The term dual disorders or dual diagnoses refers to cases in which the individual has both a substance abuse disorder (also referred to as chemical dependency or addiction) and a coexisting psychiatric illness such as depression, schizophrenia, borderline personality disorder, social phobia and other illness.  The symptoms of one condition may mask or aggravate the symptoms of the other. It is possible for people to have more than two disorders. Having a dual diagnosis can make treatment in a drug rehab more difficult and demands a level of competence from the staff.

How Common is Dual Disorder Diagnosis?

Dual diagnosis, the co-occurrence of substance use disorders and mental health conditions, is highly prevalent with research indicating that 50% of individuals experiencing one will also suffer from the other at some point in their lives. In 2020, the U.S. reported 17 million adults with both a mental health disorder and a substance use disorder. Symptoms vary widely depending on the specific disorders involved, encompassing withdrawal from social circles, behaviour changes, mood fluctuations and difficulties in concentration among others. The cause-and-effect relationship between the two types of disorders is complex, without a clear indication of which typically precedes the other. Contributing factors to dual diagnosis include genetics and environmental stressors, both of which can influence the development of these disorders. Additionally, individuals with mental health disorders may use substances as a form of self-medication, exacerbating both conditions.

Historically, addiction and mental health disorders have been treated separately, often leading to less effective outcomes. However, in recent years, there has been a notable shift towards an integrated approach that addresses both conditions simultaneously. This new approach acknowledges the interconnectedness of addiction and mental health, recognising that treating one without addressing the other may not lead to long-term recovery.

Recognising Dual Disorders

Identifying a dual diagnosis, where an individual simultaneously suffers from a substance use disorder and a mental health condition, is challenging due to the interplay and varying symptoms of each disorder. The complexity increases as symptoms can differ significantly based on the type of substance abused and the specific mental health issue present. For instance, the symptoms of depression combined with marijuana abuse may differ markedly from those of schizophrenia with alcohol abuse. General indicators of a co-occurring disorder include using substances to cope with negative emotions or situations, noticing a link between substance use and mental health, family history of similar issues, feeling unwell even in sobriety and previous unsuccessful treatments focused on only one aspect of the dual diagnosis.

Denial is a significant barrier in addressing both substance abuse and mental health conditions with individuals often reluctant to acknowledge the extent of their dependence or the impact of their issues. Acceptance of these problems and seeking help are important first steps towards recovery, transcending fear, shame or the stigma of being perceived as weak.

Treating Dual Disorders

Understanding dual disorders is crucial, as they can manifest in various ways—some individuals might develop mental health issues due to substance use, while others might use substances to cope with existing mental health disorders. The interplay between mental health and substance use disorders is complex with common co-occurring mental health conditions including depression, anxiety, bipolar disorder and PTSD. These can both contribute to and be worsened by substance use, highlighting the importance of recognising dual disorders for effective treatment.

Managing dual diagnosis requires a comprehensive approach that often includes both pharmacological and non-pharmacological treatments. Pharmacological treatments target the neurobiological changes and symptoms of psychiatric disorders and help manage substance withdrawal and cravings. Non-pharmacological treatments encompass a variety of psychosocial interventions, such as family therapy, motivational interviewing, cognitive behavioural therapy and mindfulness practices, aimed at reducing relapse rates and improving overall functioning.

Effective treatment for dual diagnosis involves a multidisciplinary team of healthcare professionals, including psychiatrists, psychologists and social workers to provide a tailored approach that addresses both the substance use and psychiatric conditions simultaneously. This integrated treatment model has become the norm, focusing on multiple conditions and employing a combination of therapies for the best outcomes.

An integrated treatment approach, combining therapies targeting both addiction and mental health, is essential for addressing dual disorders. This comprehensive strategy may involve individual counselling, group therapy, medication management, support groups and holistic practices like yoga or meditation. Overcoming dual disorders poses challenges but is achievable with transparent communication between individuals and their healthcare providers, ensuring a treatment plan that addresses all symptoms and concerns.

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