Last Updated on March 16, 2020 by Dr. Alberto Solà

The concept of dual diagnosis has been around for over twenty years, but until recently, it was not fully embraced in a cohesive way by the many groups that work with individuals towards recovery. The reason for this is simple. Dual diagnosis, also known as co-occurring disorders, is a practice that treats people who suffer from both an addiction and a psychiatric disorder concurrently. Unfortunately, due to the way that medical care is set up in the United States, the health care providers and programs in place to treat these two separate issues are two separate groups of people and programs, and this often makes it quite difficult for people suffering to get the proper and correct targeted help that they need.

A dual diagnosis can be a combination of any number of conditions from two different categories. Addictions can include addictions to drugs or alcoholism, food addiction, or gambling or sex addiction. Many people suffering from addiction are addicted to more than one of these things. Conditions that classify as psychiatric disorders have a wide range as well and can include schizophrenia, bipolar disorder, eating disorders, depression, borderline personality disorder, panic disorder, obsessive-compulsive disorder, or others. The combination of an addiction with a psychiatric condition can be extremely difficult to live with, and can be just as difficult to treat. An alcoholic may also suffer from depression. A sex addict may also present with anorexia nervosa. A food addict may experience bipolar disorder. These combinations involve two different, but related problems. What should be treated first?

Co-occurring disorders are very common, actually. The 2011 National Survey on Drug Use and Health found that 17.5% of adults with a mental illness also had a substance abuse disorder. This percentage is quite large, and amounts to nearly 8 million American adults. Clearly, treatment for people with dual diagnoses needs to be addressed and more research should be done. Sadly, people with co-occurring disorders face many complex challenges, including increased chance of relapse when in recovery, and higher likelihood of hospitalization, homelessness, and contracting Hepatitis C, than individuals who are suffering from either addiction or a psychiatric condition alone.

Why Are Dual Diagnoses So Common?

The reason that so many people with psychiatric disorders also become substance abusers and addicts is simple. Many people who experience mental health conditions are drawn to alcohol or drugs as a form of self-medication, especially when they are not getting any professional treatment otherwise. However, research shows that use of drugs or alcohol actually worsens the symptoms of mental illness. Although in these cases the introduction of drugs or alcohol was inspired by a desire to find relief, substance abuse instead ends up creating more suffering.

Doctors find that in some cases it becomes difficult to diagnose people with co-occurring disorders because drug and alcohol abuse can often present as mental illness. It is difficult for them to determine what parts of the patient’s behavior is a result of ingesting the drug or being addicted to it for a period versus what aspects are indicative of mental health issues that existed before the substance abuse. As a result, this dual nature is present in many addicts, but is often left untreated. Unfortunately, only a small portion of people with a dual diagnosis receive treatment for both issues; the 2001 National Survey on Drug Use and Health found that only 12.4% of subjects that reported co-occurring disorders got treatment that addressed both their addiction and their psychiatric condition.

How Can Individuals with Dual Diagnoses Be Treated Effectively?

One tenet of dual diagnosis treatment is that addiction has little to do with addiction itself; rather, addiction is sparked by trauma and other deep lying issues within the individual. Unfortunately, despite the correlation or even causation between the two, it is difficult for people with two different, but related, issues to get treatment for both simultaneously. Some people get turned away from substance abuse treatment facilities if they admit they have a mental health problem. Alternately, some people get turned away from mental health treatment facilities if they admit their substance abuse problem. This creates a vicious cycle that keeps the person out of treatment and almost encourages him or her to keep using drugs and alcohol to self-medicate.

Historically, people who presented with both an addiction or a psychiatric condition were treated either sequentially, in which one issue is treated first, and hopefully cured or stabilized, and then the other issue would be treated afterwards, or, separately, where each condition would be treated concurrently but by completely different providers. While the second option, also known as parallel treatment is better than the first, it is not ideal either.

In the mid-1990s, initiatives were passed to try to change the way people with addiction diagnoses were treated. At that time, substance abuse treatment took a major turn; previously, a confrontational approach was often taken with people suffering from addiction, but that transitioned to a more supportive one. As a result, a movement to change treatment to individuals with dual diagnoses changed as well. Most detoxification and rehabilitation facilities began to understand that separate or even parallel treatment was not very effective, and what needed to be promoted was instead integrated treatment. Integrated treatment treats the whole individual in one facility. It helps the user break free from his or her addiction, and also helps to find and treat the roots of the addiction, too. This can help the individual to heal in more ways that one, and can help to keep him or her to avoid painful relapses down the road. Further, a new focus on long-term care also helped to find some relief for dual diagnosis patients onward into their futures.

Today, according to the National Alliance for Mental Illness (NAMI), dual diagnoses are treated by a six-pronged approach: detoxification, inpatient rehabilitation, supportive housing, psychotherapy, medications, and self-help and support groups. Even for individuals without a dual diagnosis, most will agree that each of these branches is important to recovery. Thanks to changes in the addiction recovery industry and climate, treatment programs aim to treat the whole individual, and as a result many have found success. Unfortunately, treatment is still out of reach for many people, and in many cases, it is the individuals suffering from co-occurring disorders are the people who fall through the cracks. Hopefully, with better funding and legislation, and with more treatment centers embracing this more thorough approach, all people who are suffering will soon be able to receive appropriate treatment for their conditions.

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