dual diagnosis

Pinpointing a substance use disorder can be easy if you know that a person is using a drug. For instance if a person is using heroin and suffering from an addiction, it’s pretty easy to determine that the person is suffering from a heroin use disorder. How did they get there? That takes a closer look but the base of the problem should seem pretty obvious.

There are a lot of different factors in life that contribute to an addiction, sometimes a person’s social life can play a part, or sometimes it can be genetics. Studies show that psychological factors can play a part in addiction as well. One of the problems that can come with a substance use disorder is when it’s paired with a mental health disorder; this occurrence is known as a Dual Diagnosis.

What Are Substance Use Disorders And Mental Disorders?

Substance use disorders are fairly common and for the most part, treatable conditions. According to the Substance Use and Mental Health Services Administration (SAMHSA), “substance use disorders occur when the recurrent use of alcohol and/or drugs causes clinically and functionally significant impairment, such as health problems, disability, and failure to meet major responsibilities at work, school, or home.”

A mental disorder is broadly defined as a condition that affects a person’s mood, thinking or behavior. The cause of mental disorders can vary and “your genes and family history may play a role. Your life experiences, such as stress or a history of abuse, may also matter. Biological factors can also be part of the cause. A traumatic brain injury can lead to a mental disorder. A mother’s exposure to viruses or toxic chemicals while pregnant may play a part” (U.S. National Library of Medicine).

Definition Of Dual Diagnosis

As mentioned earlier, “a person with dual diagnosis has both a mental disorder and an alcohol or drug problem. These conditions occur together frequently. In particular, alcohol and drug problems tend to occur with depression, anxiety disorders, schizophrenia, personality disorders” (U.S. National Library of Medicine).

This condition is also sometimes referred to as a co-occurring disorder, but the difference is that co-occurring conditions are used to refer to connected disorders while a dual diagnosis involves two separate diagnoses.

What’s The Purpose Of  Treatment?

Treatment is used to address both conditions. All the treatment modalities listed above serve a common purpose—to help a person get well, but they can also help:

  • Reduced substance use
  • Improved psychiatric symptoms and functioning
  • Decreased hospitalization
  • Increased housing stability
  • Fewer arrests
  • Improved quality of life

Integrated Treatment Programs For Dual Diagnosis Recovery

When treating dual diagnosis, each condition must be tended to. So if a person suffers from an antisocial personality disorder and an alcohol use disorder but continues to drink every night while being treated for the personality disorder, that treatment would seem ineffective, right? The main goal of treatment is to treat all disorders that a person may have. Even though quitting a drug habit won’t be easy, it will be essential for effective treatment.

The same is true with any dual diagnosis; and really the same goes for any mental health disorder as well. If a person is going to allow their therapist into their life to help them, they have to stop using drugs or alcohol while getting treatment. At Vertava Health Ohio, we understand that each patient is different and that treatment needs to be tailored to their individual needs.

Substance Use Disorder Or Mental Health Disorder—Which Comes First?

While a person isn’t paying attention, they hit their head, then later on they have a throbbing headache. Now if getting a throbbing headache is out of character for that person, we can easily assume that it happened from hitting their head.

The reasoning for a dual diagnosis can be harder to understand, because sometimes the substance use disorder comes first, while other times the mental disorder comes first. A person with a mental disorder might cope with their symptoms by using drugs—thereby leading to a substance use disorder. In the other case, a person’s drug or alcohol use can lead to serious emotional and mental issues; leading to a mental disorder.

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Different Types Of Recovery via Dual Diagnosis

Dual diagnoses come in lots of different variations and professionals continue to learn more about them. Deciding which condition came first isn’t the main point of treatment, it’s pinpointing what the disorders are and then treating them. Some potential dual diagnosis combinations are:

  • Antisocial Personality Disorder and Alcohol Use Disorder
  • Anxiety Disorder and Cocaine Addiction
  • Depression and Heroin Addiction
  • Post Traumatic Stress Disorder and Opioid Addiction
  • Schizophrenia and Marijuana Addiction
  • Obsessive Compulsive Disorder and Substance Use Disorder
  • Bipolar Disorder and Substance Use Disorder

Treatment For Antisocial Personality Disorder And Alcohol Use Disorder

Antisocial personality disorder is characterized by the disregard of another’s feelings and rights. It is also common for use of manipulation to exploit and hurt others. A person suffering from an alcohol use disorder or alcoholism might not care about anyone else and oftentimes they do or say hurtful things to people they care about. We make it a point not to criminalize our patients to avoid further complications such as resentment, compulsion to drink and complexes about their own behavior.

