Specific Dual Diagnosis Conditions and Self-Medication

Dual diagnosis treatment

Self-medication is a common problem for people who have co-occurring or dual diagnosis problems. It is often an attempt to medicate mental health symptoms that people have when mental health problems are not appropriately treated. For example, people with depression have low energy, blue moods, poor concentration, and often times sleep disturbances. While this is just an example of how untreated mental health problems can interrupt daily functioning, it is a classic example of the reasons that people often reach to substance abuse to help them do better. Of course, there are many other dual diagnosis problems that, unfortunately, go unresolved and untreated.

Also, self-medication is a problem among people who have physical ailments that are chronic, untreated, or only partially treatable. In fact, many people who are addicted to pain medications begin their substance abuse with prescribed medicines. Typically, however, while they have legitimate needs for medication, their distress has caused them to use more than prescribed, or to mix their prescribed medications with other substances.

Overall, self-medication is one of the most common reasons that people first turn to substance use and develop substance abuse problems. Some of the conditions that are commonly self-medicated are depression, anxiety, grief, trauma and physical ailments. These combinations of dual problems can take many forms as there is a wide range of addictive substances and possible mental health symptoms.

Self-medication and Dual Diagnosis Problems Involving Clinical Depression

While everyone feels down or blue at times, clinical depression is another issue altogether. Clinical depression interferes with life functioning to the point of causing significant impairment. Life activities are interrupted, causing more problems on top of the usual depressive symptoms. People with co-occurring depression and addiction can develop severe disabilities.

When one is clinically depressed, these impairments last for at least 2 weeks. Many people, however, have a clinical depression that is chronic, even lifelong. The symptoms of a clinical depression are considered significant in that they make it difficult to do daily activities, and can seriously erode the quality of life, even becoming life-threatening.

Symptoms of a clinical depression include feeling down (or dysphoric) most days of the week and most hours of the day. There is also a pervasive sense of hopelessness and helplessness, meaning that one feels there is very little that can be done to improve the situation. Hopelessness and helplessness are self-defeating and tragically convince a person that there’s no point in seeking help. Unfortunately, this reinforces the depression and causes many people not to seek help for it. It can also lead to suicidal thinking, or just a generalized wish to die. In severe cases, of course, one can be in danger of actually attempting suicide.

There is a general misunderstanding about depression in our culture. Many people believe that everyone gets depressed from time to time, but they do not fully understand the difference between being down and being clinically depressed. There is also the misunderstanding that depression is laziness because people have low energy and low motivation. Consequently, people beat themselves up, thinking that the illness is a character flaw rather than an illness. Also, others can be shaming and unsupportive, thinking the depressed person is simply not willing to take responsibility.

Other symptoms of depression include appetite and sleep disturbances. And these can go in either direction. For instance, some depressed people compulsively eat and others have difficulty eating at all. Clinically, depression is known to cause unintentional weight gain or unintentional weight loss consequently. Also, depression involves physical fatigue and a lack of energy, making it difficult to be motivated or to follow through on obligations, responsibilities, or the pursuit of life goals. This leads to problems with feeling helpless and hopeless, having a poor self-image, and poor self-esteem. Depression also involves feelings about the self which are self-sabotaging such as feeling worthless, having a lack of confidence and self-esteem, and generally an overall negative image of self as inadequate and worthless.

When people have a dual diagnosis issue involving depression and substance use, they may take substances that do one of several things. For example, people whose depression involves sleep disturbance and insomnia may self-medicate with depressants such as sleeping pills or alcohol in order to rest. On the other hand, dealing with poor sleep may require that during times when people need to be more active, they turn to stimulants to keep themselves awake. This is just one example of how people with an untreated depression can self-medicate, but it clearly illustrates the vicious cycle of self-medication that people with dual disorders can become involved in.

Self-Medication and Dual Diagnosis Problems with Clinical Anxiety

Clinical anxiety is another condition that is common in both general medicine and psychiatric medicine. Clinical anxiety also significantly impairs one’s ability to function in everyday life. There are actually several forms of clinical anxiety such as phobias, panic, social anxiety, performance anxiety, and generalized anxiety.

