What is Dual diagnosis?
Dual diagnosis or co-occurring disorders (COD). Dual diagnosis is the condition in which an individual suffers from a mental health disorder as well as a comorbid substance abuse problem simultaneously. Both of these disorders branch out from the brain. Basically, a person suffering from a mental disorder is more prone to developing an addiction disorder and the same can be said for the reverse case. Why this occurs isn't precisely known but there are some theories that provide a vague idea- People take to drugs as a strategy for coping with mental disorders - Drugs abuse is a contributing factor in worsening or causing a mental health disorder.
It is necessary to distinguish between pre-existing and substance induced mental illness, as it is a challenging aspect to diagnose a primary psychiatric illness in abuser since drug abuse may develop psychiatric symptoms of its own.
Co-occurring disorders are said to be more complex than mental and substance abuse disorders separately as people diagnosed with dual disorders are more prone to relapse. Co-occurring disorders increase the risk of HIV, Hepatitis C infection as well.
How can we differentiate between pre-existing and substance induced mental illness?
Abusing addicting substances can induce symptoms of mental health disorders in the consumer, however these symptoms eventually tend to disappear when victim gets clean. These induced symptoms may remain in the withdrawal period or even months after cessation. This condition is termed as protracted withdrawal syndrome. However, abuse of some particular substances can especially prolong these symptoms. Among these symptoms, the most commonly induced are anxiety and depression.
How are co-occurring disorders diagnosed?
Often addiction induced disorders are confused with other psychiatric disorders. This can create complications in the correct diagnosis. Therefore it is recommended that mental illness disorders are diagnosed in the abstinence of intoxication.
What are the signs and symptoms that implement one should be diagnosed with COD/dual diagnosis?
There is only one way to make certain dual diagnosis exists, and that is to consult a professional. However there are some signs and symptoms that may help you recognize it by yourself. These signs are- Patients of dual diagnosis fail to keep up with work or school/college. They tend to isolate themselves and withdraw from social interactions. Troubled sleep patterns, failure in staying sober, persistent guilty feelings and development of tolerance (Needing larger doses to get the same level of intoxication) are also some helpful indications.
What is the relation between mental illness and substance abuse?
To explain the relationship between mental illness and substance abuse, a number of theories have been established. Let us have a look at them.
Casualties: This theory specifies that certain types of substances are more capable of inducing mental illness than the others. For example, intake of cannabis increase the risk of psychosis and its effects are found to be more persistent.
ADHD or Attention-deficit hypersensitivity disorder: ADHD is more common in people with substances abuse disorders, making it difficult to treat both. This disorder corresponds to the temptation to abuse drugs. Its outcomes are drastically negative in case of addicts who started abusing substances at a young age, as they've been exposed to the risk of induced psychiatric illness longer.
Past exposure to psychiatric medications theory: In this theory, the medication only seems to working on treating the psychiatric condition but actually it is only treating the disorders induced by itself. As soon as the medication is discontinued, the symptoms of psychiatric illness reappear but are resolved as soon as the medication is restarted. This medication alters neutral synapses, creating an imbalance that didn't exist previously.
Self-medication theory: Antipsychotic medications for the treatment of mental illness tend to have some negative side-effects while some certain abusive substances create effects that have the ability to relieve and counter those negative side-effects. According to this theory, some people resort to misusing such substances to fight off the sedation caused by antipsychotic medication, falling prey to addiction in this process. For example, consumption of SNRI antidepressants to counter the anxiety and insomnia resulting from some medications.
Autism spectrum disorder: Autism spectrum disorder has some typical traits such as introversion, inhibition and lack of sensation seeking personality. These traits provide protection against addiction as a result of which individuals on autism spectrum have less chances of succumbing to substance abuse. However alcohol abuse can worsen the symptoms of autism spectrum. The individual may find him/herself impaired from their social skills and ability to perceive facial emotions and understand humor.
Multiple risk factor theory: There are some specific factors such as social isolation, lack of structured daily activity, interaction with other abusers and easy access to drugs that contribute to both mental illness as well as substance abuse which increase the risk of co-occurring disorders/dual diagnosis.
The supersensitivity theory: Some people found themselves profusely vulnerable to biological and psychological disorders (arising from genetic or early environmental life events). This vulnerability, when met with stressful life events, renders them too responsive to substance abuse and they face negative consequences from even small levels of substance misuse. It can be established that these individuals are supersensitive to abusive substances and are at more risk of developing psychotic disorders.
Alleviation of dysphoria theory: It is not surprising to find that some people have very low self-esteem and the image they have of themselves is too negative for their own good. Such people take to substance abuse as a coping strategy to alleviate these feelings of low self-worth which makes them vulnerable to dual diagnosis disorders
How can co-occurring disorders be treated
Dual diagnosis patients often found themselves in a dilemma when it comes to treatment, as they may feel they will be excluded from mental health services if they go for substance abuse treatment and vice-versa. Therefore, to treat concurring disorders, there are a number of approaches. These approaches are
- Partial treatment where the main focus is on primary disorder.
- Sequential treatment where primary disorder is tended to first and then the secondary disorder.
- Parallel treatment where the patient receives services for both disorders simultaneously from different sources.
- Integrated treatment: This treatment is a blend of interventions into one package where both disorders are considered primary. Integrated treatment is said to be in the best interests of the client.
Medication is also proven to be effective in reducing the cravings, anxiety and paranoia. Such as methadone or buprenorphine for the treatment of opioid addiction- Baclofen for alcoholics, opioid addicts, cocaine addicts and amphetamine addicts. They are also effective in prevention of relapse, fatality and legal trouble.