Dual Diagnosis and the Importance of Treating Co-existing Mental Health and Substance Use Disorders

People who seek addiction treatment services tend to have a lot more at stake than their uncontrollable use of drugs or alcohol with multiple treatment needs across a wide range of personal, economic, and social areas.  According to the Institute of Medicine (US), “Each year, more than 33 million Americans use health care services for their mental problems and illnesses or conditions resulting from their use of alcohol, inappropriate use of prescription medications, or illegal drugs.”  

Quality addiction treatment services that cater to the unique needs of the individual play a key role in reducing illicit substance abuse, harms, associated behaviors, and preventing relapse, but, services that address co-existing conditions of mental health disorders are urgently important and necessary.  Left inappropriately treated, a dual diagnosis can be the major contributing factor to self-medication, relapse, suicide, and overall addiction treatment ineffectiveness.

What is Dual Diagnosis?

People with mental health issues such as depression or anxiety may abuse substances as a coping mechanism.

Addiction is a chronic and relapsing brain disease that often co-exists with other physical and psychological conditions that worsen the longer they are left untreated.  Dual diagnosis often includes a substance abuse problem that occurs simultaneously with depression or anxiety disorders, bi-polar disorder, ADHD, schizophrenia, or eating and sleeping disorders, but, there are many more.  Although the majority of substance abusers present a wide range of adverse psychological conditions at the time they enter treatment, assessing a dual diagnosis is complicated and requires professional interventions for those needs that are not typically addressed in the normal course of addiction treatment. 

For many, their conditions require only short-term interventions to help them develop coping and management skills for less severe problems such as anxiety or depression that dissipates with time in abstinence.  Others may require medication, inpatient, or specialized treatment services to optimize recovery outcomes and prevent worsening conditions.  According to the SAMHSA’s 2014 National Survey on Drug Use and Health (NSDUH), “ Among the 7.9 million adults in 2014 with co-occurring AMI (any mental illness) and an SUD (substance use disorder) in the past year, slightly less than half received either mental health care or substance use treatment at a specialty facility in the past year.”

Common Links

It’s a well known fact that mental health disorders can lead to substance abuse or vice versa and overlapping areas of the brain that are known to be involved in both can exacerbate the conditions of one or the other.  Addiction and mental illnesses share many commonalities which can progress to the state of chronic illness spilling over into their physical health, families, work, education, and societal functioning capabilities.  The most common links are imbalances or disruptions in the brain’s circuitry, neuronal transmissions, or pathways where rewards and stress are mediated to control thoughts, behaviors, emotions, hormones, and moods. 

In addition to biological factors, several influential risk factors are also involved including genetics, culture, environmental influences, personality, and social influences.  Compared with the general population, people who abuse drugs or alcohol are roughly twice as likely to suffer a mental illness. The National Survey of Substance Abuse Treatment Services (N-SSATS), estimates show “about 45% of Americans seeking substance use disorder treatment have been diagnosed as having a co-occurring mental and substance use disorder.”

Treating a Mental Health and Substance Abuse Dual Diagnosis

Dual diagnosis conditions require separate treatment interventions, albeit simultaneously, and each in the context of the other disorder for the best possible chances of a full and lasting recovery.  A lot of stigma has been placed on those suffering from mental illness and for men, especially, it may be more difficult to tackle the issues with their counselors or peers, but, left unattended, the outcomes can be dismal if not, fatal.  Treatments must be tailored to fit the individual’s unique needs in a manner that addresses their goals using treatment strategies that are acceptable to them.  

Many dual diagnosis clients are treated as outpatients through referrals to mental health counselors, psychiatrists, or other agency professionals while they continue to participate in addiction treatment counseling, behavioral therapies, and supportive systems.  For those who are experiencing a severe crisis such as with clinical depression, suicidal ideations, violent or harmful behaviors, or other psychotic episodes, an inpatient stay, (at least, temporarily) is warranted for safety.

Why are Anxiety and Substance Abuse Linked?

Benefits of Treating Co-existing Mental Health and Substance Use Disorders

According to the SAMHSA, “Integrated treatment or treatment that addresses mental and substance use conditions at the same time is associated with lower costs and better outcomes such as:

Reduced substance use Improved psychiatric symptoms and functioning Decreased hospitalization Increased housing stability Fewer arrests Improved quality of life

It should also be noted that overdose, suicide attempts, and suicide completions have reached epidemic proportions among substance abusers.  Adults aged 18 and up appear to be at higher risk of suicides from drug abuse, while adolescents are at a higher risk than ever in developing a mental illness where substance abuse increases their suicidal rates exponentially.  According to the Center for Behavioral Health Statistics and Quality (CBHSQ),”In 2013, an estimated 1.3 million adults aged 18 or older (0.6 percent of the population) attempted suicide in the past year, 2.7 million (1.1 percent) made suicide plans, and 9.3 million (3.9 percent) had serious thoughts of suicide. ” Helping these individuals comply with other treatment plans such as those involving their physical health, relationships, environmental, and social functioning skills cannot be overlooked in value.