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The Dual Diagnosis Drug Rehab Controversy

Using Dual Diagnosis to Address Possible Co-Occurring Disorders – is this a Valid Method of Treatment?

Dual diagnosis has become a rather controversial subject in the recovery field, with some fervent proponents and harsh critics. We want to explain what the concept means, explore both sides of the argument and provide you with the information available so you can decide for yourself what you believe may be the best option.

What Does Dual Diagnosis Mean Exactly?

Dual diagnosis is the coined term to describe patients who suffer from addiction to drugs and/or alcohol while having coexisting mental illness issues. As you can imagine, there is a complex relationship between the two, those who suffer from both at the same time require a rather more intense and complex treatment than a person who suffers from either condition by itself.

Are Co-Occurring Disorders Common?

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According to SAMHSA (the Substance Abuse and Mental Health Services Administration), almost four million Americans had problems with a substance abuse disorder according to the latest available data (2002). Even though that number appears high already, we have to take into consideration that there are many people who might benefit from treatment but never receive it. According to SAMHSA, only about 50% of all patients who actively need help for both issues ever get the treatment they need. As we previously mentioned, there is a great deal of controversy surrounding the notion of co-occurring disorders, with some suggesting that the behavior and mental problems may be a direct result of the addiction.

According to the National Institute on Drug Abuse, both mental illness and dependency have a number of shared risk factors. These include the following:

  • Environmental triggers – Stress or traumatic events could lead to dependence (as a method of coping) or to a mental illness (such as Posttraumatic stress disorder).
  • Life stages – According to the NIDA, both addiction and mental illness begin to take hold during adolescence. During this time, the brain is rapidly developing. If the person abuses illicit substances during these formative stages, it could possibly lead to issues later on.
  • Brain abnormalities – There are specific portions of the brain that respond to chemical rewards or stress in such a way that it is considered ‘abnormal.’ If the person suffers from a mental disease, it could make it easier for that person to become addicted.

Is there a Connection between Mental Illness and Substance Abuse?

Remember that the relationship between substance abuse or dependency and mental illness is a complex one. The relationship between the two can be considered in these ways:

  • Self-medication – Sometimes a patient may have incomplete treatment or untreated issues (depression or anxiety for example) that feel “less painful” if the patient uses alcohol or drugs. Even though this may exacerbate the problem down the road, the patient will likely only focus on what feels good for the moment.
  • Worsening underlying mental illnesses – This can happen during withdrawal from a substance (e.g. heroin withdrawal making preexisting panic attacks worse) or during acute intoxication (e.g. a patient struggling with depression becoming suicidal after a night of heavy drinking).
  • The onset of symptoms – If a patient uses illicit substances and becomes paranoid, it may represent the first episode of psychosis  or alternatively, represent a “substance-induced psychosis” as a reaction to the drug.

Given the numbers, it should be obvious that there are people who suffer from co-occurring disorders every year. With the number of people who suffer from dependence and the number of patients struggling with mental health issues, it would be almost impossible for these numbers not to overlap. This makes it reasonable to advocate the existence of dual diagnosis treatment programs. However, it is important to distinguish whether the mental issues are a byproduct from the drug use or whether they were present before.

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Why One Must Be Careful

Even though there is no denying that certain people clearly suffer from both issues, the National Center for Biotechnology Information (NCBI) states that the abuse of certain illicit substances can often mimic mental illness disorders. For example, the prolonged dependence to and abuse of certain drugs may manifest itself in certain symptoms that may cause others to believe that the patient is struggling with mental illness. We will look at a few of the most notable examples:

  • Alcohol
    Alcohol functions as a depressant. Someone who abuses alcohol on a regular basis may show an elevation in blood pressure, anxiety and hyperactivity.
  • Cocaine
    Once a patient comes down from their cocaine high, they may appear apathetic and lethargic.
  • Opioids
    If the third party only sees the person after they have come down from an opiate high, they may (incorrectly) assume that this person is suffering from depression.
  • Hallucinogens
    Hallucinogens produce clinically evident hallucinations and visual distortions. The person may experience feelings of depersonalization and a distortion of time. This may manifest itself in paranoia or a drug-induced panic. Even though these are different from schizophrenic-type hallucinations, a third party may not necessarily see the difference.

Any of the following substance-induced symptoms may cause those around the user to believe that they are struggling with a mental illness, when they are in fact suffering from the side effects of abusing illicit substances:

  • Persisting amnesia disorder
  • Delirium
  • Psychotic disorder
  • Anxiety disorder
  • Sexual dysfunction
  • Sleep disorder
  • Mood disorder

Not All Addicts Have a Mental Illness

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It is important to remember that the side effects that mimic a mental illness may not indicate that a patient is actually suffering from a mental illness. This does not mean that the patient does not need help (clearly, there are underlying issues with drug addiction) but it does mean that being prescribed additional medication to deal with mental illness when there is not actually one present may be counterproductive. Oftentimes the dual diagnosis treatment includes powerful psychotropic drugs and 12-step therapy (whether it be the AA or NA principle), this may be quite negative for a patient not actually struggling with mental illness. We are not suggesting that there are not a percentage of drug abusers who suffer from a co-occurring disorder, we are merely suggesting that it is important to be certain rather than make assumptions.

Admitting that you or someone close to you is having problems with addiction can be a painful step. Adding strange side effects and confusion caused by uncharacteristic behavior can make the problem even worse, oftentimes leaving people unsure as to where to turn for help.

Knowing that, it is important to note that these substance-induced symptoms can be treated. It is possible to receive help and it is only a phone call away. The right treatment works; believe in that and you will start the path to a new beginning.

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