“Many people with a dual diagnosis are misunderstood, cannot communicate, or are denied certain services. They may have access to some services, but outcomes will be poor unless services are designed to meet their particular needs.”
~ Policy paper of the National Coalition on Dual Diagnosis
One of the biggest challenges that can face someone who needs treatment for such as abuse is the fact that their disease may co-occur with another psychiatric disorder. The simultaneous manifestation of comorbid conditions can make a successful recovery from either much more difficult.
What Is a Dual Diagnosis?
Simply put, dual diagnosis is when a substance abuse disorder such as:
- Prescription drug diversion
- Illicit drug addiction
- The abuse of inhalants
co-occurs with a psychiatric condition such as:
- Post-Traumatic Stress Disorder (PTSD)
- Bipolar Disorder
- Obsessive-Compulsive Disorder
- Conduct Disorder
- Attention Deficit Hyperactivity Disorder (ADHD)
- Disordered Eating
What Is the Link between Substance Abuse and Psychiatric Disorders?
Each type of disorder – addictive and psychiatric – can play a role in the development and worsening of the other.
A person with a psychiatric disorder will self-medicate with drugs or alcohol in an attempt to reduce the symptoms of their condition – they want to feel better.
On the other hand, a person addicted to drugs or alcohol will often experience depression, anxiety, or trauma as a result of their chaotic substance-fueled lifestyle.
How Common is a Dual Diagnosis?
The National Bureau of Economic Research records that there is a “definite connection mental illness and the use of addictive substances“. The Substance Abuse and Mental Health Services Administration estimates there are nearly 9 MILLION American adults with comorbid addictive and psychiatric illnesses.
Unfortunately, less than 8% ever get treated for both disorders. Even worse, nearly 56% never receive any treatment at all.
Here are some statistics from the Journal of the American Medical Association and other sources:
- Half of all people with a diagnosable psychiatric disorder also abuse alcohol or drugs.
- Just over half – 53% – of all people addicted to drugs and over a third – 37% – of alcoholics have a diagnosable mental illness.
- Approximately 30% of people with a mental illness will have a comorbid Substance Abuse Disorder (SUD). This is more than TWICE the rate of the general population.
- PTSD and SUDs are the most-common co-occurring disorders.
- Among drug-or-alcohol-dependent people, PTSD is THREE TIMES more likely than it is in the general population.
- Up to 95% of people seeking treatment for an SUD self-report having experienced intense trauma.
- Around 50% of women and 20% of men in drug or alcohol rehab were sexually abused as children. Childhood sexual abuse DOUBLES the number of symptoms related to addiction or PTSD.
- Roughly 60% of women and 80% of men in drug or alcohol rehab were neglected or physically abused as children.
- Men with PTSD are FIVE TIMES more likely to have an SUD than men without PTSD.
- Substance abusers with comorbid PTSD tend to use/become dependent upon cannabis, alcohol, cocaine, and prescription drugs.
- In 2007, the Centers for Disease Control and Prevention reported that 70% of all successful suicides had an anxiety and/or depressive disorder. Of that 70%, 90% were self-medicating with alcohol or drugs at the time of their suicide.
- More than a third of all teenagers with ADHD abuse at least one substance. Only 20% of those without ADHD do so.
- Over half of those with UNTREATED ADHD will abuse alcohol or drugs.
- About 8% of US children and 5% of adults have ADHD – but among teenage marijuana users, that percentage shoots up to 30%.
- Approximately 13% of people with ADHD become dependent upon marijuana, compared to 7% of those without ADHD.
- Greater than 15% of all adult patients with ADHD meet the standard for a diagnosis of a SUD, compared to under 6% of those without ADHD.
- One-third of substance abusers have a co-occurring anxiety disorder. Reciprocally, one-third of people with an anxiety disorder struggle with substance abuse.
- Anxiety disorders affect 40 MILLION US adults.
- Women are TWICE as likely as men to struggle with anxiety.
- Male substance abusers have a rate of depression that is THREE times higher than that of the general public, while female substance abusers have a rate that is FOUR times higher.
- Men are more likely to develop an addictive disorder before becoming depressed, while women typically experience depression before the addiction.
- More than 50% of people with eating disorders also abuse drugs and/or alcohol. This is a rate that is FIVE times that of the general population.
- Up to 40% of female alcohol abusers also have an eating disorder.
- Conversely, 57% of males with an eating disorder will abuse drugs or alcohol at some point within their lifetime.
How is a Dual Diagnosis Treated?
Successful treatment for a dual diagnosis requires a deliberate approach –the Substance Abuse and Mental Health Services Administration recommends that both disorders be treated simultaneously by using an integrative, cooperative approach.
Unfortunately, too many service providers on both side of the aisle – addiction and mental health – on experienced or expert enough to (1) properly diagnose co-occurring disorders or (2) offer effective, evidence-based strategies for that dual diagnosis.
Treatment is “integrative” when the patient can get virtually all of the services they need from one rehab program. Service providers and other members of the treatment team stay in constant communication, working collaboratively under the umbrella of a shared treatment strategy.
Treatment is “comprehensive” when it addresses both disorders simultaneously on multiple levels – medical, emotional, behavioral, spiritual, relational, social, etc. – in order to promote total wellness and prevent relapse.
One of the biggest things to look for in effective dual diagnosis treatment is the use of prescription medications. There are medicines that can stabilize moods or ease cravings and withdrawal symptoms associated with addiction. Only then can the person be clear-minded enough to truly begin real recovery.
Integrated Treatment for Co-Occurring Disorders: Treating People, Not Behaviors, by Jack Klott
Faces of Dual Diagnosis: a Canadian Perspective, by Robert B. Pereira