Dual Diagnosis Treatment and Issues: Not as Rare as You May Think

Dual diagnosis treatment and issues (co-occurring or dual disorders) involve simultaneous substance and mental health disorders. While at first glance, this may appear to be an overwhelming and rare set of disorders, it is not. The U.S. Substance Abuse and Mental Health Services Administration found in their 2014 national survey that approximately 8 million adults in the United States have dual diagnosis problems. This is roughly the equivalent of every citizen of NYC having these issues. When thought about in that way, dual disorders seem far less than rare, and in treatment settings, they are not rare at all.

It is thought that about 65% of all people with a Substance Use Disorder also have a mental health condition. And, that among those with mental health disorders, over 50% will also have a Substance Use Disorder at some point. This leaves addiction treatment professionals to expect dual diagnosis issues among those seeking their help. A best medical practice is to think of dual disorders as to be expected rather than as the exception among the people they treat.  Effective treatment professionals will rule out dual diagnosis issues for everyone they treat.

Dual Disorders Involve Two Primary Illnesses

A person who has dual disorders has two primary illnesses–a Substance Use Disorder and another form of a mental health condition. A primary illness is a disease that arises spontaneously and is not associated with or caused by a previous disease, injury, or event. This means that a person with true dual disorders will have a mental health condition that was not caused by whatever Substance Use Disorder they have. While dual disorders are separate entities, they do influence one another. This dynamic can be likened to, for example, someone who has diabetes experiencing blood sugar fluctuations when having a bout of influenza because they are unable to eat well while sick with the flu. Neither condition caused the other, but one can greatly complicate the other as it runs its course.

Because dual disorders involve two primary illnesses, both need treatment at the same time. One would not forego a diabetic’s needs for blood sugar control because he or she has the flu, for example. The same is true for a Substance Use Disorder and a mental health condition. Both need immediate attention in treatment. Consequently, treatment of dual diagnosis issues is most effective when an integrated approach is taken. Substance treatment must be integrated with mental health treatment in a comprehensive, ongoing plan. One illness is not treated first, or given more importance.

Not Every Dual Diagnosis Is the Same

The possible issues involved in dual diagnosis treatment cover a wide scope. Some of the factors involved in just one person’s struggle with dual issues include:

  • Substance(s) used, how much and for what duration
  • Severity of the Substance Use Disorder–how much life impairment has resulted from substance use?
  • The mental health condition present
  • The severity of mental health symptoms–how much life impairment has resulted from these symptoms?
  • What stressors in an individual’s life impact both illnesses?

There are just under 300 mental health diagnoses listed in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). This currently used manual contains the diagnostic criteria for psychiatric conditions such as depression, anxiety, Bipolar Disorder and PTSD, as well as substance use disorders. Consequently, in a group of dually diagnosed people, each may have vastly different dual diagnoses. Also, the substances used stand to vary greatly among a particular group as well. For example, two people each diagnosed with a Depressive Disorder may not be addicted to the same substances. One may use prescription stimulants, and another may be alcoholic, for instance.

Also, life stressors can vary in type and severity. Among such stressors one may find in a group of dually diagnosed people are:

  • Lack of employment, income
  • Lack of housing
  • Estrangement from family
  • Divorce
  • Traumatic loss through death
  • Legal problems
  • Child custody issues
  • Debt
  • Relationship conflict

Dual Diagnosis Treatment Has to Be Individualized

Because the possible combinations and permutations of issues in dual diagnosis treatment are seemingly endless, effective treatment has to be individualized for each person in a program. This is done through individualized treatment plans for each program participant. Goals and objectives are established that specifically address an individual’s situation and resources.

One-size-fits-all treatment programs can miss critical unresolved issues in an individual’s life. For example, relapse prevention plans are a common element of treatment for everyone. However, if those plans are the same for everyone, people with unique needs will fall through the cracks. For instance, if someone has nowhere to live after rehab, working on a relapse prevention plan that does not include resources for housing is unrealistic. The chances of relapse are greatly increased by leaving rehab with no viable options for housing. Each person’s specific needs have to be addressed not only in plans for life back in the community, but in the entirety of a treatment program, too.

