Dual Diagnosis and Co-Occurring Disorders: Say What?
You have probably heard the terms “dual diagnosis” and “co-occurring” disorders being discussed more frequently as addiction treatment professionals continue to learn about the connection between mental illness and substance abuse.
But what do these terms mean?
Dual diagnosis, also known as co-occurring disorder, refers to someone who has been diagnosed with both a mental illness and a drug or alcohol problem. The symptoms of one disorder tend to worsen the symptoms of the other. What does this tug-of-war look like? How does one problem complicate the other?
More here about the connection between addiction and mental health conditions. Then, we invite your questions and feedback at the end. In fact, we have a comments section at the end for your questions…and we try to respond to real-life questions personally.
Which comes first: A mental health problem or addiction?
The answer is that it’s different for each person. A mental health disorder can be considered a risk factor for drug use, which may lead to addiction. In other cases, drug use can trigger the development of a mental health disorder. But what’s clear is this:
Once both issues are co-occurring, they are likely to perpetuate one another.
Difficulty in Identifying the Root Problem
Mental illness can be difficult to diagnose among those struggling with a drug or alcohol addiction because psychiatric symptoms are sometimes misattributed to the person’s drug use. Likewise, the display of withdrawal symptoms or a person’s altered state under the influence of a given substance is occasionally misinterpreted as mental illness.
Problems with substance abuse can cover up a person’s mental illness, making underlying issues difficult to diagnose and properly treat. For example, long-term abuse of alcohol can lead to Wernicke-Korsakoff syndrome, a serious brain disorder with symptoms that include:
- confusion and loss of mental activity
- loss of muscle coordination
- loss of memory
To better understand the interplay between addiction and mental health issues, we need to examine how addiction hijacks a person’s brain.
How Addiction Hijacks the Brain
Drugs and alcohol cause an unnatural surge in the neurotransmitter dopamine, which produces a feeling of euphoria. Another neurotransmitter called glutamate is also released. Glutamate is responsible for memory functions, making it more likely that you will remember your experience with whatever substance that has just been introduced to your system.
Increased levels of dopamine and glutamate end up causing drugs or alcohol to become a higher priority in the brain’s functioning.
Given the body’s reaction, harmful substances become rewarding and associated with pleasure in the memory. Addiction is playing out a chemical process. But why can’t we simply stop using drugs once our brains start shifting focus from other important needs to the need for drugs or alcohol?
Unfortunately, it’s not that simple.
Addiction alters the structure of the brain. As neurotransmitter levels change, the brain’s pleasure center is impacted, affecting the way a person learns and makes decisions. Furthermore, chronic substance abuse can lead to the brain adapting to our habits. Rather than making complex decisions and thinking through problems rationally, our brains shift activity away from the prefrontal cortex—which controls emotions and decisions—and place it towards the dorsal striatum—which is where we form habits.
At this point in the addiction cycle, a person’s brain has been conditioned to seek out his or her substance of choice to maintain balance in response to various triggers. Combining this state of addiction with a mental health disorder creates a situation fraught with physical, mental, and emotional dangers.
Mental Illness Can Perpetuate Addiction
Though substance use often exacerbates the symptoms of mental health disorders, many people suffering from social anxiety, PTSD, bipolar disorder, and other conditions are prone to addiction because of a hope that their symptoms will be alleviated by drugs and/or alcohol. According to the Anxiety and Depression Association of America, those with anxiety disorders “are two to three times more likely to have an alcohol or other substance abuse disorder at some point in their lives than the general population.”
People living with depression and other mental disorders are experiencing feelings of:
- persistent sadness
- loss of interest
- feelings of low self-worth
In search of an escape from these feelings, many individuals dealing with a mental illness turn to substance use. The substance use, in turn, worsens their mental illness symptoms and the cycle of addiction is perpetuated.
Substance Abuse Affects Mental Illness
As mentioned above, substance use disorders and mental health disorders often have a reciprocal relationship with each other. For example, it is common for those living with anxiety or mood disorders to use alcohol or drugs as a means of alleviating their symptoms. But mood-altering substances (especially alcohol) can only reduce symptoms of social anxiety temporarily. In fact, using alcohol to alleviate anxiety can often result in increased levels of anxiety, irritability, or depression a few hours after consumption.
Additionally, those suffering from low self-esteem may turn to drugs or alcohol as a means of boosting their mood through the brain’s release of dopamine. However, “self-medicating” in this way ultimately has the opposite effect as the feelings of euphoria wear off, and the individuals are left to restart addiction’s vicious cycle once again.
Dual Diagnosis Questions
If you or a loved one are caught between a mental health disorder and addiction…don’t despair! There are effective therapy methods that can help you manage both conditions successfully. You can learn more about what you can expect from dual diagnosis treatment and suffer no more.
If you have any questions that we didn’t address in this article, please post them in the comments section below. We welcome your feedback and try to respond to all legitimate inquiries in a personal and prompt manner.