Dual diagnosis is a complicated intersection of mental health and substance use problems which presents exceptional challenges in diagnosis and management, as the two groups of disorders often influence each other’s development and progression.
People with co-occurring disorders in the UK face a combination of emotional, mental, physical, and social hardships. Recognizing and addressing the consistent nature of mental health and substance use is vital for offering comprehensive and effective care to people dealing with dual diagnosis.
The integrated approach for dual diagnosis treatment in the UK identifies the sophisticated relationship between substance use and mental health and aspires to promote holistic recovery and healing.
Dual diagnosis is a medical term that represents a condition where a mental health disorder and a substance use disorder occur concurrently. Another name for dual diagnosis is co-morbidity or co-occurring disorder. Management for both illnesses is undertaken at the same time. Treatment comprises medication, behavioural therapy, in-patient or outpatient care and support groups .
Common mental health conditions that are more often involved in dual diagnosis are anxiety and depression. A substance disorder may include problems with recreational or prescription drugs, alcohol, or another substance with addictive potential. When a combination of these disorders occurs, the consequences of each can be more damaging.
Unaddressed mental health problems serve as the basis of substance abuse. Substance abuse in turn makes you vulnerable to mental health problems and hence, this generates a vicious cycle.
There is a complex connection between substance use and mental illness.
Individuals with mental health problems may use drugs and alcohol for the same purpose compared to other people – to feel good and relaxed.
Often, the mental health problem comes first and the substance abuse follows as a coping mechanism or a method to self-medicate.
On occasions, substance abuse and mental health problems start at the same time, originating from a common cause like genetics, stress or trauma.
Substance abuse can alter the neurochemical composition and stability of the brain, triggering mental health issues or making a prevailing mental disorder worse.
The most prevalent mental health conditions that co-occur with substance abuse problems include depression, anxiety, behavioural disorders, schizophrenia, and bipolar disorder.
There are no limits to the blends of mental disorders and recreational or prescription substance abuse. Here we list some of the common examples of dual diagnosis .
Researchers have estimated that around half of people with a substance use disorder will have some sort of mental health problems and vice versa.
An estimated 17 million adults in the United States had a comorbid substance abuse and mental health condition in 2020 .
At least one significant mental illness has been observed in 53 percent of drug abusers and 37 percent of alcoholics.
Among all individuals diagnosed with mental disorders, 29 percent abuse drugs or alcohol.
While substance abuse and mental disorders have their objective complications, there can be added challenges when they co-occur, including:
People's understanding and encounters of dual diagnosis differ.
It varies with the particular form of mental illness and its effects on the body, alcohol or the drugs used, and how a combination of these interact inside the body.
It is also influenced by the treatment methods or support network the person has. Certain treatments may be effective for some individuals but not others.
Studies conducted in the UK have reported the occurrence of dual diagnosis in 20–37% of individuals in all mental health centres . There is supplementary evidence for these dramatic stats.
As per UK statistics, 86% of individuals receiving alcoholism treatment had a co-morbid mental health disorder, and about 44% of individuals with drug use problems also had a mental condition.
The prevalence of anxiety co-occurring with substance use disorder in the UK is 9%. Depression with substance use is more prevalent, with an estimated 1/3rd of adults suffering from substance use will suffer from major depression.
The prevalence of addiction increases further in people with ADHD or Autism Spectrum Disorder (ASD), with 36% of ADHD/ASD individuals suffering from addiction on average. Likewise, substance use co-occurs in 43% of total individuals with PTSD .
Common substances that are abused include prescribed medications (including ADHD meds, opioid pain relievers, and sleep aids), alcohol (wine, beer, liquor), and street drugs or recreational drugs (like cocaine, methamphetamines, marijuana).
Substance addiction or substance use disorder is not labelled by the form of alcohol you drink or the drug you use. More accurately, it relates to the effects on your quality of life of the alcoholic beverage or the drug you use. In other words, if the use of drugs or your drinking habits is causing difficulties in your everyday life, you are said to have a substance abuse issue.
To help you recognize the symptoms of a substance abuse issue, going through the following questions may help. The more “yes” responses you provide, is more probable that your drinking or drug abuse is a significant problem and interfering with your everyday life.
The mental disorders that most frequently co-occur with substance use disorders are anxiety, depression and bipolar disorder.
Unwanted worry and tension
Sense of restlessness
Feeling always “on edge” or excessive touchiness
Headaches and stiff muscles
Difficulty in concentrating
Sudden breathing difficulty or Racing heart
Trembling, sickness or light-headedness
Sense of hopelessness and helplessness
Lack of interest and loss of purpose in everyday activities
Lack of vigour and energy
Pervasive feelings of insignificance or responsibility
Inability to feel pleasure
Changes in body weight or appetite
Changes in sleep habits
Trouble in focusing on specific tasks
Physical discomfort, anger, and reckless attitude
Feelings of extreme irritability or euphoria
Impractical, grandiose views
Compromised decision-making and impulsivity
Rage or anger
Reduced sleep requirement
Fast speech and sprinting thoughts
Other mental conditions that generally co-occur with addiction or substance abuse include Borderline Personality Disorder, Schizophrenia and Post Traumatic Stress Disorder.
