Dual diagnosis or co-existing conditions (also known as comorbid conditions or concurrent disorders) are common in those with substance abuse issues. A dual diagnosis is where there is a mental illness such as major depressive disorder, social anxiety disorder, or schizophrenia present along with the substance use disorder.
Addictions and other mental illnesses are closely linked. One-in-four adults living with a serious mental illness develop substance use disorders, and it is known that:
1. Substance abuse increases a person’s risk for another mental illness and
2. another mental illness increases a person’s risk of drug abuse.
It is not known why addiction and other mental illnesses are so closely related but it is likely a combination of the following three factors:
1. Drugs of abuse can cause users to experience psychiatric symptoms, such as the experience of psychosis with cannabis use.
2. When one suffers from a mental illness such as an anxiety disorder, that person may be tempted to self-medicate using a drug. For example, it has been shown that up to 90% of people with schizophrenia smoke, and this appears to lessen some symptoms of the disease as well as improve cognition.
3. Addiction disorders and mental illnesses appear to share common roots such as genetic vulnerability, underlying brain defects, and early exposure to stress or trauma.
MOOD & ANXIETY DISORDERS WITH DRUG USE DISORDERS
Mood disorders include major depressive disorder and bipolar disorder, and these conditions are the ones most commonly diagnosed in combination with a drug use disorder. Of those with a mood disorder, about 32% also have a substance use disorder. More than half of all people with bipolar disorder also have an addiction.
Those diagnosed with a substance use disorder are about twice as likely to also have a mood or anxiety disorder. Marijuana abuse is most closely linked to mood and anxiety disorders, but abusing any drug increases the risks of these mental illnesses.
Anxiety disorders include social anxiety disorder (also known as social phobia), generalized anxiety disorder, and posttraumatic stress disorder. Any anxiety disorder increases the risk of substance abuse. About 20% of people with panic attacks, panic disorder, posttraumatic stress disorder, or generalized anxiety disorder also experience a substance use disorder at some time in their lives. Alcohol abuse may be associated with anxiety disorders, particularly social anxiety disorder.
PERSONALITY DISORDERS WITH DRUG USE DISORDERS
One study found that 46% of those admitted to a psychiatric facility for the first time with a substance use disorder also had a personality disorder, with antisocial personality disorder being the most prevalent followed by borderline personality disorder. Those with dual diagnoses were younger at addiction onset, used more illicit drugs, were more distressed, and attended work or school less frequently.
TREATING THOSE WITH A DUAL DIAGNOSIS
It’s important that a recovery plan for those with a dual diagnosis includes treatment for both the substance use disorder and the other illness concurrently. While having a dual diagnosis can complicate treatment, it is likely that when the addiction is treated the other mental illness will improve and vice versa. Treatment for both disorders can create recovery from both.
While options for dual diagnosis patients have been limited in the past, more research is being done on the best way to treat these people. Some treatments may focus on multiple diagnoses simultaneously. Behavioral therapies such as dialectical behavior therapy (DBT) and others are considered the cornerstone of treatment of those with dual diagnoses.
Being diagnosed with any illness is daunting, but being diagnosed with more than one can feel impossible to deal with. If this is you, however, you are not alone. Many people with addictions are fighting other mental illnesses as well, and many people recover from both illnesses.
Addiction “detox”—short for “detoxification”—is a medically managed process of allowing drugs and alcohol to leave the body so that withdrawal symptoms may be carefully managed. It’s the initial step when entering recovery, and it provides a clean slate for the healing process to begin.
While it is normal to be afraid of both entering detox and of withdrawal symptoms, it’s important to know that many people detox successfully every year and come out the other side grateful for being clean. Temporary pain is worth long-term gain.
It’s also to important to know that cravings, and sometimes withdrawal symptoms, may last beyond the detox period. This is normal and a qualified rehab facility will help you manage these situations.