It is very common for people with substance use disorders to also have mental health conditions and vice versa. This phenomenon goes by several names, including “dual diagnosis”, “co-morbid conditions” and “co-existing conditions”. At Safe Harbor Recovery Center, in Portsmouth, Virginia, we offer integrated treatment for co-occurring substance use and mental health disorders.
Because of stigma and lack of accurate information, people with co-occurring mental health and substance use disorders have often been blamed for causing their own conditions. While it is true that people sometimes don’t manifest mental health symptoms until after they have misused drugs or alcohol, this does not mean there is a causal relationship. There are several other ways to explain co-occurring disorders:
- Shared risk factors. Many of the same things that place a person at risk for addiction, also increase the likelihood that they will develop a mental health disorder. This includes trauma, genetics, and differences in brain structure and functioning.
- Self-medication. Many develop a mental health disorder first and attempt to manage their symptoms with alcohol or other drugs. This is sometimes the result of insufficient healthcare access or distrust of medical professionals.
- Symptoms that went unrecognized. The symptoms of mental health disorders often manifest in late childhood or adolescence. This is a time that is often associated with big changes due to hormones and normal human development, so it is exceedingly common for people with mental illnesses to struggle for years before their condition is diagnosed because their mental health issue is labeled “typical, angsty teenage behavior”. Using alcohol or other substances may intensify mental health symptoms, making them more obvious to outside observers, but those symptoms may be solely attributed to substance misuse, which has more visible clues.
- Misdiagnosis. Many overlapping warning signs can complicate the assessment and diagnosis process. Clinicians who aren’t trained and experienced in identifying and treating dual-diagnosis disorders can easily make mistakes.
Consequences of Failing to Treat Dual Diagnosis Disorders
People who struggle with both, addiction and mental illness, who don’t receive proper treatment, are at increased risk for:
- Relapses
- Hospitalizations
- Financial issues
- Isolation
- Legal system involvement
- Homelessness
- Victimization
Mental Illnesses Found in Patients with Substance Use Disorders
Some mental health conditions that frequently co-exist in patients who have struggled with addiction include:
- Mood disorders
- Schizophrenia
- Bipolar disorder
- Major depression
- Conduct disorders
- Post-traumatic stress disorder (PTSD)
- Attention deficit hyperactivity disorder (ADHD)
Substances Frequently Misused by Patients with Mental Health Disorders
Patients diagnosed with a mental health condition are most likely to misuse one or more of the following substances:
- Legal drugs, including alcohol, tobacco, and prescription medications
- Opioids
- Stimulants
- Marijuana
- Hallucinogens
Treating Dual-Diagnosis Disorders
In the past, it was common to treat either the mental illness or the substance use disorder first, before treating the other. This is no longer considered best practice, as the lack of treatment for one disorder can prevent the patient from progressing in their recovery for the other condition. Additionally, medications that may be recommended to treat one disorder may be contraindicated for the other, so clinicians need to consider the full picture, instead of simply treating one of the issues a patient is facing.
The services that are commonly recommended, to treat co-occurring mental health and substance use disorders include:
- Detox. This is typically the earliest stage of recovery when the substances are leaving a person’s body. They may experience withdrawal, which can be dangerous, if not supervised by qualified medical professionals.
- Inpatient rehabilitation. People with dual-diagnosis disorders are more likely to need in-patient treatment than people who just have one diagnosis or the other. This level of care offers 24/7 support and supervision.
- Therapy. There are many different types of therapy available. Adults with co-existing conditions are often treated using:
- Cognitive-behavioral therapy (CBT)
- Dialectical behavior therapy (DBT)
- Assertive community treatment (ACT)
- Therapeutic communities (TC)
- Contingency management (CM) Children and adolescents with co-existing disorders often benefit most from:
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- Brief strategic family therapy (BSFT)
- Multidimensional family therapy (MDFT)
- Multisystemic family therapy (MST)
- Medication. Not only are there medications that help patients to manage their mental health but some medications can make it easier for patients to manage cravings and withdrawal symptoms.
- Supportive housing. Living amongst other people who are focused on recovery can sometimes make it easier for people to maintain long-term sobriety.
- Self-help and support groups. AA, NA, and therapy groups can all be helpful. There are also recovery groups, such as Double Trouble in Recovery, that cater to people with dual-diagnosis disorders.
At Safe Harbor Recovery Center, we treat mental health conditions alongside substance use disorders. We develop individualized treatment plans that meet the unique needs of each patient we serve, including not just their substance use struggles, but also their mental health needs.