By Dr. Alkesh Patel, MD
One in two addicts can be dually diagnosed
Psychiatric disorders and substance use disorders (SUD) can – and frequently do – coexist. In fact, more than 50 percent of those individuals who abuse drugs or alcohol are likely to have at least one significant mental health condition. When this occurs, medical professionals describe it as “dual diagnosis.”
The eight most common mental disorders found in dual diagnosis patients are:
- Bipolar Disorder
- Borderline Personality Disorder
- Major Depression
- Obsessive Compulsive Disorder
- Anxiety Disorder
- Post-Traumatic Stress Disorder
- Eating Disorders
Establishing an accurate diagnosis is key!
To address and manage underlying dual disorders, it’s critical to establish an accurate diagnosis for patients in addiction and mental health settings. Clinicians must determine between acute primary psychiatric disorders versus psychiatric symptoms caused by SUDs.
Consider a 40-year-old patient with panic disorder whose first symptoms of alcohol addiction and panic attacks started at age 18, who continues to experience drinking relapses in addition to separate panic attacks. At this point, the patient has two well-developed independent disorders that both require treatment. Alcohol withdrawal can present itself with symptoms resembling generalized anxiety or panic attacks, so it’s important to understand which symptoms arise from which disorder, draw out a timeline, and take a good clinical history in order to define treatment goals and appropriate interventions.
The relationship between substance use and psychiatric disorders
There are several possible relationships that exist between substance use disorders and psychiatric disorders. Substance use disorders may induce, worsen, or diminish psychiatric symptoms in these patients, complicating the diagnostic process further. Substance use disorders can cause psychiatric symptoms and mimic psychiatric disorders. Acute and chronic drug and alcohol use can prompt the development, provoke the reemergence, or worsen the severity of psychiatric disorders. Patients may use alcohol and drugs to self-medicate unwanted psychiatric symptoms and to ameliorate the unwanted side effects of medications.
What makes dual diagnosis so hard?
Compared with patients who have a primary psychiatric disorder or an SUD alone, patients with dual disorders often experience more severe and chronic:
- Medical dysfunction
- Social dysfunction
- Emotional dysfunction
Because these patients have two disorders, they are vulnerable to both addiction relapse and a worsening of the psychiatric disorder. Further, addiction relapse often leads to psychiatric decompensation, and worsening of psychiatric problems often leads to addiction relapse. Thus, relapse prevention must be specially designed for patients with both disorders.
Compared with patients who have a single disorder, patients with dual disorders often:
- require longer treatment
- have more crises
- progress more gradually in treatment
How is dual diagnosis treated?
Due to such complexity, patients with dual diagnosis require an individualized treatment plan. It’s important for medical professionals to:
- Obtain a thorough addiction and psychiatric history.
- Establish an appropriate timeline regarding onset of psychiatric symptoms and onset of underlying addiction.
- Formulate an integrated, multidisciplinary plan of care that will embrace treatment for both disorders.
Integrated care refers to treatment from both psychiatric and addiction professionals under the same roof. This treatment “team” is able to communicate with one another about the best ways to help the individual and make sure each component of the plan compliments the other: For example, treating alcohol addiction may require appropriate treatment of the underlying anxiety disorder with specialized long-term psychotherapy and anti-anxiety medication for which the patient was previously self-medicating the anxiety with alcohol.
Integrated care is the most effective way to treat dual diagnosis patients. Despite its benefits, availability of integrated treatment continues to remain a challenge. In one study, of the almost 3 million adults employed and living with a dual diagnosis, only about 40 percent received any treatment intervention at all for either disorder and less than 5 percent received treatment for both disorders.
How to cope with a dual diagnosis
Five things you need to practice every day if living with dual diagnosis:
- Take good care of yourself and make sure you are maintaining sobriety and adhering to your medications and psychotherapy regimen for any psychiatric disorders. Adherence to each regimen impacts outcome in a reciprocal way.
- Practice mind-body medicine which can help with stress management and treatment of both disorders.
- Recognize daily patterns in your mood or cravings, in order to assess if you risk self-medicating any mental health symptoms or risk relapse.
- Exercise and eat well, in order to maintain your vitality and self-care.
- Attend specific self-help groups for patients with dual diagnosis in your community.
Reach out for help and ask for help if you feel overwhelmed by the pressures of having a dual diagnosis. There are several specialty programs and clinics, in addition to residential care programs that can help patients find appropriate dual diagnosis treatment.