Substance Abuse Treatment for Dual Diagnosis

Substance abuse treatment for dual diagnosis issues is a specialized treatment for people with a Substance Use Disorder and another mental health condition. Effective dual diagnosis treatment addresses both conditions at the same time, and simultaneous, or integrated treatment of dual disorders, is considered an evidence-based best medical practice.

In 2014, the last date of a national survey for dual disorders, approximately 8 million American adults were identified as having dual, or co-occurring disorders. Consequently, there is a great need for substance abuse treatment for dual diagnosis issues, and such treatment can be found along a continuum of treatment settings. There are dual diagnosis rehabs, outpatient services, and partial hospitalization programs, as well as intensive outpatient programs for people with co-occurring disorders.

A New Day for the Dually Diagnosed

Many people have struggled for years, having one disorder treated at a time, and continuing in a vicious cycle of relapsing in both conditions eventually. For many years in the U.S., a person with a mental disorder and substance problem would have to get mental health treatment in one setting and go to another setting for substance abuse treatment. Unfortunately, people fell through the cracks of such fragmented health care. Often, too, both disorders were not diagnosed. Integrated treatment for dual diagnosis problems has remedied a great deal of the frustration and confusion that arose from fragmented services. However, due to the nature of dual disorders, an accurate diagnosis can still take some time.

Dual diagnosis symptoms are frequently quite complex and difficult to identify early in treatment. A substance use symptom can appear to be a symptom of another mental disorder, for example, and vice versa. Also, problems can go undisclosed or even denied until one trusts health care providers enough to discuss them. Both substance disorders and other mental health disorders cause symptoms to arise biologically, emotionally, cognitively, and behaviorally. It can take the time to sort out what the cause of symptoms are. Also, to add to the confusion, symptoms of both interact and influence each other.

Undiagnosed and untreated dual disorders can lead to many adverse consequences for people who have them and their loved ones. Untreated dual disorders have led many to lives of hopelessness and despair. There is a high rate of untreated dual disorders among the homeless, those who are incarcerated and those who suicide. Contributing to the hopelessness of many will unresolved dual issues is ‘treatment failure’, or getting treatment that does not resolve both illnesses at the same time.

Fortunately, healthcare providers and healthcare systems in the U.S. have made many strides in recent years toward better understanding the needs of people with dual diagnosis problems. Consequently, health practitioners of all sorts are better informed and better able to screen for dual problems. Also, treatment programs for dual disorders, once rare, are now widely available. Improved dual diagnosis awareness and more dual services have helped countless people reclaim healthy and successful lives. ‘Treatment failures’ are less common, and the treatment itself is less confusing for the people who need it. Healthcare for dually diagnosed people has become dramatically more effective and more cost effective. People can now have hope for early diagnosis and a sustainable recovery like never before. Research has shown that integrated treatment for dual disorders results in:

  • Reduced use of substances
  • Decreased psychiatric symptoms
  • Fewer hospitalizations
  • Improved overall quality of life
  • Fewer incarcerations
  • Increasing lifestyle stability

Co-Occurrence of Substance and Mental Disorders

People who have a mental disorder are more likely to have problematic substance use. Similarly, people with a substance disorder are more likely to have a mental disorder. It is estimated that 6 in 10 people who have substance disorders also have a mental disorder.

There are several mental disorders that are more prevalent among people who also have a Substance Use Disorder. These are: Mood Disorders such as depression and Bipolar Disorder; Anxiety Disorders; Schizophrenia, and Anti-social Personality Disorder. Why dual disorders occur is still being researched, but it appears that not everyone with the same dual disorders arrived there the same way.

Research has indicated that one of the dual disorders can contribute to the other’s development and severity. We know, for example, that people who have certain psychiatric issues in their childhood or teen years are more likely to develop substance problems than people who do not have those issues. Similarly, people who use substances early in life are more likely to develop later mental health disorders. Among the early life problems that are strongly correlated to later substance use problems are learning disabilities, ADHD, sexual abuse, conduct problems, and PTSD.

Self-medication is one explanation for why mental health issues lead to substance problems. Alcohol and/or drugs are frequently used to reduce mental health symptoms—for example, someone may drink or use drugs to sedate themselves when experiencing depression-related insomnia, or the high-energy of Bipolar Disorder. Another may use stimulants such as cocaine to self-medicate the low energy and poor concentration of a Depressive Disorder.