Treatment for alcohol use disorders should start off with a detoxification to get a drug out of the system. After detox, cognitive behavioral therapy and dialectical behavior therapy can lead to the root of the problem and help a patient see that what they are doing is hurting others. A person should go to treatment for as long as they’re able. Studies show that treatment for less than 90 days is more likely to end in relapse and further substance use.

Treatment For Anxiety Disorder And Cocaine Addiction

Anxiety disorder is characterized by living in a constant state of panic or fear of impending doom. There are a few different drugs that can cause anxiety, some of which are stimulants like methamphetamine or cocaine. A person suffering from a cocaine addiction is constantly pushing their heart to the limit. This can not only cause serious physical health issues but also mental health issues. Panic attacks can be a frequent problem for someone who’s regularly using cocaine.

After a necessary detoxification, some different treatments that used to help a person stop using cocaine (or methamphetamine), which in turn can help with a co-occurring anxiety disorder are:

  • Cognitive-Behavioral Therapy
  • Contingency Management, or Motivational Incentives—providing rewards to patients who remain substance free
  • Therapeutic Communities—drug-free residences in which people in recovery from substance use disorders help each other to understand and change their behaviors

Treatment For Depression Disorder And Heroin Addiction

Heroin isn’t the only drug that can lead to a depression disorder but because it’s symptoms are so closely related, the two often go hand in hand—like heroin, methamphetamine addiction is also known to lead to depression and anxiety. Heroin addiction messes with a person’s mental process and can lead a person to having suicidal thoughts, serious shifts in moods and behaviors. It’s important and vital to identify both depression disorder and heroin addiction in the early stages of treatment.

dual diagnosis treatment centers

As we mentioned before, in order for a treatment program to be successful, it must treat all disorders and rehab treatment shorter than 90 days is considered less effective. Though, any treatment is better than no treatment. After detoxification, some modalities used to treat a person suffering from a heroin addiction and depression disorder are:

  • Motivational Interviewing
  • Group Therapy
  • Individual Therapy
  • Dialectical Behavior Therapy
  • Cognitive Behavioral Therapy
  • Contingency Management
  • Family and Peer Support
  • Medication-Assisted Therapy (Suboxone, Zubsolv or Anti-Depressants)

Treatment For Post Traumatic Stress Disorder And Opioid Addiction

An opioid addiction frequently happens after a traumatic event—for instance, if a person gets injured in a car accident and gets put on an opioid painkiller they might become addicted to that medication. This is an area where identifying the cause of an addiction shouldn’t be difficult. The symptoms of post-traumatic stress disorders can be very hard to deal with, and they can include nightmares about said traumatic event, having flashbacks and other terrifying memories that can make normal life harder to deal with.

Some people resort to opioids and other prescription medications (such as benzodiazepines or other sedatives). This way of coping can be dangerous and quickly lead to addiction, because once a person’s mind becomes dependent on the drug they’ll have a hard time quitting it on their own. Even weaning off of a prescription can lead to unwanted withdrawals. The experienced professionals at Vertava Health Ohio can help with both of these disorders.

Sometimes a patient will need to be put on a medication regimen to be able to manage the withdrawal symptoms. Even though treating an opioid addiction can be difficult and emotionally draining, it will be necessary for wellness. This can include revisiting the trauma with a therapist, along with treating the addiction with similar methods as a heroin addiction.

Treatment For Schizophrenia Disorder And Marijuana Use Disorder

Marijuana is recently being brought back to the drawing board for other medicinal uses, however it is also believed to be a major contributor to schizophrenia disorders. Some would argue that the benefits of cannabis outweigh the adverse effects but any drug that leads to an outcome of a mental disorder like schizophrenia should be reconsidered or used with extreme caution.

