What is Dual Diagnosis?
Dual diagnosis, also known as co-occurring disorders, refers to the presence of both a mental health condition and a substance use disorder in the same person. This means that an individual with a dual diagnosis has two different but interconnected health conditions.
For example, a person might be dealing with depression while also struggling with alcohol addiction. These conditions often interact with each other, making treatment more complex.
Comorbidity Explained
Who Is Prone to Co-Occurring Disorders?
While dual diagnosis can occur in anyone, certain groups are more likely to experience it. For example, men are more prone to developing dual diagnosis than women. This might be because men generally have higher rates of substance use.
Young adults are also at higher risk. Dual diagnosis often starts in young adulthood – a time when many mental health disorders first appear. Adolescence is also when individuals are more likely to experiment with substances, increasing their risk of developing a substance use disorder.
Individuals who start drinking at age 14 or younger have a 47% chance of developing alcohol dependence later in life, whereas those who start drinking after age 21 have only a 9% chance.1
Prevalence of Dual Diagnosis
Dual diagnosis is a significant global health issue. The World Health Organization estimates that 1 in 4 people in the world will be affected by mental or neurological disorders at some point in their lives.2Among these individuals, the proportion who also suffer from substance use disorders is substantial. Approximately 50% of individuals with a substance use disorder also have a co-existing mental health disorder.3In the United States, a 2019 survey by SAMHSA estimated that about 9.5 million adults experienced both mental health disorders and substance use disorders in the past year.4
Common Types of Dual Diagnosis
Some of the most common mental health conditions that co-occur with substance use disorders (SUD) include:
Depression
This is a mood disorder that involves persistent feelings of sadness and losing interest in activities that you once enjoyed. Many people with depression may turn toward substances to cope with symptoms. About 1 in 3 individuals with mood disorders, like depression, also suffer from a SUD.5
Alcoholism and Depression
Anxiety
Anxiety is a chronic condition that is characterized by excessive and intrusive worries, fears, and physical symptoms, like sweating or a racing heart. Stimulants and alcohol are commonly misused to self-medicate.
Attention Deficit Hyperactivity Disorder (ADHD)
ADHD is a developmental disorder marked by inattention, impulsivity, and hyperactivity. This dual diagnosis often involves a dependence on prescription medication, such as Adderall or Ritalin.
Post-Traumatic Stress Disorder (PTSD)
PTSD is a mental health condition caused by experiencing or witnessing a traumatic event. Individuals with PTSD may turn to alcohol or sedatives to cope with their symptoms.
Bipolar Disorder
Bipolar disorder is a mood disorder characterized by extreme shifts in emotions and behavior, alternating between periods of depression and euphoria. Alcohol is commonly misused for the temporary relief it can provide from bipolar episodes.
Schizophrenia
This is a mental disorder characterized by delusions, hallucinations, and disorganized thinking. Nicotine is the most commonly abused substance among those with schizophrenia, with up to 79% of this population smoking.6
Other Combinations and the Challenges of Identification
Identifying dual diagnosis isn’t always straightforward. Mental health and substance use disorders can each have a wide array of symptoms, and these can overlap or mask each other. This complexity can make it difficult to discern whether a person has one condition or a combination of conditions, let alone specify which conditions are present. If you can’t determine the exact conditions, or if you’re feeling uncertain about a potential dual diagnosis scenario, J. Flowers Health Institute can help.
Our “Living MRI” evaluation provides a holistic overview of your health. This sophisticated assessment can help us establish a comprehensive diagnosis and treatment plan for individuals with co-occurring disorders.
Can One Disorder Exacerbate the Other?
When someone has a dual diagnosis, the presence of one disorder can often make the other worse. This is because mental health disorders and substance use disorders can influence and amplify each other.
If someone is dealing with depression, they might start using drugs to help lift their mood. However, many substances can increase feelings of sadness or emptiness, so the person’s depression might become even more severe, especially if they are using substances in the long term.
Important Note About Co-Occurring Disorders
On the other hand, a person with a substance use disorder who develops a mental health disorder like depression may find that their drug use makes their depressive symptoms worse. The withdrawal symptoms from the substance might cause them to feel even more low and unenergetic. As a result, their depression could become more severe, leading them to use more of the substance, creating a worsening cycle. That’s why it’s so critical to diagnose both conditions, even if one condition appears first.
Risk Factors for Dual Diagnosis
There are multiple risk factors that may lead an individual to develop a co-occurring disorder. These may include:
Genetic Vulnerabilities
Dual diagnosis is significantly influenced by your genes. This means that if someone in your family has a history of mental health or substance use disorders, you may also have a higher risk of experiencing a dual diagnosis.
Genes are the blueprint for our bodies, including our brains. Certain variations in these genetic codes can make some people more susceptible to developing such disorders.
