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What is Dual Diagnosis?
A person who has both an alcohol or drug problem and an emotional/psychiatric
problem is said to have a dual diagnosis. To recover fully,
the person needs treatment for both problems.
How Common Is Dual Diagnosis?
Dual diagnosis is more common than you might imagine. According
to a report published by the Journal of the American Medical
Association:
Thirty-seven percent of alcohol abusers and fifty-three
percent of drug abusers also have at least one serious mental
illness.
Of all people diagnosed as mentally ill, 29 percent
abuse either alcohol or drugs.
What Kind of Mental or Emotional
Problems are Seen in People with Dual Diagnosis?
The following
psychiatric problems are common to occur in dual diagnosis
- i.e., in tandem with alcohol or drug dependency.
- Depressive
disorders, such as depression and bipolar disorder.
- Anxiety disorders, including generalized anxiety disorder,
panic disorder, obsessive-compulsive disorder, and phobias.
- Other psychiatric disorders, such as schizophrenia and
personality disorders.
The following table based
on a National Institute of Mental Health study, lists
seven major psychiatric disorders and shows how much
each one increases an individual’s
risk for substance abuse.
Psychiatric Disorder and Increased
Risk For Substance Abuse
Antisocial personality disorder: 15.5%
Manic episode: 14.5%
Schizophrenia: 10.1%
Panic disorder: 4.3%
Major depressive episode: 4.1%
Obsessive-compulsive disorder: 3.4%
Phobias: 2.4%
Thus, someone suffering from schizophrenia
is at a 10.1 percent higher-than-average risk of being an
alcoholic or drug abuser. Someone who is having an episode
of major depression is at a 4.1 percent higher-than-average
risk of being an alcohol or drug abuser…and so on.
Which
Develops First - Substance Abuse or the Emotional Problem?
It
depends. Often the psychiatric problem develops first.
In an attempt to feel calmer, more peppy, or more cheerful,
a person with emotional symptoms may drink or use drugs;
doctors call this “self-medication.” Frequent
self-medication may eventually lead to physical or psychological
dependency on alcohol or drugs. If it does, the person then
suffers from not just one problem, but two. In adolescents,
however, drug or alcohol abuse may merge and continue into
adulthood, which may contribute to the development of emotional
difficulties or psychiatric disorders.
In other cases, alcohol
or drug dependency is the primary condition. A person whose
substance abuse problem has become severe may develop symptoms
of a psychiatric disorder: perhaps episodes of depression,
fits of rage, hallucinations, or suicide attempts.
How Can a Physician Tell Whether the Person’s
Primary Problem is Substance Abuse or an Emotional Disorder?
At
the initial examination, it may be difficult to tell. Since
many symptoms of severe substance abuse mimic other psychiatric
conditions, the person must go through a withdrawal from
alcohol and/or drugs before the physician can accurately
assess whether there’s an underlying psychiatric problem
also.
If a Person Does Have Both an Alcohol/Drug Problem and
an Emotional Problem, Which Should Be Treated First?
Ideally,
both problems should be treated simultaneously. For any
substance abuser, however, the first step in treatment
must be detoxification - a period of time during which
the body is allowed to cleanse itself of alcohol or drugs.
Ideally, detoxification should take place under medical
supervision. It can take a few days to a week or more,
depending on what substances the person abused and for
how long.
Until recently, alcoholics
and drug addicts dreaded detoxification because it meant
a painful and sometimes life-threatening “cold
turkey” withdrawal. Now, doctors are able to give hospitalized
substance abusers carefully chosen medications which can
substantially ease withdrawal symptoms. Thus, when detoxification
is done under medical supervision, it’s safer and less
traumatic.
What Is Next After Detoxification?
Once detoxification
is completed, it’s time for dual
treatment; rehabilitation for the alcohol or drug problem
and treatment for the psychiatric problem.
Rehabilitation
for a substance abuse problem usually involves individual
and group psychotherapy, education about alcohol and drugs,
exercise, proper nutrition, and participation in a 12-step
recovery program such as Alcoholics Anonymous. The idea
is not just to stay off booze and drugs, but to learn to
enjoy life without these “crutches.”
