The Leading Expert in Treatment for Alcohol and Substance Abuse
and Founder of The Hills Treatment Center
Dual Diagnosis

Dual diagnosis is a two-part diagnosis consisting of a substance abuse problem and a mental disorder. Combinations can vary greatly as there are a variety of addictions and a variety of mental and mood disorders. Some combinations are general such as depression and addiction. However, they can also be more specific, such as dissociative personality disorder and cocaine addiction. There are some mental and mood disorders such as generalized anxiety disorder and depression that can be either a symptom or cause of addiction.

Dual diagnosis can be difficult because substance abuse problems can induce psychiatric issues that mirror mental disorders. Some cocaine addicts may find themselves suffering from anxiety, paranoia, panic attacks, mania, and depression. These symptoms mirror bipolar personality disorder. However, it can be difficult to distinguish if the person had bipolar personality disorder and began using cocaine to help with the depression, or if the mania and depression were a result of the cocaine addiction. Used in high quantities many drugs can often induce full-blown psychosis. On the other hand many people with mental or mood disorders begin using substances because they haven't been diagnosed and therefore are not on the right medication. Without proper medication they turn to drugs or alcohol to ease some of the symptoms associated with their other illness. For example someone suffering form agoraphobia (literally meaning a fear of the market place, this disorder is characterized by a fear of crowds, people, or "unsafe spaces") that drinks to ease the anxiety associated with leaving his or her home. Due to the difficulty in diagnosing which came first, the mental disorder or the addiction problem, many psychiatrists will not make a diagnosis until the person has a length of sobriety to see if the symptoms still persist.

When people have a combination of different Axis disorders they may also have a dual diagnosis. The Diagnostic Statistical Manual classifies different disorders according to axis. For example axis one disorders are disorders such as depression and anxiety. These disorders are characterized by their regression as a result of therapy or medication. Axis two disorders are those that are mental retardation or incurable and drug resistant. Some disorders on axis two might involve borderline personality disorder or antisocial personality disorder.

Research has been done on the prevalence of dual diagnosis and has yielded some interesting results. Most studies show that those with a preexisting mental disorder are about three times as likely to also have an addiction disorder. However, results do vary greatly depending on the source. There is no debate about a positive correlation between addiction and mental disorders; the debate is over how strong that correlation is.

Treatment for those with dual diagnosis can be difficult because many treatment centers will not take patients with severe mental or emotional disorders. Some treatment programs do exist for people with dual diagnosis, and the consensus is that treatment for the addiction and other disorder should be integrated. Often the topic of medication becomes a topic of debate because some medications are considered addictive and people in recovery are asked to abstain from them, even if they are legitimately prescribed the medication. As an alternative people are asked to take medications that are non-narcotic and non-addictive. For many people with mental disorders this is not possible. For example in order to manage anxiety they may have to take a benzodiazepines, which is considered an addictive drug, however, alternative medications simply may not work.

Much like treating substance abuse by itself, families should be involved and supportive of a person with dual diagnosis' recovery. It is important for the family to understand their role in the addiction and to stop enabling. It is also important that the family educates itself about the mental disorder and addiction. It is important for the patient to understand that they do not have to go at this alone, and that they will be supported in their recovery.

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