All forms of anxiety impair functioning in overall daily life, and in particular situations, activities or events. And, all anxiety involves the biological survival instinct mechanisms in the brain, activating fear and the impulse to fight or flee. There are people who have very specific triggers, for example, such as being afraid of certain situations or certain other stimuli such as spiders, snakes, flying or public speaking. People with clinical anxiety that is untreated will often turn to depressant substances such as alcohol, benzodiazepines, or sleeping pills that quiet the fear, excessive worry, inability to relax or sleep, and inability to perform the tasks before them. Some may also turn to stimulants such as cocaine to increase their sense of confidence and ability to focus without the intrusion of worry, for instance.

Generalized anxiety appears as having little to do with specific events or situations, and people with this form of anxiety typically experience excessive worry, fear, and symptoms of internal agitation chronically. These individuals are very vulnerable to the daily use of substances to self-medicate this chronic and pervasive issue. They may also strain personal relationships, relying upon others to compensate for their inabilities to perform certain tasks, or becoming generally too dependent upon loved ones causing others to push away.

Self-Medication and Dual Diagnosis Problems Involving Complicated Grief

A significant loss of any type can become complicated and chronically unresolved when people turn to substance abuse to cope with it. In fact, many who recover from an addiction will find that a loss from years ago still has not been thoroughly processed due to substance use postponing or suppressing the natural grief process. Grief is a natural process that is meant to help us adjust to a significant loss. The process involves many stages of feeling, adjusting and coping that, in the end, lead us to acceptance, letting go as best we can and moving on with life.

A significant loss will bring a multitude of emotions including shock, disbelief, anger, despair, depression, fear, hopelessness and helplessness. These can feel so overwhelming that we try to suppress them and avoid them by using substances. However, while it is natural to want to avoid pain, a significant loss requires us to feel and work through the pain in order to move on with our lives as best we can.

A complicated, unresolved and prolonged grief experience will typically have many components in daily life that sabotage our healthy functioning. The choice of substances to use can be very varied, depending on what we need to cope with currently, and often people with unresolved grief will find themselves using multiple substances in various situations. For example, one may try to self-medicate recurring sadness with stimulants or try to medicate recurring anger with depressants. This can lead to a vicious cycle of polydrug use. Of course, in all dual diagnosis issues, this can be the case.

Trauma, Dual Diagnosis Issues, and Self-Medication

Traumatic reactions are the lingering and unresolved adjustment to having experienced an overwhelming event. Keep in mind that the event itself is not necessarily the cause of a traumatic reaction that becomes chronic and problematic in daily life long after the event. Rather, it is the impact upon an individual that the event has. Typically, an event will have involved direct experience or witnessing of an event that took someone else’s life, could have or could have caused severe injury to one’s self or even could have caused one’s own death. Also, we can be traumatized by learning of such things involving a loved one even when we did not witness it directly. Such events as interpersonal violence (including sexual assault), natural disasters, and accidents are common causes of traumatic reactions.

In daily life when there is an unresolved trauma, symptoms can be significantly distressful and impairing. For example, traumatic reactions can cause what is known as mental intrusions. One may have recurring feelings of re-experiencing the trauma such as having mental images, remembering disturbing details, having thoughts ‘pop’ into one’s mind about the event, or having nightmares related to the event. There is also a phenomenon known as flashbacks that can occur. Flashbacks take one back into the event as if it is occurring right now.

All of these symptoms can be terrifying and horrifying. They can also significantly interrupt daily functioning and can, like all symptoms of dual issues, be debilitating. People with unresolved traumatic reactions are also very vulnerable to self-medication and can try to medicate a variety of issues such as poor sleep and mental intrusions with a range of substances.

Physical Ailments, Dual Diagnosis Issues, and Self-Medication

People with chronic physical ailments that are not properly treated, or can only be partially resolved, like severe and chronic pain, are very vulnerable to self-medication. Also, chronic physical ailments lead to clinical depression and can very well involve traumatic reactions as well. For example, a person who has been injured in an accident and suffers daily from chronic pain because of it may have distressful mental intrusions like those described above. In short, unresolved physical ailments can leave one vulnerable to abuse prescription medications that are necessary like pain medications. They also leave one vulnerable to polydrug use such as adding alcohol or other substances not prescribed to try to further suppress physical symptoms or cope with untreated depression or trauma reactions caused by the physical problem.

Do You or a Loved One Need Help?

The combined effects of substance use and mental health problems can be devastating. If you or a loved one have these issues, there is effective treatment available that can restore sobriety and stability and dramatically improve the quality of life for you or your loved one. Give us a call today for a free consultation. We can pinpoint appropriate treatment options that meet both your clinical needs and your financial situation.