Dual diagnosis doesn’t imply a singular diagnosis — it is rather a mixture of two or more diagnoses occurring simultaneously.
Sometimes, it can be tough for your health professionals to make a precise diagnosis because the signs of these conditions often overlap. For instance, self-neglect can be a sign of substance abuse as well as major depression.
However, your health professionals will use a variety of screening assessments to assess you for both disorders. It is essential to be honest and sincere when speaking with your doctor or other health professional. Based on your responses, they can decide your conditions and ascertain appropriate management .
Here we will list a few of the screening and diagnostic methods for identifying dual-diagnosis disorders:
Clinical Interviews: Includes demographic background, medical history, family history, drug history, and socioeconomic status.
Self-Assessment Questionnaires: Includes detailed questions on signs and symptoms of mental health conditions and substance use disorder to identify the disorders and quantify the severity of both conditions.
Blood Tests: In some cases, certain blood tests might be advised to ascertain the effect of long-term drug use or identify co-occurring physical health issues.
Imaging Scans: Rarely, imaging scans would be required if you have a history of trauma or other relevant signs of physical/neurological illness that might have contributed to your mental health condition.
Managing dual diagnosis includes treating your primary mental health condition along with the substance abuse problem. It is a long-term therapeutic journey that comprises working with a healthcare provider to recognise how each condition affects the other. This will help you decide which management options will be most successful.
To achieve a complete recovery from your dual diagnosis disorders, you must take a break from the addictive substances. For most people, this begins with a process of detox or detoxification. For the period of inpatient detoxification, health professionals monitor your health status 24/7 for at least a week. They will help you dissuade off the substance and offer ways to decrease the impact of withdrawal.
Depending on certain factors, your action plan for dual diagnosis will comprise medication, behavioural therapy, in-patient care support groups or any combination of these. For instance, CBT can be undertaken for alcoholism treatment as well as for dealing with mood disorders .
The authorized health professionals may recommend medication for one or both of your dual diagnosis conditions.
Selected drugs can aid in the alleviation of the symptoms of both dual-diagnosis conditions.
For example, the FDA has approved bupropion for nicotine dependence and for the treatment of depression.
Certain behavioural therapies have shown promise in treating co-occurring disorders. These include:
Cognitive behavioural therapy (CBT): This type of therapy teaches you how to change ineffective thinking patterns or cope with them.
Dialectical behavioural therapy (DBT): This therapy reduces behaviours that can induce self-harm. These can include suicidal thoughts, drug use or other actions that involve self-harm of any sort .
A healthy support group can be very useful by giving you the social and emotional support you want to sustain your sobriety.
The individuals in these groups have been through the same situation before. Your mates will disclose their experiences and practices and answer your queries.
They can also provide tips on how to manage everyday life and routine encounters.
If you are feeling dependent on substances for day-to-day functioning along with dealing with symptoms of a mental health condition that affects your quality of life, you will benefit from enrolling in an inpatient treatment centre that specializes in dual diagnosis treatment.
Once enrolled, you will get the benefits of 24/7 monitoring along with round-the-clock mental health care that can include therapy, medication and support.
The clients can choose to enrol in an outpatient treatment centre if their work-life commitments don’t allow for continuous inpatient care. These centres will set up a flexible schedule for your therapy sessions and appointments suited to your routine, though 24/7 monitoring wouldn’t be possible.
1. Cleveland Clinic. Dual Diagnosis. https://my.clevelandclinic.org/health/diseases/24426-dual-diagnosis
2. Medline Plus. Dual Diagnosis. https://medlineplus.gov/dualdiagnosis.html
3. National Alliance On Mental Illness. Substance Use Disorders. https://www.nami.org/About-Mental-Illness/Common-with-Mental-Illness/Substance-Use-Disorders
4. Dualdiagnosis.org. Dual Diagnosis Statistics https://www.dualdiagnosis.org.uk/dual-diagnosis-statistics/
Helping your loved ones with a dual-diagnosis disorder can be very tricky. Your loved one might be in denial. They might resist the need for treatment or lack the insight that they have a grave health problem. Even when the treatment begins, the recovery road is long and bumpy.
As a caregiver, you have to accept your limits, you won’t be able to do all. You cannot force them to remain sobriety; ultimately they have to take their medication or attend counseling by themselves. You can offer positive alternatives, be alongside them in this difficult journey, encourage them to seek professional help and provide unconditional support.
Holistic treatments with the integration of various modalities of treatment have shown to be more effective than non-holistic methods, regardless of the high costs and complications linked with them. Given the complex nature of dual-diagnosis disorders, a more focused and dedicated treatment is required to help individuals recover fully. The outcomes of these integrated treatments have shown promise.
In a holistic treatment model designed to manage patients of schizophrenia, group therapy includes both an addiction counsellor and a mental health specialist. Studies suggest that such integrated modes of management are much more successful than managing both disorders separately. If the treatments for substance use and mental health issues are delivered and coordinated in the same setting, the management could be even more successful
Mental disorders are linked with a higher incidence of physical illness, including:
Metabolic and nutritional disease.
Blood and heart disease
Bone and muscle disease.
Substance abuse can have numerous undesirable effects on health, eventually giving rise to:
Heart and blood disease.
Hepatitis B and C.
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