What is Dual Diagnosis?
The term “dual diagnosis” refers to a condition in which a person has both a mental illness and an addiction issue. Either condition, when dealt with alone, could be devastating or even deadly, but when put together, the conditions tend to reinforce and interact with one another, making recovery all the more difficult for the person to accomplish without help.
While the specific causes of dual diagnosis conditions aren’t fully understood, researchers know that family history, genetics, brain chemistry and environmental factors all tend to play important roles in the dual diagnosis process. And, researchers know that treatments that impact all of these factors, providing complete care for both conditions at the same time, have the greatest chance of success. This is the kind of treatment we provide at La Paloma.
We are one of very few facilities that are prepared to deal effectively with a dual diagnosis. This article will outline the fundamentals of care, and will underscore why it’s so important for people with a dual diagnosis to ask for, and receive, the help they’ll need in order to recover.
Co-occurring Disorders Are Remarkably Common
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), about 4 million American adults who have a serious mental illness also had a substance abuse disorder in 2002. This number might seem high, but the reality is that there might be thousands more people who struggle with dual diagnosis issues, and who never come to the attention of the researchers and doctors who might be able to help them. SAMHSA makes this quite clear by reporting that only about half of people who have a dual diagnosis ever get treatment. It’s quite possible that there are many people who have this disorder who simply escape detection, because they never ask for help or enter any sort of treatment program.
As mentioned, researchers aren’t entirely sure why so many people have a dual diagnosis issue, but the National Institute on Drug Abuse reports that addictions and mental illnesses could be caused by shared risk factors, such as:
Shared Risk Factors
- Genetic vulnerabilities to both addiction and mental illness. These “overlapping genetic vulnerabilities” could make a person susceptible to a dual diagnosis, or could increase the risk of developing a secondary issue when the first appears.
- Environmental triggers. Traumatic experiences or stress could lead to both a mental illness (such as PTSD) and/or an addiction.
- Brain abnormalities. Portions of the brain that respond to stress or chemical reward could be abnormal in people with specific mental diseases, and those changes could also make people vulnerable to addiction.
- Life stages. Both mental illnesses and addictions tend to take hold during adolescence, when the brain is changing at a rapid rate. Adding drugs to the mix at this time could do damage that leads to mental illness.
Given these statistics, it’s clear that there are a substantial number of men and women who experience dual disorders each year. While it might be reasonable to expect that many treatment programs exist for people with a dual diagnosis, the fact is that many people who have a dual diagnosis don’t get the care they need in order to recover. According to 2005 statistics from SAMHSA, only 8.5 percent of people with a dual diagnosis got care for both problems. The rest received no care, or received care for one problem and not the other. This is a tragedy, as specialized programs and ongoing community-based support groups can provide lifesaving help for men and women who experience dual disorders. With this sort of care, they can recover.
The Many Types of Dual Disorders
While researchers often conduct studies on the dual diagnosis issue, lumping all people with mental illnesses and addictions into one group, most treatment providers agree that there is no single type of dual disorder. Some forms of psychiatric illness can severely impair an individual’s ability to function and relate well to others on a daily basis, while another mental illness might only cause cyclical impairment. The symptoms people experience might also vary greatly depending on the mental illness at hand. People with depression might not have the same daily experiences as people with anxiety, for example, although people in these two groups might very well have a dual diagnosis.
The nature of dual disorders becomes even more complex when alcohol and drug use is considered. For example, there are many types of intoxicating chemicals to choose from. A person who chooses heroin might feel sedated and calm, while a person who chooses methamphetamine might feel keyed-up and paranoid. Both addicts could have a dual diagnosis, but their disease paths are quite different, and their treatment paths will also be different.
