Dual Diagnosis Issues–Self-Medicating with Drugs and Alcohol
Dual diagnosis issues are far-ranging because there are many factors involved in anyone’s life that has both a substance problem and a mental health condition. Just to begin to understand the possible issues, think of how many different substance problems one may have. You may, for example, be addicted to any one of a myriad of addictive substances. You may also use several together. In fact, many people use a mixture of substances regularly. For example, a common combination is pain pills, benzodiazepines, and alcohol–all of which pose serious risks alone, but together can be deadly. Any particular mix of addictive substances will present its own complications.
Another complicating factor in dual diagnosis issues is that you may also be at any of several stages of a substance problem at any given time. Substance Use Disorders, or as we commonly call them, addictions, or substance abuse problems, can be mild, moderate or severe. The various stages of a substance disorder also present unique issues.
To further illustrate how complex dual diagnosis issues can be, we have to also consider the other side of a dual problem. That is, there are a great many forms of mental health issues that can be paired with a substance disorder. The DSM-V, or Diagnostic and Statistical Manual, used to medically diagnose mental health disorders, defines approximately 300 mental health conditions. Any of these conditions, or even more than one can be paired with a substance problem.
The Issue of Self-Medication
Dual diagnosis issues are fertile ground for the use of addictive substances to self-medicate. And, self-medication always indicates untreated symptoms that are causing distress. Some of the most common untreated mental health issues that lead to self-medication are depression, anxiety, mood swings, problematic anger, prolonged grief, and trauma. Each of those issues would benefit from treatment, however, people often turn to substances to ease the initial distress, but then continue on without seeking appropriate help. Consequently, the original issue does not get treated and often worsens, while the substance use escalates into a problem itself.
Choosing Self-Medicating Substances
Commonsense tells us that whatever untreated symptoms you have, you are apt to choose a self-medicating substance that somehow suppresses that symptom. For example, people with low energy and depression may choose a stimulate to increase energy and improve mood. At the other end of the spectrum, people who are agitated, anxious or have insomnia are apt to choose a depressant that will calm them.
People also get stuck in a polydrug cycle in which they attempt to manage various aspects of a mental health problem. For example, people with an untreated Bipolar Disorder may use stimulants when they are depressed and depressants when they are agitated as their illness cycles through severe mood swings.
Self-Medication Can Sabotage Treatment and Recovery
Substance use of any type can confuse and sabotage mental health treatment. And, there are multiple problems that cause problems when one seeks help for mental health symptoms while using substances. One of the most sabotaging of all is that people often conceal their substance use from healthcare providers, or they may disclose use, but greatly underreport how much is taken or how often. Consequently, healthcare providers do not have a clear idea of what is happening, and cannot always make an accurate diagnosis or establish an appropriate treatment plan.
Another common problem in treatment and recovery is that what appears to be a mental illness may be the effects of a substance. This works in the other direction, too. What appears to be effects of a substance problem may actually be a mental illness. Working with dual diagnosis experts can sort through all of this to establish an accurate diagnosis and an effective treatment plan.
Additionally, self-medication can sabotage the gains you make in treating a mental illness. If substance use continues because you have developed a pattern of use and an addiction, the mental health condition will eventually worsen despite your best efforts to stabilize it. Unfortunately, many people who self-medicate mental health symptoms will continue use even if the symptoms disappear for a while. This happens because the substance use itself has become a problem.
The Personal Confusion of Vicious Cycles
People with untreated dual diagnosis issues can be caught in relentless vicious cycles. There can be so much distress and chaos to deal with that one cannot ‘see the forest for the trees’, and really, it is not your responsibility to diagnose yourself or a loved one in such a situation. However, it can be difficult to know how to seek help and from whom.
It is wise to seek a dual diagnosis evaluation when you are using substances regularly and have distressful mental health symptoms such as depression, anxiety, mood swings, distressful thoughts or memories, flashbacks, disturbed sleep, nightmares, hallucinations, false beliefs (delusions), periods of unusually high energy and agitation, or angry or aggressive outbursts.
Vicious cycles develop in dual disorders when one has such symptoms listed above and uses substances, only to find that the symptoms come back, and more substances are then used. In that cycle, too, substance use can temporarily relieve symptoms, but overall, cause other symptoms, or worsening symptoms that one then tries to self-medicate, too.
The Plight of Many with Untreated Dual Disorders
Untreated dual diagnosis issues can take us to very severe consequences. In the later stages of addiction, for example, the compulsion to use is so strong that physical and mental health deteriorates to an inability to function adequately. One can lose the ability to work, to maintain a home, or to maintain relationships. The same is true of some mental health disorders. They can worsen to the point of an inability to negotiate daily self-care activities. Together, a severe mental illness and a severe addiction can be catastrophic, with people unable to maintain contact with reality, much less the necessary independent living activities one needs to be safe and healthy.
Of course, these are extremes, but even before things progress to such catastrophic proportions, there can be dire life consequences when dual disorders are untreated. Loss of control and unmanageability in various life realms can occur such as in mental and physical health; work or school; relationships in general; finances; the ability to support one’s self and maintain a stable, independent lifestyle; parenting; marriage, and the ability to pursue meaningful activity, life goals, ambitions and dreams.
Psychiatric Issues and Dual Diagnosis Problems
Among the most severe of negative consequences involved in dual disorders are psychiatric emergencies. These can involve potential harm to self or others through self-harm, aggression or the inability to care for one’s self. Certain mental health conditions can become severe when there is substance use, resulting in psychosis which is a break with reality. Other conditions can worsen to the point of suicidal thinking and the desire to harm one’s self. And, some conditions can involve acute agitation, anger, and aggression toward others when substances are involved. Any of these situations can constitute a psychiatric emergency.
Psychiatric emergencies involve psychosis or being out of touch with reality to the point of having hallucinations or believing delusions that aren’t based on reality. Sometimes at the extreme, people can believe others are plotting against them and mean to do them harm, that they have unusual powers, or that they see hidden meanings in ordinary events and situations. Psychosis can be a psychiatric emergency when one’s ability to manage self-care and sustaining life activities is compromised, or when safety is compromised.
Harm to self or others through injuring one’s self or another person is always an emergency. Some with dual disorders can become so depressed that they intend to end their own lives, for example. Others can become paranoid or so enraged that the people around them are not safe. In the event of psychosis, suicidality or violence toward others, emergency medical care such be obtained. In the event of imminent danger, call 911 for first responders. If there is no imminent danger, individuals with such symptoms can be seen in a hospital emergency room.
Seeking Treatment for Dual Diagnosis Issues
As stated above, an emergency requires emergency response through 911 or a hospital emergency room. When issues have not yet evolved to include any dangerousness, one may seek outpatient or inpatient services. There are now many dual diagnosis programs in such settings with specially trained professionals. These professionals understand the complexities of simultaneous substance use and mental health problems.
The best medical practice for dual disorders is simultaneous treatment. Consequently, a treatment setting should be able to handle both substance withdrawal and detox as well as psychiatric issues. The program should be able to manage withdrawal safety as well as safety for psychosis, suicidal tendencies, or aggression. This requires a highly qualified and diverse staff in a rehab setting, so make sure to verify the training and expertise of program staff in any rehab you consider.
At Elite Rehab Placement we are trained to help you find the right help. You can consult with us to identify your treatment needs and options that will accommodate your financial needs, too. Our service is free and you can call us anytime. Dual diagnosis issues can be overwhelming and devastating, but with the right help, they can be managed and recovery is more than possible.