What Is Dual Diagnosis? Symptoms and Treatment
Although it’s not uncommon for two mental health diagnoses to intersect—mixed anxiety/depression, for example—the term “dual diagnosis” refers to a different kind of challenge. In these cases, a substance use disorder overlaps with a mental health condition. This is also referred to as a co-occurring disorder or co-morbidity.
Dual diagnosis occurs more commonly than you might think. According to the National Alliance on Mental Illness (NAMI), 8 million of the 21 million people in the U.S. who have a substance use disorder also have a mental health disorder. Other studies have found that, among adolescents and young adults, dual diagnosis can reach rates as high as 40-88%.
The presence of more than one disorder complicates both diagnosis and treatment, while increasing health risks. Fortunately, with the right treatment for both issues—the mental health and substance use disorders—it’s possible to live a productive and fulfilling life.
Many people who have undiagnosed mental health conditions self-medicate with drugs and end up addicted. Others experience brain changes through drug addiction, which pave the way for mental health conditions.
SYMPTOMS OF DUAL DIAGNOSIS
Since various mental health conditions may be co-occurring, each with its own unique symptoms, the signs of dual diagnosis run the gamut. To confuse matters further, some symptoms of substance abuse, or the side effects of withdrawal when trying to quit a substance, can resemble those of certain mental health disorders. Symptoms of substance use disorders include:- Increasing use of a substance: As tolerance levels climb, more and more of the substance is needed to get the same effects. Or some people may feel like they need a substance just to “function normally.”
- Negative life consequences: Substance abusers often neglect their responsibilities, leading to problems at work or school. Or they may engage in illegal activities (such as stealing) to fuel their habit, leading to trouble with law enforcement.
- Isolation: Substance use often interrupts a person’s usual routines. They may withdraw from family and friends.
- Powerlessness: Those who abuse substances often want to stop, but they don’t know how. They can experience guilt, shame, and remorse over their actions, triggering defensiveness if asked about their habits. In addition, trying to quit can lead to unpleasant withdrawal symptoms, which fuels the cycle of addiction.
- Noticeable changes: Substance abuse changes a person’s brain, behavior, and even appearance in a variety of ways. There may be signs like weight fluctuations, lack of personal hygiene, sleeping too much or too little, and not remembering events (“blacking out”).
- Impulsivity
- Hopelessness
- Feeling numb
- Nervousness
- Extreme mood swings
- Trouble concentrating or comprehending
- Suicidal thoughts or attempts
WHAT YOU NEED TO KNOW ABOUT SUBSTANCE USE DISORDERS
Remember that substance abuse can occur with any drug, not only dangerous street drugs. For example, many people treat alcohol as a different category, because it’s legal and socially accepted. However, alcohol has been found to be the most harmful drug in multiple countries, surpassing cocaine, heroin, and methamphetamine in terms of its societal damage. It is also one of the few drugs that can cause death during the withdrawal process when someone tries to quit drinking. Others hold a more tolerant view of cannabis, which is legally available in a growing number of U.S. states and is often misidentified as “nonaddictive.” But we know it is addictive—and potentially very harmful, especially to our youth. Finally, people can also abuse their prescription medications, such as benzodiazepines, opiates, stimulants (such as those prescribed for ADD/ADHD), sleeping pills, and more. As we have seen in recent years amid the opiate crisis, addiction can happen to anyone. Unfortunately, there is still a great deal of stigma surrounding addiction, and it’s often misunderstood or misdiagnosed by the medical community. However, single photon emission computed tomography (SPECT) brain scans can help. Through working with tens of thousands of patients, Amen Clinics has identified 6 types of addicts based on different brain patterns:- Compulsive Addicts
- Impulsive Addicts
- Impulsive-Compulsive Addicts
- Sad or Emotional Addicts
- Anxious Addicts
- Temporal Lobes Addicts
MENTAL HEALTH DISORDERS IN DUAL DIAGNOSIS
Asking “Which came first?” when discussing mental health and substance use disorders can feel like a chicken-or-egg scenario. Many people who have undiagnosed mental health conditions self-medicate with drugs and end up addicted. Others experience brain changes through drug addiction, which pave the way for mental health problems. That’s why it’s so important to receive help for both the addiction and the mental health disorder in dual diagnosis cases. Though addiction may accompany any mental health condition, here are some of the most common:- ADD/ADHD
- Anxiety
- Depression
- Post-traumatic stress disorder (PTSD)
- Bipolar disorder
- Schizophrenia
- Psychosis
DUAL DIAGNOSIS AND TREATMENT
Just as Amen Clinics has outlined 6 types of addicts, it has pinpointed 7 types within 3 common conditions: depression, anxiety, and ADD/ADHD. These designations are based on over 30 years of brain-imaging work with patients grappling with addictions and mental health disorders. Knowing which type is at work is the first step toward receiving targeted, effective treatment. It’s also important to assess other factors—biological, psychological, social, and spiritual—that may be influencing the onset of dual diagnosis symptoms. Ultimately, having an addiction and a mental health disorder (or multiple disorders) means that there are multiple issues in the brain that must be addressed. For example, someone who is addicted will have a problem within the brain’s reward system. The brain’s drive circuits (the nucleus accumbens and deep limbic system) dominate, which lead the addict to seek out the desired reward (that is, the drug). Meanwhile, addiction compromises the prefrontal cortex (PFC). Because the PFC is responsible for tasks like judgment and impulse control, addicts show a lack of self-restraint in the face of their addictions to substances. That’s one reason why people feel like they can’t quit, even if they suffer severe consequences from using drugs. The dysfunction in the brain’s reward system pushes them to repeat the same behavior over and over again. A SPECT brain scan will determine which areas of the brain have too little or too much activity, along with healthy areas of activity. Substance abusers’ scans often show an unhealthy, toxic appearance of the brain. These brains look less active and more shriveled. Fortunately, many treatment options can help those with a dual diagnosis. Aside from prescription medications, the following may be helpful:- Therapy modalities such as cognitive behavioral therapy (CBT) or dialectical behavior therapy (DBT) can help change damaging behavior and thinking patterns.
- Addiction support groups (as well as detox and rehabilitation centers) can help an addict quit substances.
- Lifestyle changes, such as diet and exercise, can reduce mental health symptoms by improving mood and overall well-being.
