Dual Diagnosis Treatment and Substance Abuse
January 2, 2008
The term “dual diagnosis” may be new to your life and vocabulary or it may be something you are familiar with and have heard about before today. While not particularly well-known, dual diagnosis is more common than you might imagine. According to a report published by the Journal of the American Medical Association (JAMA), “Thirty seven percent of people who suffer from alcohol abuse and fifty-three percent of people who suffer from drug abuse also have at least one serious mental illness, which creates a dual diagnosis. Of all people diagnosed as mentally ill, 29 percent abuse either alcohol or drugs (NMHA, 2005). “Dual diagnosis” is defined as an individual who has two separate but very interrelated diagnoses. For the purpose of this article, dual diagnosis means a person has both:
1. A psychiatric diagnosis
2. A substance abuse diagnosis which may include drug addiction or alcohol addiction
A dual diagnosis occurs when an individual is affected by both chemical dependency and an emotional or psychiatric illness. Both illnesses may affect an individual physically, psychologically, socially and spiritually. Each illness has symptoms that interfere with a person’s ability to function effectively and relate to themselves and others. Not only is the individual affected by two separate illnesses, both illnesses interact with one another. The illnesses may exacerbate each other and at times the symptoms can overlap and even mask each other making diagnosis and dual diagnosis treatment more difficult.
Dual Diagnosis and Drug Rehab
December 25, 2007
Dual Diagnosis and Drug Rehabilitation: The New Hybrid Disorder and Addiction Treatment
Written by Rachel Hayon, MPH
Dual diagnosis is defined by the presence of both mental health disorders and substance abuse disorders (alcohol and/or drug dependence or abuse) [1]. There are a variety of different mental health disorders that can be associated with substance use and labeled dual diagnosis. Some of these disorders include: schizophrenia, bipolar disorder, anti-social personality disorder, narcissistic personality, and depression. A big question among the experts is which comes first- the mental health problem or substance use? It’s a difficult question to answer because so many of the symptoms associated with mental health disorders resemble the by product of substance use and vice versa. This is also an important topic right now because of the overwhelming amount of substance use cases and mental health disorders that overlap.
In a recent study conducted by the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), it was estimated that 17.6 million American adults meet the criteria for an alcohol use disorder and approximately 4.2 million meet the criteria for a drug use disorder [2]. In addition to this, 19.2 million adults can be diagnosed for independent mood disorders (major depression, dysthmia, manic disorder, and hypomania) and 23 million meet the criteria for independent anxiety disorders (including panic disorder, generalized anxiety disorder and specific social phobias) [2]. The NESARC also reported that approximately 20% of those individuals reporting a mental health disorder also reported a substance abuse disorder. Conversely, 20% of those individuals with a substance abuse disorder also displayed mental health problems [2].
When alcohol use is observed along with mental health disorders, alcoholics usually report that they “self-medicate” in order to alleviate symptoms of their psychiatric condition, such as depression [3]. One of the problems with using drinking as an emotional balm are the negative effects of heavy drinking as well as withdrawal from drinking- both can worsen an already negative mood state [4]. Having said this, it is interesting to see how different mental health disorders manifest themselves when substance use enters into the equation. Depending on what the disorder is, substances use is reported to be used for different reasons and also to either alleviate or bring on certain symptoms. For instance, in the case of bipolar disorder, though drinking may occur in both the manic and depressive phases, drinking is more prevalent during the manic phase [4]. Similarly, drinking may also produce symptoms that are similar to the manic phase of bipolar disorder such as grandiosity, irritability or physical agitation. In regards to anxiety disorder for instance, alcoholics usually report intense symptoms such as palpitations, sweatiness, and fear of objects or social situations which usually disappear with the discontinuation of alcohol use. However, individuals with agoraphobia or social phobia might drink in order to reduce the amount of anxiety they feel [5].
Understanding Dual Diagnosis
December 22, 2007
The term dual diagnosis is a common, broad term that indicates the presence of two independent medical disorders. Recently, within the fields of mental health, psychiatry, and addiction medicine, the term has been popularly used to describe the coexistence of a mental health disorder and drug addiction / alcohol addiction problems. The equivalent phrase dual disorders also denotes the coexistence of two independent (but invariably interactive) disorders, and is the preferred term used in this Treatment Improvement Protocol (TIP).
The acronym MICA, which represents the phrase mentally ill chemical abusers, is occasionally used to designate people who have an drug addiction / alcoholism disorder and a markedly severe and persistent mental disorder such as schizophrenia or bipolar disorder. A preferred definition is mentally ill chemically affected people, since the word affected better describes their condition and is not pejorative. Other acronyms are also used: MISA (mentally ill substance abusers), CAMI (chemical abuse and mental illness), and SAMI (substance abuse and mental illness).
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