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Breaking the Cycle: Understanding and Treating Dual Diagnosis

An individual with dual diagnosis presents with two separate but interrelated diagnoses – the combination of a psychiatric diagnosis and a substance abuse diagnosis. Trying to manage just one of these conditions can be extremely stressful. Add to this the mix of multiple symptoms that overlap and mask the ability to make a proper diagnosis, and you're left with an extremely complex challenge just to find the right treatment. It is critically important that both disorders be treated simultaneously to achieve the best possible outcome. Thus a dual diagnosis treatment should be sought.

Dual Diagnosis

Dual diagnosis is a term that is used when referring to someone who is not only suffering from a substance abuse issue (addiction) but also has a mental health problem such as depression, anxiety, bipolar disorder, schizophrenia, etc.

How to Deal with Dual Diagnosis

Dual diagnosis can develop into a vicious cycle. People with mental health issues, like depression, may turn to substances to self-medicate, leading to addiction. However, this only offers temporary relief and ultimately worsens the underlying mental health problem. Individuals with dual diagnosis need treatment for both their substance abuse and their mental health condition.

It can also be the case that someone will develop a dual diagnosis due to their continued substance misuse. For example, many chronic alcoholics develop alcohol-induced depression. Here the individual will be trapped in a vicious circle of drinking to escape depression and becoming increasingly depressed due to their alcoholism.

The dual diagnosis can similarly develop with any other form of substance abuse. Find a detailed article here on → Substance Abuse and Depression: The Link and The Treatment.

Therefore, to ensure successful treatment of alcohol and drug addiction, any underlying mental health problems must also be addressed.

The most usual way to treat a person with a dual diagnosis is to first get them clear of their addiction. This will most often involve a medically supervised period of withdrawal. This is due to the fact no real progress can be made in treating any mental illness if the person is still under the effects of alcohol or drugs. It will also have to be the case that the person is willing and ready to give up their addiction.

Any person who needs to go through alcohol or drug addiction treatment is at risk of severe withdrawal symptoms; these withdrawals can be potentially life-threatening so the focus of all treatment should be to get the individual safely through before any attempt is made to fix their other problems.

If an individual with dual diagnosis manages to escape their addiction then they need to begin treatment for their other mental health issue. Progress cannot be made in recovery unless this occurs and there is a real risk of relapse if life remains unbearable despite quitting substance misuse.

The presence of the condition needs to be diagnosed quickly to prevent relapse. There are likely many individuals with addiction problems who are unaware of their other psychiatric problems.

To ensure that dual diagnosis clients will make a full recovery, their care should include:
  • What is referred to as “parallel treatment” of their substance abuse and mental health problems by the members of a specialized, well-coordinated treatment team.
  • Medications, such as antidepressants and anti-anxiety medications, can be helpful in managing symptoms of dual diagnosis.
  • Providing therapy that builds their confidence and reinforces self-esteem, rather than taking an aggressive, negative approach in dealing with them.
  • Not surprisingly, this method also brings in spouses, children, and various family members for sharing information, group meetings, and private counseling.
Note: Not everyone who has a dual diagnosis will benefit from the same treatment program. There is a wide range of mental health disorders, and the connection between patients' substance abuse and their mental health problems can be difficult to determine.

For example, people who are given a dual diagnosis may need treatment for a mood disorder, an anxiety disorder, a personality disorder, or an eating disorder, all of which must be treated differently. At the same time, people who have a co-occurring disorder need an integrated form of treatment to make a full recovery.

A dual diagnosis complicates recovery from substance use disorder, but this does not mean that a full recovery can’t be achieved. Many people with this diagnosis have not only escaped their addiction but have also gone on to lead happy and fulfilling lives.

The important thing is to be aware of the problem; many of those with a dual diagnosis relapse because they just were not aware that they had another psychiatric problem which was making their recovery from addiction so difficult.

Dual Diagnosis Treatment

Dual diagnosis treatment is a therapy plan for treating someone who has a mental illness or an emotional condition in addition to having a substance abuse problem.

The complications of dual diagnosis demand a carefully planned treatment module that can simultaneously treat both disorders to counteract the cumulative effect that influences all aspects of the individual's life and greatly increases the risk of relapse.

Research shows that often a psychiatric problem occurs first. An individual suffering from a mental illness often attempts to self-medicate with alcohol or drugs which can lead to a chemical dependence. Of course, the reverse is possible as well. Regardless of which disorder presents first, dual diagnosis treatment is the best way to achieve a positive outcome.