Environmental Risks
Your surroundings can also play a significant role in the development of dual diagnosis. Certain environmental factors may cause mental health or substance use disorders, leading to dual diagnosis. For instance, if you’ve experienced trauma or stress, this can lead to mental health problems like post-traumatic stress disorder (PTSD). Many people turn to substances as a way to cope with their emotional pain, eventually leading to a substance use disorder. High-stress environments, lack of social support, and exposure to substance use can also act as risks, further increasing your likelihood of developing co-occurring disorders.
Psychological and Developmental Factors
Early onset of mental health disorders or substance use also places individuals at a higher risk of dual diagnosis. Also, people with specific psychological traits like impulsivity or high levels of anxiety might be more susceptible. Childhood developmental factors, such as poor academic performance, difficulty in making friends, or problems with authority, may contribute to the development of dual diagnosis as well. Epigenetics or the combination above factors account for about 40-60% of an individual’s vulnerability to addiction.7
The Importance of Integrated Treatment in Dual Diagnosis
At J. Flowers Health Institute, integrated treatment is a standard practice for addressing dual diagnosis. This type of treatment considers both the mental health and substance use disorders together, rather than separately. For example, in an integrated treatment approach, your comprehensive treatment team may include a psychiatrist for managing mental health conditions, a counselor for handling substance use issues, and a social worker for addressing daily living needs. By collaborating, these professionals can devise a comprehensive treatment plan that covers all aspects of your well-being.
Enhanced Recovery and Improved Outcomes
Integrated treatment for dual diagnosis can lead to enhanced recovery and improved outcomes. This is because it addresses the entire individual, not just isolated symptoms of a single disorder. When both disorders are treated concurrently, you will better be able to understand how they influence each other. Therefore, you can also learn more effective coping strategies. This can lead to a more successful recovery and a higher quality of life.
Breaking the Cycle of Relapse
One of the challenges in dual diagnosis is the cycle of relapse, where one disorder can exacerbate the other. This can lead to a setback in recovery.
However, relapse doesn’t mean that treatment has failed. Integrated treatment can help break this cycle by treating both disorders together. This reduces the chance that symptoms of one disorder will exacerbate or cause symptoms of the other.
As part of the integrated treatment approach at J. Flowers Health Institute, you will receive education on relapse prevention strategies. This includes recognizing early warning signs, developing a solid support network, and maintaining a healthy lifestyle.
Addressing Underlying Causes and Risks
Integrated treatment for co-occurring disorders involves digging deeper to address the underlying causes and risks of both mental health challenges and substance use disorder.
By identifying these root causes, you can better understand why you use substances and what you can do to manage your mental health in a healthier way.
For instance, if you use drugs or alcohol to cope with symptoms of depression or anxiety, integrated treatment can help you find more effective coping strategies.
Assessment and Diagnosis of Dual Diagnosis
Dual diagnosis requires a well-structured approach for assessment, and at J. Flowers Health Institute, we use various screening tools and assessment instruments to pinpoint co-occurring mental health and substance use disorders.
The process begins with a ‘Living MRI’, a thorough review of your medical history, which helps create a unique evaluation schedule.
We make use of specialized questionnaires that can identify symptoms of both mental health and substance use disorders. The tests provide insights into your patterns of thought, emotional responses, and behavior, as well as any problematic substance use. Moreover, additional tests, including hormone testing and brain mapping, are performed if necessary. These detailed studies give us a more comprehensive understanding of your neurobiological status and how it might be contributing to the dual diagnosis.
Challenges in Diagnosis and Differential Diagnosis
Diagnosing dual diagnosis can be challenging due to several reasons. First, symptoms of mental health and substance use disorders often overlap, making it difficult to separate one from the other.
This means that what might seem like a symptom of a mental health disorder could be a consequence of substance misuse, and vice versa.
Also, the severity and type of substance use can affect mental health symptoms. For instance, withdrawal from certain substances might mimic or exacerbate the symptoms of a mental health disorder.
How Can J. Flowers Health Institute Help?
In such complex situations, J. Flowers Health Institute’s multidisciplinary team works together to perform a differential diagnosis. This means we carefully consider all the possible conditions that could be causing your symptoms, evaluate each one, and then determine the most accurate diagnoses.
Holistic Evaluation of Co-Occurring Disorders
At J. Flowers Health Institute, we believe in a holistic evaluation of co-occurring disorders. This means that we look beyond just the symptoms of mental health and substance use disorders. We consider factors like your overall physical health, lifestyle habits, relationships, and environmental conditions.
Our holistic approach may include physical therapists, dieticians, psychotherapists, and more. Our professionals work in unison to evaluate how these different factors might be influencing your mental health and substance use.
For instance, chronic physical pain or nutritional deficiencies could exacerbate mental health symptoms, and certain lifestyle habits or environments might encourage substance use.
Treatment Approaches for Dual Diagnosis
Depending on your symptoms and needs, your treatment team may recommend various treatment approaches. Some of these may include:
Pharmacotherapy
Pharmacotherapy involves using medications to manage the symptoms of mental health conditions and substance use disorders.
