The term dual-diagnosis describes the presence of both mental health issues and the addiction to drugs or alcohol, the impact on daily functioning, complications related to a problem left untreated, and the impact on others. Understanding co-occurring disorders also poses questions for both the professional and the patient in determining what came first, genetic loading or environmental influence?
By definition, patients with dual-diagnosis have one or more disorders, substance use, and mental or physical health issues. A diagnosis of dual-diagnosis occurs when at least one of the recognized disorders exists independently and is not part of a cluster of symptoms. Substance use and addiction can be a means to deal with mental health symptoms self-medication, the reason why clinical issues worsen or set the foundation for developing mental health disorders.
Some of the most common mental health disorders found in chemically dependent people include mood and anxiety disorders. An even higher percentage of people with severe mental illness also have co-occurring substance use disorders. This would strongly indicate that the two are inexorably linked.
We already know there is a biological vulnerability as well as situational stressors, life challenges, that trigger the onset of symptoms. Many of the patients seen with dual-diagnosis use alcohol and substances as a means to cope with mental health symptoms and facilitate social connections. There are many consequences of undiagnosed, untreated, or poorly treated dual diagnosis including higher probabilities of experiencing homelessness, incarceration, physical health conditions, suicide or self-injurious behaviors, and early mortality.
People with dual-diagnosis many times go untreated due to the health care systems focus on only one of the extremes of the complex. Many people with dual diagnosis end up receiving services through emergency rooms to avoid the stigma associated with formal treatment for substance abuse and mental health issues. A large percentage of the population with dual-diagnosis receive inadequate treatment or don’t even seek treatment.
The ideal treatment situation includes the identification and structured screening for dual diagnosis, collaboration, and communication among clinical providers, and the integration of both mental health and substance abuse issues.
Integrated treatment has shown to be more effective, featuring a client-centered approach, assuring that only one provider works on the comprehensive treatment plan. Individuals with dual-diagnosis not only need clinical treatment but also an array of services from housing, employment, family psycho-education, to case management, among others. The onset of mental illness is disrupting to the family, their cognitions, and social-emotional development. Combined with substance use problems, dual-diagnosis interferes with the patient’s ability to complete schooling, establish and maintain healthy relationships, find and procure regular employment, etc.
Hitting bottom and the other negative consequences of co-occurring disorders can lead to death. Providers and sources of support are key to the reduction of harmful consequences. The motivation for recovery is a must, the process of engaging and persuading the person to actively participate in treatment and focus on relapse prevention.
Without appropriate treatment both extremes of the disorders would lead to a loss of control over thinking and behaviors, causing a decreased ability of self-regulation and loss of willpower to make the steps to change and work towards recovery. We have to be strong believers that change is possible and know that treatment is available.