Treatment
for a psychiatric problem depends upon the diagnosis. For
most disorders, individual and group therapy as well as
medications are recommended. Expressive therapies and education
about the particular psychiatric condition are often useful
adjuncts. A support group of other people who are recovering
from the same condition may also prove highly beneficial.
Adjunct treatment, such as occupational or expressive therapy,
can help individuals better understand and communicate
their feelings or develop better problem-solving or decision-making
skills.
Must a Dual Diagnosis Patient Be Treated in a Hospital?
Not
necessarily. The nature and severity of the illness, the
associated risks or complications, and the person’s
treatment history are some of the facts considered in determining
the appropriate level of care. There are several different
levels or intensities of care including full hospitalization
or inpatient treatment, partial hospitalization, and outpatient
treatment.
What is the Role of the Patient’s Family
in Treatment?
With both rehabilitation
for substance abuse and treatment for a psychiatric problem,
education, counseling sessions, and support groups for
the patient’s family
are important aspects of overall care. The greater the
family’s understanding
of the problems, the higher the chances the patient will
have a lasting recovery.
How Can Family and Friends Help with
Recovery from the Substance Abuse?
They need to learn to
stop enabling. Enabling is acting in ways that essentially
help or encourage the person to maintain their habit of
drinking or getting high. For instance, a woman whose husband
routinely drinks too much, might call in sick for him when
he is too drunk to go to work. That’s
enabling. Likewise, family members or friends might give
an addict money which is used to buy drugs, because they’re
either sorry for him or afraid of him. That’s enabling
also.
When family and friends
participate in the recovery program, they learn how to
stop enabling. If they act on what they’ve
learned, the recovering substance abuser is much less likely
to relapse into drinking or taking drugs.
How Can Family and
Friends Help with Recovery from a Psychiatric Condition?
They
should be calm and understanding, rather than frightened
or critical. They should be warm and open, rather than cool
or cautious. Although it is fine to ask the person matter-of-factly
about the psychiatric treatment, that shouldn’t be
the only focus of conversation.
If Someone I Know Appears
To Have A Substance Abuse Problem And The Symptoms Of A Psychiatric
Disorder, How Can I Help?
Encourage the person to acknowledge
the problems and seek help for themselves. Suggest a professional
evaluation with a licensed physician, preferably at a medical
center that’s
equipped to treat addiction problems and psychiatric conditions.
If the person is reluctant, do the legwork yourself - find
the facility, make the appointment, offer to go with the
person. A little encouragement may be all it takes. If you
talk to the physician first, be honest and candid about the
troubling behavior. Your input may give the doctor valuable
diagnostic clues.
There Is Hope
As a relative or friend, you can play an
important role in encouraging a person to seek professional
diagnosis and treatment. By learning about dual diagnosis,
you can help this person find and stick with an effective
recovery program.
The more you know about dual diagnosis,
the more you will see how substance abuse can go hand-in-hand
with another psychiatric condition. As with any illness,
a person with dual diagnosis can improve once proper care
is given. By seeking out information, you can learn to
recognize the signs and symptoms of dual diagnosis - and
help someone live a healthier or more fulfilling life.
Other Resources:
National Clearinghouse on
Alcohol and Drug Information
Phone: 800-729-6686
http://findtreatment.samhsa.gov/facilitylocatordoc.gov
Dual Recovery Anonymous World Services Central Office
P.O. Box 8107
Prairie Village, KS 66208
Toll-Free Number: (877) 883-2332
Website URL: http://draonline.org
Alcoholics Anonymous
P.O. Box 549
New York, NY 10163
Phone Number: (212) 870-3400
Website URL: http://www.alcoholics-anonymous.org
Narcotics Anonymous World Service Office in Los Angeles
P.O. Box 9999
Van Nuys, CA 91409
Phone Number: (818) 773-9999
Fax Number: (818) 700-0700
Website URL: www.na.org
Alanon and Alateen Family Group Headquarters Inc.
1600 Corporate Landing Parkway
Virginia Beach, VA 23454-5617
Phone Number: (757) 563-1600
Fax Number: (757) 563-1655
Email address: wso@al-anon.org
Website URL: www.al-anon.alateen.org
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