The United States is currently in the third wave of the overdose epidemic. It officially started in 1999 when pharmaceutical companies convinced doctors to prescribe potent opioids to their patients. Opioids are used to relieve pain. The issue is that sometimes they work too well.
Over the last two decades, the medical community has been gathering information. Something that has also happened is the development of more mental health issues. Dual diagnosis, for example, is a condition that occurs when there is a substance use disorder and a mental health disorder at the same time. A dual diagnosis can also be known as a co-occurring condition as well as comorbidity.
Research compiled by the National Institute on Drug Abuse (NIDA) states that an individual who has a substance use disorder is at higher risk to develop a mental health condition and vice versa.
Research has found that youth are not immune. They are actually at a higher risk for dual diagnosis since their brains continue to develop well into their adolescent years. Adolescents in community-based substance use disorder treatment programs were likely to meet diagnostic criteria for another mental illness at a rate of 60%.
Serious emotional disturbance, for example, refers to a diagnosable mental, behavioral, or emotional disorder that occurred in the past year. It often is a result of a functional impairment. It substantially interferes with or limits a child’s ability to function in family, school, or community activities.
Youth who are between the ages of 18 to 25 experience a lot of stress. They are transitioning from young adults to adults, and this is when they are finding their footing in the workforce, contemplating getting married, and starting a family. The stress of these potential changes makes adolescents vulnerable. Moreover, an individual who experiences trauma as a child may seek to cope with a substance of his or her choice, especially when they are no longer living at home. Untreated trauma at the childhood level can lead to a co-occurring disorder in the adult years.
When it comes to dual diagnosis, some of the common mental health conditions that are found include:
• Generalized anxiety disorder
• Panic disorder
• Post-traumatic stress disorder
If the mental health disorder developed first and the substance use disorder developed after, common mental health disorders were:
• Bipolar disorder
• Attention deficit hyperactivity disorder (ADHD)
• Psychotic illness
• Borderline personality disorder
• Anti-social personality disorder
The data indicates that patients with schizophrenia are more likely to develop alcohol, tobacco, and drug use disorders than the public.
Another mental health condition that is tracked is serious mental illness. An individual who is 18 years of age or older can develop a serious mental illness if he or she is diagnosed with a mental, behavioral, or emotional disorder that leads to serious functional impairment. The impairment interferes with or limits an individual’s ability to live his or her life on a daily basis. Conditions may include major depression, schizophrenia, and bipolar disorder. One in four individuals with a serious mental illness also has a substance use disorder.
What Is Dual Diagnosis?
Dual diagnosis is treatment that an individual receives when he or she has a mental health condition and a substance use disorder. This condition came to be in the 1980s. Today, the Substance Abuse and Mental Health Services Administration refers to it as co-occurring disorders. In 2007, the National Survey on Drug Use and Health found that:
• 2.7 million adults reported a co-occurring major depressive episode and alcohol use disorder in the last year
• 40.7% of those adults did not receive treatment for either disorder
• At least 24 million Americans reported severe psychological distress
Symptoms of Dual Diagnosis
The NIDA has found that the symptoms of a dual diagnosis are sometimes difficult to identify. A medical professional has to figure out whether the substance use disorder is causing depression or if the mental health condition is responsible. Getting it right is important for the patient’s safety. If a doctor attempts to medicate the mental disorder but it has a negative effect on the substance use disorder, the results could be fatal.
Symptoms can be tricky because there are drugs that cause mental health-type symptoms when the patient does not have that particular mental disorder. The medical community does agree that overlapping factors do occur due to factors such as:
• Underlying brain deficits
• Genetic vulnerabilities
• Early exposure to stress or trauma
Doctors have to take a look at the symptoms with a fine-toothed comb. When the substance use disorder develops first, drugs can change the structure of the brain. Then, the mental disorder can develop.
Another caveat is that if a patient is undergoing withdrawal, the symptoms of that withdrawal may be similar to those produced from a mental health disorder. One thing doctors have to lean on is that the symptoms exhibited by a patient with a dual diagnosis will be much more severe, persistent, and resistant to treatment than a patient who only has a substance use disorder.
Nonetheless, some symptoms also are:
• Retreating from relationships
• Sudden changes in behavior
• Difficulty managing daily tasks
• Engaging in risky behaviors
• Neglecting health and hygiene
• Using substances under unsafe conditions
• Losing control over substance use
• Developing high tolerance to a substance
• Experiencing withdrawal symptoms
• Feeling the need to use the substance to function normally
As soon as a person realizes that something is not right, he or she is encouraged to seek help.
How Common Are Co-Occurring Disorders?