The High Risk of Complications in Dual Diagnosis

There is a high risk of complications when one has dual disorders. One that causes a great deal of distress is that

symptoms of one disorder can cause problems in the other. For example, substance use can worsen mental health symptoms, and in the other direction, mental health symptoms can lead one to use substances for temporary relief. Other issues include:

  • Self-medication–self-medication is common among people with dual diagnosis treatment issues. It is common, for example, that people who have had more than one course of addiction treatment are found to have an untreated mental health condition that has sabotaged even their most earnest attempts to maintain sobriety.
  • Personal safety and the safety of others–these issues are certainly not unique to people with dual disorders, and they are not typical for everyone with dual disorders. However, there is the potential for suicidal thinking among people with mental health disorders and among people who have only substance use disorders. Depression, despair, hopelessness and helplessness are commonly experienced. People with these feelings should be monitored for suicidal thoughts and feelings throughout treatment. Also, both mental health conditions and substance use disorders can cause impulsivity, poor judgment and mood dysregulation. Anger, hostility and aggression can result in the ‘right’ circumstances. While not everyone with a mental health condition experiences these things, some certainly do. Also, the addition of substance use to such problems can make a volatile mix. Just as some dually diagnosed people may have self-harming tendencies at times, they may also lash out at others.
  • Psychosis–psychosis is a mental state that includes hallucinations and/or delusions. These symptoms can be severe enough to cause a high degree of disorganization, separation from reality, and the inability to care for one’s self properly. Psychosis can result from substance use, substance withdrawal, or a number of mental health conditions. Dually diagnosed people may require a therapeutic setting in which they can be cared for until these issues subside.
  • Substance-Induced Disorders–there are disorders that are caused by substance use that appear like other mental health disorders. In fact, they can present complications for care professionals seeking to make an diagnosis. These disorders can have onset with intoxication or with withdrawal. Some Substance-Induced Disorders can mimic other mental health problems such as:
    • Depression
    • Anxiety
    • Schizophrenia
    • Psychotic
    • Bipolar Disorder
    • Obsessive Compulsive Disorder

Is a Dual Diagnosis Program Right for You or a Loved One?

A lot factors into whether a particular treatment program is for you or not. There are a lot of things to consider such as:

  • Your clinical issues
  • The expertise of the program’s staff
  • The location of the program
  • The costs of treatment
  • The treatment philosophy of a particular program

If you are wondering whether a dual diagnosis program is appropriate for you or a loved one, here are some things to consider. A ‘yes’ to any of these may be an indication that you have dual disorders. However, you should discuss your concerns with trained professionals:

  • Have you made previous attempts in treatment and recovery that have failed?
  • Do you feel depressed, anxious, worried, fearful, or have racing thoughts?
  • Did you have problems before you started to use substances?
  • Do you ever have thoughts about dying?
  • Do you have difficulty controlling your behavior?
  • Do drugs and alcohol seem to affect you differently than they do others?
  • During periods of abstinence, did you have problems?
  • Are you overwhelmed with past events or distressful memories when you don’t use substances?

There are many more indications of dual diagnosis problems, and only meeting with a skilled professional can clarify whether you or your loved one have dual disorders that need specialized treatment. Keep in mind that getting your final diagnosis can be a lengthy process. You have to withdraw and detox, then have some abstinence from substances before other issues can be clarified. Your mental state on day one, with substances still in your system, will be very different than that 30 days after detox.

There is simply no way to predict what changes withdrawal and detox will cause, but you can be sure they are positive and moving you forward toward your happier and healthier future.  Every step of a dual diagnosis treatment program is helpful. And, it is important to follow recommendations for the next steps in the process. After rehab, for example, you may be recommended to dual diagnosis treatment in an outpatient setting where you can continue to maintain the gains made in rehab.

If you would like some help to find appropriate treatment options for yourself or a loved one, we offer a free consultation service. We can discuss specific problems and find recommendations for treatment programs that can meet those needs. We can also clarify which programs are suitable for your financial situation. If you believe you or a loved one need dual diagnosis treatment, give us a call today.