Dual Diagnosis

What is dual diagnosis?

Dual diagnosis is a term used to describe a condition where someone may suffer from both mental health issues whilst also suffering from alcohol or drug problems.

Dual diagnosis is not a new condition as mental health issues and its relationship with problematic drug use has had a complex history.

Dual diagnosis also known sometimes as COC (co-occurring condition) can be very difficult to diagnose as it is often the case that the use of drugs and alcohol can be the cause of the mental health issue being experienced by the individual.

Being able to differentiate between substance-induced disorders and independent psychiatric disorders is hugely important when deciding which treatment may be the most effective in daily clinical practice.

For people who are experiencing drug problems, which include prescription drugs and alcohol, often experience symptoms which may resemble that of mental illness.

For many of these cases, the psychiatric disorders can disappear with prolonged abstinence.

Although in many cases the substance-induced psychiatric symptoms can be witnessed both when intoxicated and during the withdrawal state. In some cases, these symptoms can last long after a person has refrained from using drugs or alcohol such as prolonged psychosis or depression after cocaine or amphetamine abuse.

The abuse of hallucinogens has been known to trigger psychotic and delusional phenomena long after a person has stopped taking the drug.

Cannabis, when used frequently, may trigger panic attacks and can cause a state similar to dysthymia (persistent mild depression) and in some cases when continued can lead on to recurring depression.

Severe depression and anxiety can be induced by continuous alcohol abuse and even moderate sustained use of alcohol can increase anxiety and depression levels in some people.

Those with dual diagnosis face a range of complex challenges. Increased rates of relapse, hospitalisation and homelessness are more prevalent than in substance and mental health disorders alone.

For people who have a dual diagnosis and therefore complex needs may have experienced great adversity in their lives.

This may include childhood abuse, deprivation. Poverty or loss of close family.

As an adult having these multiple complex needs may affect issues such as employment and exploitation as well as poor physical health, suicide, self-harm and of perpetrating violence.

People with a dual diagnosis may experience a lack of empathy from individuals as part of our society’s entrenched attitude towards people with drug and alcohol problems are perceived as lifestyle choices rather than a condition that is deserving of treatment, care and support.

Treatment

Only a small percentage of people with dual diagnosis receive treatment for both substance and mental health issues.

An integrated treatment would require both drug and alcohol services blending with mental health services creating a philosophy of a single treatment package that can offer specialised support.

Staff from both services being trained with transferable skills and knowledge would be needed to achieve this philosophy.

A parallel approach would involve treatment from a mental health service whilst receiving support from an alcohol or drug service.

In most cases at present partial treatments are offered to treat the primary issue first and then treating the secondary problem once the first has been stabilised, however this can all be done in a Residential Rehab. It is vitally important you call us to find out which rehab can provide the correct care and support.

There is evidence to indicate that with help and support, people with a dual diagnosis can recover and stabilise.

A large percentage of the treatment for dual diagnosis is based upon behavioural interventions.

Individual psychotherapy

Can be successful in treating behaviours related to drug and alcohol abuse and/or mental health or behavioural problems.

Cognitive behavioural therapy

C.B.T works to minimize problematic behaviours and beliefs to develop a healthier pattern of thinking helping to sustain sobriety.

Dialectic behavioural therapy

D.B.T is often used to reduce self-harming behaviours that can often be witnessed with mental health conditions and substance misuse disorders.

Integrated group therapy

Which aims to treat the symptoms of both mental health illness and substance misuse disorders together.

Medication

There are multiple medicines to help both mental health issues as well as substance and alcohol misuse issues if therapies are unable to help.

There are many different theories that can explain the relationship between mental illness and substance misuse.

Causality

The causality theory indicates that that certain types of casual drug abuse may lead to mental ill health.

There is evidence that suggests using cannabis may sometimes produce temporary and mild psychosis.

More frequent users may show symptoms of psychosis.

Although the effective outcome is less strong there is no real evidence that the connection between people using cannabis is more lightly to experience psychotic disorders.

The causality theory is often challenged due to the fact that all though cannabis use has greatly increased over the last forty years, cases of psychosis has remained relatively stable.

Attention deficit hyperactivity disorder.

It is suggested that people with ADHD will try drugs and alcohol much younger than their peers.

They are more likely to have a poorer outcome, as in a longer time to remission. They may experience more psychiatric complications from substance misuse.

Past exposure to psychiatric medications theory.

This theory suggests that exposure to psychiatric medications may alter neural synapses introducing an imbalance that may not have been present before.

Self-medication theory

This theory suggests that people with mental health conditions might misuse substances in order to create a set of symptoms to counter the negative side effects of anti-psychotic medication.

Multiple risk factor theory

This theory suggests that there may be shared risks that can lead to both substance misuse and mental health issues.

These may include social isolation, poverty, a lack of adult role responsibilities or a lack of structured daily activities.

Other evidence suggests that traumatic life events such as abuse can lead to both mental health and substance misuse issues.

For many people a dual diagnosis can be very lonely and frightening.

Having to deal with mental health issues or substance misuse alone is normally a long and painful experience that often leads to heartache, relapses and many tries before reaching abstinence.

For people who have to take on both issues at the same time may face a constant struggle working out which issue is the most prominent and which is working against the other at any given time.