Addictions rarely emerge in a vacuum. In many cases, those who suffer from alcoholism or substance use have a contributing mental health condition. Conversely, an addiction may cause or exacerbate a psychiatric disorder. Over the last several decades, a growing body of research has made it abundantly clear: mental illness and addiction are closely intertwined. This is why, with comorbidity rates being so high, a holistic and integrated approach to treatment is essential.
What is dual diagnosis?
Dual diagnosis refers to the co-occurrence of a mental health disorder and a substance use disorder (SUD) in an individual. However, the term is something of a misnomer, as there are other instances of dual-diagnosis, like, for example, those with developmental disabilities and mental health disorders. That being said, today, it mainly refers to when a person is diagnosed with both a mental illness and a substance use problem.
The mental health disorder can be anything from anxiety, depression, bipolar disorder, personality disorder, or schizophrenia. And the substance use disorders can involve the use of any psychoactive substances such as alcohol, opioids, cannabis, or other drugs.
Effective treatment for dual diagnosis typically involves a combination of therapy, medication, and support groups. The goal is to address both the substance use disorder and the mental health condition fully, helping people achieve lasting recovery and improved mental well-being.
The history of dual diagnosis
It wasn’t until the late 1980s that dual diagnosis became officially recognized. Before this time, the medical designations of co-occurring disorders and dual diagnosis hadn’t yet become standardized. As a result, those who suffered from such comorbidities tended to be labeled as “young adult chronic patients” and the lack of understanding or integrated treatment programs meant sufferers weren’t adequately cared for.
Because individuals with co-occurring substance use and mental health disorders were often diagnosed and treated separately, this tended to result in fragmented care and poor treatment outcomes. Even by 1990, people faced many barriers (organizational, administrative, financial, and clinical) when attempting to obtain both mental health and addiction treatment services simultaneously.
Since the early 1990s, the link between substance use disorders and other detrimental effects for people with dual diagnosis has become steadily recognized. A growing body of research—some of it from prospective studies—indicates that co-occurring disorders are linked to relapse and rehospitalization, familial issues, homelessness, a decline in functional status, and noncompliance with medication.
The challenges of dual diagnosis
One of the main problems clinicians face is the difficulty of accurately diagnosing a mental health disorder in someone with a substance use disorder. For example, depression and anxiety are common symptoms of both—if these symptoms persist after substance use has stopped, it can be difficult to determine whether they are related to the substance use disorder or a separate mental health condition.
Another issue is the complexity of treatment. Those with a dual diagnosis require a coordinated approach to recovery, one that addresses both conditions simultaneously. Unfortunately, mental health and substance use disorders are often treated separately, making it difficult to find healthcare professionals well-versed in treating both conditions at the same time. Additionally, given certain contraindications, medication-assisted treatment (MAT) for substance use disorders may not be appropriate for people with certain mental health disorders.
Studies show that co-occurring conditions can make recovery more challenging. For example, if someone with a mental health disorder uses substances to self-medicate, it may be difficult to maintain sobriety while their mental health symptoms persist. Likewise, if someone with a substance use disorder also has a mental health disorder, they may be more likely to relapse if they don’t receive appropriate treatment for both conditions.
People with dual diagnosis often have to contend with the social stigma associated with both conditions. This can make it more challenging for them to seek help and feel supported during their recovery process. Stigma can be a roadblock to accessing resources and support, potentially exacerbating symptoms and increasing the risk of relapse.
Substance use disorders may also cause medical complications, which can be worsened by a mental health disorder. For example, people addicted to certain drugs may be at a higher risk of contracting infectious diseases, such as HIV or hepatitis C. Conversely, mental health disorders, such as depression or PTSD, can also increase the risk of suicidal ideation in people with substance use disorders.
Why an integrated approach to treatment is important
According to research, integrated treatment programs that combine mental health and substance use therapy show promise, whereas separate services for those with multiple disorders often prove ineffectual. With respect to alcoholics with co-existing psychiatric disorders, this 1996 study points out that:
“…research has demonstrated that both disorders must be addressed if the dually diagnosed patient is to have the best chance for a good outcome.”
However, despite the apparent leaps and strides in dual diagnosis treatment, the statistics on comorbidity are alarming. For example, as of 2018, out of roughly 20 million adults with substance use disorders, nearly 38% had a co-occurring psychiatric disorder. And of the 42 million with a mental illness, over 18% had a substance use disorder.
Despite this clear relationship, over 50% didn’t receive treatment for either condition, and only 9.1% received treatment for both.
What’s more, due to methodological challenges and selection bias, it’s likely even this data is an underestimation, and dual diagnosis remains vastly underreported.
To properly serve those with dual diagnosis, an integrated approach to treatment is essential. Often, the needs of those afflicted are complex and multifaceted, requiring a careful and holistic approach to facilitate recovery.
Care must be coordinated between mental health and substance use disorder treatment providers. This coordination helps to prevent conflicts in treatment plans and promotes consistency in care.
By taking a holistic approach, all aspects of the person’s health and well-being can be properly addressed. This encompasses social, environmental, and lifestyle factors that may impact their recovery. For instance, along with therapy and medication, their treatment plan may include counseling, wellness practices (for example, yoga, art therapy, and meditation), and lifestyle changes.
By recognizing the interdependence of mental health and substance use disorders, an integrated approach can help tackle associated stigma. By addressing both disorders simultaneously and employing an empathetic approach to care, those with dual diagnoses are treated as a whole person with unique needs and circumstances.
How does dual diagnosis work in practice?
While there are different modalities and methodologies, along with ongoing debate as to which are most effective, below is an example of how dual diagnosis treatment may work in practice:
The first step in treating dual diagnosis is to assess both the mental health and substance abuse disorders. This involves evaluating the severity of the conditions, identifying any underlying causes along with how they inform each other and determining the best treatment approach.
Dual diagnosis treatment typically involves an integrated approach that addresses both the mental health and substance use disorders. This may include a combination of therapies, such as medication management, individual therapy, group therapy, and peer support.
Behavioral therapies can be especially effective for treating both mental health and substance abuse disorders. For example, cognitive-behavioral therapy (CBT) can help individuals identify and change negative thought patterns and behaviors that contribute to both disorders.
In light of the recent opiate crisis and prevalent conflicts of interest, the practice of psychiatry has been under some scrutiny. However, the value of medications shouldn’t be ruled out. Antidepressants or antipsychotics can offer much-needed relief to those with mental health conditions, providing the stability they need to recover. Likewise, certain medications can be effective when treating substance abuse disorders, such as those that help reduce cravings or withdrawal symptoms.
Supportive services can help individuals with dual diagnoses manage their symptoms and maintain recovery. This may include support groups, vocational training, and housing assistance. Long considered an essential component of addiction recovery, supportive services are doubly important for those with dual diagnosis. For example, this 2002 study found a positive relationship between a lack of social support and an increased rate of relapse.
How Tikvah Lake can help
One of the issues facing those with dual diagnosis is the difficulty of effectively coordinating treatment. At Tikvah Lake, we provide a fully integrated approach to recovery, meaning both substance use and mental illness can be treated simultaneously.
Our experienced team understands the nuances of dual diagnosis and can ensure that you’re fully supported throughout your recovery. Each facet of our comprehensive approach—including holistic wellness treatment, group support, and aftercare—is tailored to meet your specific needs.
If you’d like to talk to us about dual diagnosis and how we can help, please don’t hesitate to contact one of our admissions counselors today.