Commonly Prescribed Medications for Mental Health and SUD
In managing co-occurring disorders, the choice of medication largely depends on the specific mental health condition and substance use disorder at play. For mental health conditions, the medications used might include antidepressants, mood stabilizers, and antipsychotics, among others.
On the other hand, substances like alcohol or opioids have specific medications which can aid in reducing cravings, managing withdrawal symptoms, and promoting recovery. It’s important to note that these medications aren’t cures, but tools that can help manage symptoms.
Challenges and Considerations in Medication Management
One challenge is the potential for drug interactions. Since medication will be used to manage both the mental health condition and the substance use disorder, it’s essential to ensure that the combined use of these drugs doesn’t result in harmful interactions.
These interactions could lead to increased side effects, decreased effectiveness of one or both medications, or other unexpected outcomes. Another significant consideration is the potential for a substance use disorder developing from the medication.
At J. Flowers Health Institute, our medical team takes into account all these challenges and considerations. A board-certified addiction specialist works closely with your personalized treatment team to ensure you receive the best possible care.
Psychotherapy: Individual and Group Therapy
Psychotherapy plays a significant role in managing co-occurring disorders. This approach aims to help individuals understand their feelings, thoughts, and behaviors.
Cognitive-Behavioral Therapy (CBT)
CBT is a widely used method for treating dual diagnosis. It focuses on identifying and changing unhelpful thinking patterns that may lead to negative behaviors.
In the case of dual diagnosis, CBT can assist you in understanding how your thoughts affect your substance use and mental health symptoms.
What is Cognitive Behavioral Therapy?
Dialectical Behavior Therapy (DBT)
DBT helps you accept and tolerate distressful thoughts and emotions, instead of struggling with them. It can be particularly helpful in treating dual diagnosis. It promotes emotional regulation and decreases harmful behaviors related to substance use.
Motivational Interviewing (MI)
Motivational Interviewing (MI) is another effective psychotherapy method for dual diagnosis. This approach encourages you to become more motivated and prepared for change. It can help you overcome any ambivalence or resistance you may have towards addressing your symptoms.
Other Effective Psychotherapeutic Approaches
Apart from these, there are many other therapy options effective in dual diagnosis treatment. These include family therapy, group therapy, and 12-step groups.
A Comprehensive Approach to Integrated Treatment at J. Flowers Health Institute
Led by Dr. James S. Flowers, our team of board-certified experts at J. Flowers Health Institute dedicates ourselves to understanding and addressing the root cause of your symptoms.
What Does Our Dual Diagnosis Treatment Include?
Our approach to treating dual diagnosis is thorough and personalized. We understand that every individual’s journey is unique. Our “Living MRI” reflects this belief.
Here’s what you can expect from our comprehensive dual diagnosis program:
- Comprehensive Diagnostic Evaluation: We will delve deep into your medical history, lifestyle, and present symptoms. We use this information to inform a detailed evaluation process that encompasses medical evaluations, psychiatric assessments, neuropsychological testing, substance use disorder testing, and more.
- Treatment Plan Development: Drawing from the insights gained during the evaluation, our multidisciplinary team will develop a treatment plan. This will address both the mental health and substance use disorders concurrently. This integrated approach is essential for ensuring a successful recovery from dual diagnosis.
- Customized Stabilization Program: To prepare you for the diagnostic process and the subsequent treatment plan, our Bespoke Stabilization Program provides 24/7 care from a dedicated medical team. This ensures that you are in the right physical and mental state to start your recovery journey.
- Ongoing Support: After your time with us, you can expect continued support. Our alumni receive regular check-ins and assistance, ensuring they have the help they need to maintain optimal health in the long term.
More Than a Diagnosis: A Path Toward Wellness
Treating dual diagnosis is not just about addressing the symptoms. It’s about working together to find the root cause and equipping you with the tools and understanding to manage your health effectively. At J. Flowers Health Institute, our team of dedicated professionals is committed to guiding you on your journey to wellness. Our goal is to return you to your best health, giving you the ability to lead the fulfilling life you deserve.
If you or a loved one are struggling with co-occurring disorders, reach out to us today. Let our team help you navigate this challenging journey with expert care, understanding, and support.
Resources
- https://www.niaaa.nih.gov/news-events/news-releases/early-drinking-linked-higher-lifetime-alcoholism-risk
- https://www.who.int/news/item/28-09-2001-the-world-health-report-2001-mental-disorders-affect-one-in-four-people
- https://www.ncbi.nlm.nih.gov/books/NBK571451/
- https://www.samhsa.gov/data/sites/default/files/reports/rpt29393/2019NSDUHFFRPDFWHTML/2019NSDUHFFR090120.htm
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851027/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5646360/
- https://nida.nih.gov/publications/drugs-brains-behavior-science-addiction/drug-misuse-addiction