In August 2018, the NIDA estimated that 7.7 million Americans were experiencing a co-occurring condition. They also found that:
• 37.9% of the 20.3 million adults with a substance use disorder also had a mental illness
• 18.2% of the 42.1 million adults with a mental illness also had a substance use disorder
• 52.5% of adults who had a co-occurring condition received no treatment
• 34.5% of adults who had a co-occurring condition received mental health treatment only
• 9.1% of adults who had a co-occurring condition received treatment for both a substance use disorder and mental health condition
• 3.9% of adults who had a co-occurring condition received substance use disorder treatment only
Some of the reasons why individuals do not get treatment include:
• Did not know where to go to get treatment
• Believed they could handle the condition without treatment
• Fear of being committed
• Did not believe treatment would help
The good news is that several cities across the United States have adopted a proactive stance to help their residents in the midst of the overdose epidemic. Several of the barriers to getting treatment years ago no longer exist. It is simply about making a phone call or visiting a rehab center in person.
Benefits of Dual Diagnosis Treatment
The main benefit of dual diagnosis treatment is the same as getting treatment for any substance use disorder or mental health condition: to get better. By addressing the disorder sooner rather than later, the condition does not get worse. For example, individuals who have been heavy drinkers for several years can recover, but it is a bigger challenge for them than for someone who has only been drinking for a year or two.
Some benefits of treatment are:
• Receiving help to stop using drugs or alcohol
• Therapy that teaches the patient how to cope with his or her mental health disorder
• Therapist working to understand how the co-occurring disorders are connected
• Addressing the root causes of the addiction and mental health disorder
• Learning coping mechanisms for mental health conditions
• Identifying and avoiding triggers that ignite cravings
• Developing a relapse prevention plan
A patient for dual diagnosis can enter an inpatient program. Long-term residential treatment is another option. At each, the patient remains on-site for at least three weeks to a year. Patients are made as comfortable as possible during their stays. Then, their days are structured with therapy, counseling, and activity sessions.
At an inpatient rehabilitation center, patients can also detox before they begin their programs. Detoxing has to occur before treatment because the patient is going to go through withdrawal. Since a dual diagnosis case is more complicated, being under the supervision of a trained medical staff is to the patient’s advantage. The medical staff has to determine why the symptoms are appearing because these professionals have to treat the symptoms according to the condition that is causing them. Additionally, if a patient experiences a seizure, stroke, or heart attack, the staff can address it on the spot.
Getting help is a preventative measure. Those whose condition remains untreated risk:
• Neglect of family members and responsibilities
• Damage to major organs
Dangers of Self-Medication
One of the reasons why an individual may turn to drugs in the first place is to self-medicate. Whether they are feeling inadequate for any reason or are experiencing heavy peer pressure, coping through drugs or alcohol occurs on a daily basis.
Once a co-occurring disorder is full-fledged, however, self-medication places the individual in a high-risk situation. Alcohol can make depression worse or an opioid can cause an anxiety attack.
There are other red flags for self-medication, including:
• Delaying the diagnosis of an individual’s disorders
• Making the symptoms worse
• Developing tolerance to the substance, which leads to deeper addiction
• Intensifying the addiction to the substance
Is Dual Diagnosis Treatment Right for You?
When a patient accepts that he or she is experiencing a substance use disorder and a mental health condition, that person can call a hotline in the area or visit a service center in person. The next step is to speak with a licensed professional. That person can direct the individual to a place where he or she can be assessed. The assessment takes into consideration symptoms, medical history, and current health. Based on the findings, the individual may discover that a dual diagnosis treatment is right for him or her. In case it is not, the medical professional will point the patient in the right direction based on the findings.
Today, the medical community has lots of data and research at its disposal. Treatment is no longer a one-size-fits-all approach. Treatment plans are usually customized to fit the needs of the patient. This means that you may enter an inpatient rehab program, and there will be 19 other patients there, but each will have a different plan to follow.
Treatment is important for several reasons. Plus, a patient can rest assured that everything is being done for his or her health and safety. Doctors, licensed professionals, and treatment centers follow treatment guidelines as outlined by the NIDA.
Effective treatment acknowledges that all conditions are treatable even though they are complex because addiction and disorder rewire the brain. Every patient receives his or her own treatment plan. Treatment has to address the disorder as well as the root cause. Holistic therapy, for example, address the mind and body through physical exercise. Patients can participate in yoga and meditation as well as workouts in an inpatient program. The natural endorphins produced during exercise are known to have positive effects on the brain and body. In some cases, patients can sleep better at night as well as feel better about themselves during the day.
Treatment has to be long enough to be productive. This is why severe cases may consider entering a long-term residential program as opposed to an outpatient program. Outpatient programs are wonderful for those who have already completed an inpatient program. Maintenance work can be completed in the outpatient program in order to prevent relapse.
Behavioral therapies have become increasingly common. They vary in focus but generally include helping the patient readjust the reward mechanism of the brain. Building coping skills is an important activity that also takes place.
How to Find Dual Diagnosis Treatment Near You
There are several ways to find dual diagnosis treatment near you. The first would be to call your city’s information line. A representative can direct you to city or county resources. You can also look up service centers in your area online. The CDC and NIDA have posted several self-help guides on their websites, too.
Getting treatment is a great way for an individual to show that they care about themselves.