

Depression is one of the most common psychological disorders. According to the World Health Organization, over 300 million people struggle with depressive disorders worldwide. Plus, many drugs of abuse including alcohol, benzodiazepines, and opioids feed off of and worsen depression. It’s common for people to seek relief through self-medication, especially where seeking help for depression is stigmatized, information about depressive disorders is limited, or where treatment resources are unavailable. Depression can go un-diagnosed for years, leading to the use of substances that can cause depression symptoms on their own.

There are several types of depression that range in severity and the length of time they are typically experienced. Seasonal depressive disorder is a mood disorder that typically comes and goes with the winter. Symptoms include lack of energy, excessive sleep, weight gain, and mood disturbances. Major depressive disorder (MDD) can last for a shorter period of time but the effects are more severe. Symptoms include low-mood, loss of enjoyment, pain without a cause, and low-energy. In some cases, a person can experience off and on two-week periods of depressive symptoms for years. Persistent depressive disorder, or dysthymia, is longer lasting but has less severe effects. The symptoms are similar to MDD but can last for up to two years.

Sometimes the use of addictive substances can mask the presence of a depressive disorder. For instance, depression is a common side effect of alcoholism and alcohol withdrawal, so it can be difficult to recognize the signs of a deeper problem with depression. If left untreated, depression can cause a high relapse potential for people in recovery.

Because it’s so common, depression is a major concern for addiction treatment clinicians. A number of therapy programs are designed to address the potential for depression alongside addiction treatment.

Schizophrenia is a serious psychological disorder that is commonly associated with substance abuse. Dual diagnosis cases are often handled by a specialist, because they are so difficult to properly treat. People who are experiencing schizophrenia often feel like they’ve lost touch with reality. It’s not as common as anxiety and depressive disorders, but it often leads to coping with drugs or alcohol.

The most common age to begin experiencing symptoms is between 16 and 30, and in rare cases it can begin to show signs earlier. Schizophrenia symptoms are divided into three categories:

  • Positive symptoms. These are symptoms that aren’t typically seen in people unaffected by the disorder. This can include hallucinations, delusions, dysfunctional thinking, agitated body movements, and strange behavior.
  • Negative symptoms. These are identified with their relationship to normal thinking and emotions. People with schizophrenia often have a deficiency in these normal emotions. This can include reduced expression (speaking in monotone, limited facial expressions), feeling less pleasure in everyday life, and not talking.
  • Cognitive symptoms. This are hindrances to normal brain functions like working memory, limited executive functioning (understanding and applying information), and trouble focusing.

People with schizophrenia are at a greater risk of heavily using alcohol and recreational drugs. Schizophrenia has been associated with increased rates of premature death and disability, and researchers believe thatdual diagnosis is a significant contributor. Schizophrenia can lead to addiction through several avenues. As with other mental illness, drugs can be seen as a way to cope with negative emotions. However, people with schizophrenia also experience a lack of enjoyment and pleasure in everyday activities, which could lead them to seek recreational drugs as a way to heighten experience.

Treating addiction and ignoring schizophrenia is more than an uphill battle. The symptoms of the disorder can dramatically impede the treatment process because the client may not be able to fully participate in therapies. With a lack of focus, working memory, and ability to understand, addiction treatment plans may show little progress. Plus, relapse prevention will be more difficult when the initial triggers coming from schizophrenia return.

There are a variety of pharmacological and psychotherapeutic treatment options for schizophrenia. Antipsychotic medications can be used to curb positive symptoms and psychosocial therapies can help you learn coping skills. Like continuing addiction treatment, regular participation in psychosocial therapy makes relapse and hospitalization less likely.

Why Dual Diagnosis Rehab Is More Effective than One-Diagnosis Drug Addiction Treatment

You may think that it would be better to take one problem at a time. Why is it important to treat both the mental disorder and the SUD at the same time? Well, the problem is that the two often feed off of each other.

According to the Journal of Clinical Psychiatry, “The consequences of dual diagnosis include poor medication compliance, physical comorbidities, poor health, poor self-care, increased risk of suicide or risky behavior, and even possible incarceration.” Learn more – addiction treatment

Again, mental health issues often go undiagnosed for years and, in some cases, lead to substance use as a coping mechanism. Once substance abuse leads to addiction and chemical dependence, the consequences start to bleed into every aspect of life. Addiction can lead to job loss, financial difficulties, family problems, health complications, and other consequences. Because addiction causes so many visible problems, it is often the only thing diagnosed. Meanwhile, the substance abuse can be making the mental disorder worse.

When a SUD is diagnosed and treated, with no knowledge of a co-occurring disorder, it may not be effective. For instance, if someone is dealing with depression and goes to addiction treatment without treating the underlying problem, when the complete the program, they will still have the depressive feelings that led them to use in the first place. In fact, dual diagnosis patients face a worse prognosis in treatment than people with just a SUD.

Because dual diagnosis disorders contribute to one another and because it so profoundly effects treatment, it’s important to treat the whole person. When you seek treatment, the potential existence of a mental illness should be a major factor in determining your personalized treatment plan.

How to Help Someone with Dual Diagnosis?

The significant comorbidity between mental health disorders and addiction have urged professionals in the addiction treatment field to develop comprehensive treatment plans for patients battling a dual diagnosis. According to SAMHSA, 7.9 million adults struggled with dual diagnosis in 2014, and more treatment centers are opening programs for co-occurring disorders. In the middle of the opioid crisis, states are also working to improve treatment options for people with dual diagnosis.

At Ocean Breeze Recovery, this starts with an evaluation. Before a treatment plan is developed, a professional will evaluate you and your experience with both addiction and mental health issues.

Dual diagnosis also highlights the importance of individualized treatment methods rather than a one-size-fits-all plan. Behavioral therapies, support groups, family therapy, and other treatment options should be personalized to individual needs, which allows you to get the best approach for your specific personality, spirituality, history, drug of choice, and comorbid mental disorders.

Starting the Path to Recovery

Ocean Breeze Recovery is also committed to staying up-to-date with the latest and best treatment methods for both medical and psychological care. While some facilities may merely treat symptoms of withdrawal in order to get addicts through detox, we believe in treatment that results in long-lasting addiction recovery. Through medical monitoring, cognitive behavioral therapy, group sessions, and a variety of other treatment options, people struggling with a dual diagnosis can learn ways to overcome addiction and cope with triggers for both addiction and mental health issues.

If you or someone you know is living with a mental health disorder, it’s important to realize that substance abuse isn’t just another symptom. Adding a substance use disorder to existing mental health disorders can be extremely dangerous.


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