For example, all people with a dual diagnosis will need to focus treatment efforts on both illnesses, and that treatment should happen concurrently. Treating one problem, while leaving the other in place, could make the original problem grow stronger. Both issues must be addressed at the same time in order for the person to truly heal. Not exploring these areas leaves the client at risk for ongoing imbalance. The best way to illustrate this is through the example of a child’s mobile. If one piece is broken or removed, the entire mobile is thrown into imbalance. Nothing works properly even though the other pieces are perfectly intact. Only by exploring all affected areas and working to bring them back into balance is true recovery possible.
Integrated Dual Diagnosis Treatment
The foundation of an integrated treatment model is a “systems approach,” which consists of looking at the psychiatric and psychological history as well as the addiction. Often, this begins with a thorough evaluation and assessment. Here, professionals get a clear picture of the severity of the mental health issues as well as the addiction issue. Often, these inpatient interviews reveal deep problems that must be addressed in treatment.
- Undesirable living arrangements
- A history of arrest
- A history of previous psychiatric hospitalizations
- Poor familial and social relationships
- A history of abuse of multiple drugs
It’s clear that these people had serious issues, and they would need a serious approach to care in order to recover. For this reason, most experts agree that people with a dual diagnosis should receive care in an inpatient program, where they live on the grounds and obtain help on a 24/7 basis. While people with less complex addiction histories might find success in outpatient programs, continuing to live at home while obtaining care, people with a dual diagnosis might need more intensive help in order to succeed.
Many people who enter programs for addiction would like to stop using any and all drugs almost immediately, without exception. While that is a reasonable approach for many people, it might not be the best approach for people with a dual diagnosis. In fact, some people who have a dual diagnosis might benefit from taking medications to treat their mental illnesses, and they might need to start that therapy as soon as they enter their addiction treatment programs. As the Depression and Bipolar Support Alliance points out, taking medications is not the same as using street drugs to self-medicate a mental illness. Illicit drugs tend to produce wild highs and crushing lows, and this can make a mental illness condition much worse. Mental illness medications, on the other hand, tend to balance out brain chemicals and make the person’s moods and behaviors more stable and predictable.
Medications for mental illnesses might take several weeks, or even several months, to take hold and help the person to feel better. As a result, dual diagnosis programs work hard to monitor patients and ensure that their clients are feeling comfortable and relaxed, even if their medications aren’t operating at an optimal level quite yet. This is the best way to ensure that people make the adjustment without too much distress.
Medications may help to ease symptoms and reduce distress, but they aren’t the only tools experts have available to help people who have a dual diagnosis. Therapeutic choices are quite vast, and they could mean real help for people who have a dual diagnosis. Most people who enter treatment programs are paired with a therapist, and are asked to go through multiple one-on-one treatment sessions in which they discuss both their addictions and their illnesses, and learn more about how they can be handled. This treatment, which is sometimes referred to as “treatment as usual,” is sometimes more effective if it is augmented with group therapy. Here, people can learn from one another, support one another and share stories of recovery. It could be a meaningful way for people to improve. In a study of group therapy, published in the journal Psychiatric Services, those who received group therapy had “significantly improved social and family relations, compared with the treatment-as-usual group,” and they also had reduced substance abuse levels. For some people, group therapy makes a world of difference.
Therapists might also use additional techniques to reach their dual diagnosis patients. For example, patients who have an anxiety disorder might benefit from exposure therapy in which they’re provided with repeated exposures to a situation, memory or object that fills them with fear. People with a dual diagnosis might find tailored therapy techniques like this to be incredibly helpful.
Help at La Paloma
At La Paloma, we are committed to treating both the addiction and the mental illness so that you or your loved one can find full and total recovery. We are so committed to an integrated, dual-diagnosis treatment model that we keep an independent director of research on staff to regularly assess the program. Twice yearly, our director performs a comprehensive fidelity assessment, reviewing charts, interviewing clinicians and rating the program in 20 different areas based on evidence-based practices. The findings from her detailed reports are disseminated back to the clinicians and the feedback is used to continually improve our program.
If you have any questions about co-occurring disorders, or you’d like to know more about obtaining help at La Paloma, please contact our call center.
Admissions counselors are available 24 hours a day at 877-345-1887.