Mental health services are usually unable to effectively treat dual diagnosis. While skilled in mental health treatment, they may lack resources for substance abuse issues. Dual diagnosis treatment programs/centers should include the following:
  • Medical detoxification
  • Long-term residential programs
  • Individual and group therapy
  • Stress management
  • Prescription medicine (when needed)
  • Aftercare programs
Dual diagnosis treatment is becoming increasingly popular as mental health counselors come to realize that more and more clients have underlying factors that perpetuate their visible signs of substance abuse. In a great deal of cases, one addiction underlies another condition or vice versa. Both conditions together form a co-dependent cycle of self-abuse and create a continuous circle of disturbing obstacles to good mental health.
Dual diagnosis treatment is based on the belief that merely entering into a drug rehabilitation program will not be successful unless the recovery program deals with the underlying psychological and emotional issues.

Sometimes, one condition is more obvious than the other. People who drink a lot are perceived to be drunk because that is all that other people see. What is not visible is that an alcoholic may be suffering from low self-esteem, clinical depression, feelings of helplessness, or inadequacy. Unresolved emotional instability is masked under the binges of heavy drinking, drug use, bulimia, or sexual promiscuity. Substance abuse is used as a shield to hide the emotions that the individual is unable to deal with daily.

Dual Diagnosis Recovery

Dual diagnosis treatment emphasizes a holistic approach for better recovery outcomes. From the point of view of the person who suffers from a substance abuse addiction or mood disorder, it doesn’t matter what condition comes first. During dual diagnosis treatment, the counselor endeavors to address the addiction while keeping in mind that once the substance abuse symptoms are cleansed from the individual, the other issues will become apparent.

Dual diagnosis treatment also deals with the emotional distress caused by a lack of available coping mechanisms. The overt symptoms of substance abuse and mental instability can lead to loss of family relationships, employment income, and self-respect. To make it worse, making bad decisions while under the influence of drugs or alcohol can lead to time spent in the penal system which exacerbates low self-esteem and related emotions.

Dual diagnosis treatment includes therapy that faces the root of the self-destructive behavior. It is a longer road to recovery, but once traveled, dual diagnosis treatment supports a better chance of full recovery and relapse resistance.

Dual Diagnosis and Teenagers

It is common for many teenagers who abuse substances to have a condition known as dual diagnosis. This is where they attempt to treat an underlying mental or emotional problem by abusing alcohol or drugs. They may be aware that they have developed a mental health problem or they may not be aware of it. Either way, the symptoms are likely to be temporarily relieved through their substance abuse.

Feeling Down When Parenting Teens? You're Not Alone. Learn how to cope with depression as a parent and support your teenager through their emotional rollercoaster, Read here → My Teenager Is Making Me Depressed: How to Cope and Thrive.

Even those teenagers who did not begin their substance use with a mental health problem are still at risk of developing one if they continue to abuse drugs or alcohol. This is because long-term substance abuse not only takes a toll on the body but also affects the mental processes. This can lead to a vicious circle where an individual increasingly abuses drugs or alcohol in an attempt to escape the mental turmoil created by their substance abuse. This will continue until that person either escapes their addiction or dies.

In adults, it is difficult for medical professionals to spot a dual diagnosis, and in teenagers, it is even more difficult. The symptoms of substance use disorder are similar to those of mental illness and are easy to miss. A teenager might be hearing voices because they are schizophrenic or because they are an addict; if an individual is high, drunk, or in the middle of withdrawals then their symptoms are likely going to be dismissed as part of their addiction. This diagnosis is further complicated by the fact that the normal changes that occur during adolescence can cause further symptoms.

Healthcare professionals are now becoming increasingly aware of dual diagnosis among teenagers and are on the lookout for it. Despite this, it is almost certain that people are falling through the net. Failure to spot an underlying mental health problem could lead to years of suffering due to addiction which could have been avoided if the teenager was treated early.

Many teenagers may be unwilling to receive help for their dual diagnosis. It may be that they are still getting some relief from their substance abuse and are reluctant to give this up. In the beginning, substance use can feel like the answer to all your problems, and it can be hard to believe those who say that it won’t last.

It is vital though, that the message is reinforced that addiction will not be a lasting solution to anything. It also needs to be emphasized that once their addiction is treated so can their other problems be tackled.

For any teenager to successfully escape their dual diagnosis it is vital that they first deal with their substance use disorder. Withdrawal from the substance they are abusing is a must for progress to occur. This will most often occur under medical supervision and no attempt at detoxification should be tried until first speaking with a doctor. Once the withdrawal stage is completed then all other problems can be tackled, and full recovery can begin.

Resources for Help

The following organizations provide support and information for people struggling with dual diagnosis.:
  • National Alliance on Mental Illness (NAMI): 1-800-950-NAMI (6264) or
  • Substance Abuse and Mental Health Services Administration (SAMHSA): 1-800-662-HELP (4357) or
  • Crisis Text Line: Text HOME to 741741.


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