“Several studies have linked marijuana use to increased risk for psychiatric disorders, including psychosis (schizophrenia), depression, anxiety, and substance use disorders, but whether and to what extent it actually causes these conditions is not always easy to determine” (National Institute on Drug Abuse – NIDA).

First things first, when treating a dual diagnosis of schizophrenia and marijuana use disorder, a person has got to stop using marijuana if they want to get well. Continuing drug use will make it difficult for therapists and other professionals to determine the cause and therefore solution of a patient’s disorder. Some short and long term effects of marijuana can be:

  • Impaired short-term memory
  • Impaired attention, judgment, and other cognitive functions
  • Impaired coordination and balance
  • Increased heart rate
  • Anxiety, paranoia
  • Psychosis (uncommon)
  • Impaired learning and coordination
  • Sleep problems

Different genetic and social factors also play a role in the likelihood that a person will develop a mental disorder along with marijuana dependence. Studies show that the age that a person started using cannabis can also make a difference. Some treatments used are motivational incentives and interviewing, as well as therapies like dialectical behavior therapy and cognitive behavioral therapy.

Treatment For Obsessive Compulsive Disorder And Substance Use Disorder

Obsessive compulsive disorder (OCD) is a type of anxiety, therefore should be treated with the same care and attention as anxiety disorders. A person with OCD might do a lot of things that seem strange to others, such as becoming overly obsessed with routines and patterns, but it’s important to remember that mental disorders are no laughing matter and the people might have a traumatic history that has led them there—what they need is care and understanding.

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Treatment programs such as cognitive behavioral therapy and dialectical behavior therapy are helpful for treating someone who’s dealing with OCD, because they help a patient dig deeper and see the root of their problem behavior. Like many dual diagnoses, it’s uncertain which comes first with obsessive compulsive disorder and substance use disorder.

Treatment For Bipolar Disorder And Substance Use Disorder

Bipolar disorder is also known as manic depression, wherein a person will have serious mood shifts. These mood and energy shifts are known as manic episodes and a person with a bipolar disorder may seem happy and energetic one minute, then seem irritable and tired the next. Like substance use disorders, bipolar disorders can alter a person’s social life, career direction and motivation.

Patients might have suicidal thoughts or feelings of apathy and indifference. It’s important to seek professional help for bipolar disorders and not try self-diagnose or self-medicate it. A person with a dual diagnosis of bipolar disorder and a substance use disorder might become severely depressed, at which point professionals might need to use a medication to properly treat them. Individual and group therapy can also be a big help.

How Many People Have A Dual Diagnosis?

“Approximately 7.9 million adults in the United States had co-occurring disorders in 2014” (SAMHSA). People who suffer from a substance use disorder are more likely to have a mental health disorder along with it. The same goes for mental health disorders—“about 45% of Americans seeking substance use disorder treatment have been diagnosed as having a co-occurring mental and substance use disorder.”


Frequently Asked Questions:

What is a dual diagnosis in mental health?

Dual diagnosis refers to an individual who has both an addiction and a mental health illness such as anxiety or depression that occurs at the same time.

How do you deal with dual diagnosis?

Dual diagnosis can be addressed through treatment programs. Here at Vertava Health Ohio, we follow evidence-based treatment and utilize cognitive behavioral therapy and dialectical behavior therapy. Our counselors are trained to treat dual diagnosis and can alter treatment and methods based on a patient’s needs and specific diagnoses.

What is the difference between comorbidity and dual diagnosis?

Comorbidity refers to any two or more disorders or illnesses occurring in the same person. Dual diagnosis is reserved to specifically refer to both a mental illness and addiction occurring at the same time.

What are the 5 most common mental illnesses?

It’s difficult to name exactly 5 of the most common mental illnesses. However, the National Center for Biotechnology Information discusses depression, General Anxiety Disorder, panic disorder, phobias, and social anxiety disorder in their guideline titled Common Mental Illnesses.