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Dual Diagnosis: What Is It?

Understanding the relationship between mental health disorders and substance abuse–referred to as “dual diagnosis”–is complex, and crucial in order to address the welfare of more than 8.9 million people in the United States, according to the 2009 National Survey on Drug Use and Health (NSDUH).

Prevalence of Patients with Dual Disorders

In the healthcare and addiction treatment industries, a person who has a mental health problem and a co-occurring substance abuse disorder is  termed as having a “dual diagnosis.”  This is a combination of any mental health problem such as depression or an anxiety disorder, and drug addiction or alcoholism, for example. In the United States alone, the NSDUH reported there are 11 million adults with a serious mental illness. The NSDUH reported that 20.8 million adults with a substance use disorder. Among those 20. 8 million adults, 42 percent (8.9 million) had a co-occurring mental illness. Of those adults with a serious mental health disorder, such as schizophrenia, greater than 25 percent have dependency on a substance.

The Importance of Accuracy in Assessment for Dual Diagnosis

The co-morbidity of dual diagnosis has vast implications for treatment and prognosis. Current research suggests that treating just the mental health component or just the substance abuse component leads to poorer outcomes, increased relapse, greater risk of legal and health consequences as well as a higher mortality rate. The symptoms tend to be more severe and persistent and standard treatment plans are not effective with. Patients and families armed with this information are able to make better choices for treatment and rehabilitation, as not all centers are equipped to deal with both mental health disorders and substance abuse at the same time. Confirming that a treatment center has the capability to help patients with a dual diagnosis  is an important factor for families that are trying to determine what type of treatment setting provides the best prognosis.

It can be very difficult to make an accurate diagnosis as so often the symptoms of one disorder can mask or exacerbate the symptoms of the other. The signs and symptoms of addiction and mental illness interact in such a way that making a determination of two separate chronic conditions can be extremely complicated.

It may not be apparent that a dual diagnosis exists until after a patient enters treatment. During substance abuse treatment, the symptoms of a mental health disorder may manifest more prominently once a period of detoxification and withdrawal are completed and a period of abstinence ensues. It is not uncommon for those suffering from mental illness to use drugs and alcohol to “self-medicate” in an attempt to control or manage the symptoms of their illness.

In some patients, substance abuse may present as anxiety, depression, violence, or paranoia with the underlying cause being the substances themselves and not necessarily a primary mental health illness. This underscores the necessity for broad assessment and diagnostic tools so practitioners can accurately diagnose patients and can develop comprehensive treatment measures that provide the best chance for recovery in these patients.

Understanding Treatment Options for Dual Diagnosis

Concurrent treatment of substance abuse and mental illness provides the best opportunities to reduce the morbidity and mortality rates of these high risk patients. Research into the genetics of addiction and mental health reveals that there are similarities between affected areas of the brain. Environmental stimuli, such as physical and psychological trauma, young age at first use, and poor coping mechanisms to deal with stress, can act as triggers for both mental illness and addiction. These environmental stimulil are important factors to consider in the treatment of both those suffering from addiction and mental health disorders. A clearer understanding of how genetics, the environment, and various combinations of risk factors can promote and exacerbate symptoms of dually-diagnosed patients is necessary to understand which treatment modalities will have the greatest success for this population. Comprehensive concurrent treatment is quickly becoming the most favored approach for these complex patients and their families.


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