Another theory states that both substance problems and mental disorders share a ‘common pathway’ in the brain. This theory looks to genetic factors that ‘wire’ the brain for the co-occurring issues, making a person vulnerable to developing dual disorders in certain conditions. This theory is tied to significant research evidence that has shown substance problems and mental health problems to ‘run in families’. It is often the case that family members of people with dual disorders may also have dual issues, or they may have either substance or mental health problems.

Effective Dual Disorder Treatment

Effective dual disorder treatment includes:

  • Assessment and diagnosis by professionals trained in dual diagnosis treatment
  • A safe, supportive, and therapeutic environment
  • Safe completion of withdrawal and detox
  • Improved and stabilized psychiatric symptoms with medication when needed
  • Illness management education for both disorders

    Dual diagnosis treatment

  • Individual, group, and family therapy
  • Coping skills development
  • Relapse prevention planning for both illnesses
  • Support system building
  • Use of self-help community support groups
  • A continuum of services dependent upon degree of stability

Family Participation in Dual Treatment and Recovery

Loved ones of people with dual disorders can benefit greatly from involvement in the treatment and recovery process of their family members. And, family support is certainly beneficial for those seeking to recover from co-occurring issues. Loved ones are often in distress, and many have been in a chronically stressful situation while trying to help a family member with dual disorders. Consequently, loved ones can greatly benefit from:

  • Education about the family member’s illnesses and treatment plan, expectations for recovery
  • Discussing the impact of the family member’s illnesses upon themselves and their families in individual, group and/or family counseling sessions.
  • Using self-help community support groups for family members
  • Learning how to interact and support a dually diagnosed loved one without enabling
  • Learning the signs and symptoms of relapse and developing a crisis plan to implement when relapse is occurring
  • Enhancing self-care activities
  • Enhancing their own support systems
  • Identifying their own needs for limits and boundaries

Do You or a Loved One Have Dual Disorders?

If you suspect you may have a dual disorder, or that a loved one does, it is always wise to consult with a professional who is trained to assess and diagnose such problems. However, it may take some time for you to decide that you need to do so. Many people ask how would they know if they should talk with a counselor, therapist, nurse, or doctor about such things. The answer is easy: if you have wondered about it, then it’s a good idea to seek a consultation; your thoughts are triggered for good reason. Talking things over with a qualified professional can get you answers and solutions you need if dual disorders are at work in your life, or affecting the life of a loved one. Also, if you find that dual disorders aren’t the issue, you can move on toward the real solutions you need, putting this issue to rest.

There are some classic indicators that dual disorders may be a problem, and some are given below. The list that follows is not an all-inclusive one, and having the experiences on this list does not definitively diagnose dual disorders. However, the signs and symptoms below do commonly occur for people who have dual diagnosis issues. They are:

  • You seem to have an unusual sensitivity to substances. If you use substances with other people, you might find that you are more strongly affected than they are, or that you have a different experience than they do. People with dual disorders are often told by others that their behavior was unusual when intoxicated.
  • After using alcohol and/or drugs, you have difficulty recovering. Many people with dual disorders will have a strong after-effect. You may feel depressed, fatigued, anxious, fearful, or agitated, for example. Again, in contrast to others who were similarly intoxicated, your after-effect may seem unusual or exaggerated.
  • Substances may have an ‘opposite’ effect. Many people with dual disorders will have an unpredictable reaction to substances. For example, they may feel energized when a substance typically sedates others.
  •  You may have unusual symptoms when intoxicated such as hearing voices, seeing things, having distressful thoughts, or thoughts of grandiosity (feeling ‘grander’, special, invincible…). Or, you may have these symptoms after an intoxication experience.

There are many more signs and symptoms of dual diagnosis problems that only a trained professional speaking with you can assess. However, if you do have dual disorders, and you get the right help, your recovery can be life-changing on many levels. Dual recovery not only brings you sobriety, and freedom from the compulsive use of substances, but it brings you internal and external stability. You will feel well and be finally able to cope and do well. Recovery happens, and it is possible for you or your loved one.