It isn’t difficult to understand the connection between mental health disorders and substance abuse. Anyone who has suffered through a bout of prolonged anxiety or depression, survived an acute traumatic event, or struggles with extreme mood swings can surely grasp the desire to find relief from the related symptoms. Whether it is chronic tension and worry, insomnia or nightmares, or the dark despair of depression, seeking solace from alcohol or drugs is an extremely common response.
For too many individuals, the reflexive response to managing the mental health condition is to simply mask it by numbing the emotional pain and suffering with a substance. Too many people still shy away from seeking professional help for their mental health needs, fearing stigma or shame, or assuming such help is financially unfeasible. Many may not be aware of the safeguards to privacy through confidentiality laws, or that their health insurance plan actually covers a portion, if not all, of the treatment. Without this knowledge they may lean instead on the substance of choice.
When the self-medicating substance turns against us, layering addiction over the existing mental health disorder, the person’s situation becomes exponentially more serious. Alcoholism or drug addiction compounds the negative consequences and exacerbates the symptoms of the original mental health condition. Addiction leaves those with a co-existing mental health disorder in a much worse situation, causing problems at work, in relationships, financial, legal, and health problems, and possibly even death.
Our nation continues to experience a shrinking expected life expectancy, with fresh, and worrisome, data being released this week by the Centers of Disease Control. The major reason for this decline in expected lifespan is due to the spike in suicides and drug overdose deaths over the past decade. The disturbing statistics bring sharp focus to the need for us, as a nation, to do a better job of removing the stigma and reaching individuals who are in need of treatment for mental health and dual diagnosis issues.
Types of Mental Health Disorders
The DSM-5 is packed full of diagnosable mental health disorders—at last count nearly 300. If the condition is included in the manual it is likely a disorder that causes psychological pain, physical effects, and impaired daily life. While all mental health afflictions cause a degree of suffering, there are some highly prevalent mental health disorders that tend to pair up with increased substance abuse or addiction.
- Anxiety disorders. Under the umbrella of anxiety disorders exist several different manifestations of anxiety, including:
- Generalized anxiety disorder
- Panic disorder
- Trauma disorder, PTSD
- Social anxiety
- Obsessive-compulsive disorder
- Depression. The spectrum of depressive disorders include:
- Major depressive disorder
- Postpartum depression
- Dysthymia, or persistent depressive disorder
- Seasonal affective disorder
- Premenstrual dysphoric disorder
- Bipolar disorder
- Psychotic disorders, including:
- Schizoaffective disorder
- Delusional disorder
Common Dual Diagnoses
Patterns have emerged that depict how some who suffer from a particular mental health disorder rely of a certain substance to help quell the discomfort of the disorder.
These combinations include:
- Anxiety and benzodiazepine addiction
- Anxiety and cocaine abuse
- Anxiety and alcoholism
- Social anxiety and marijuana addiction
- PTSD and alcoholism
- PTSD and opioid addiction
- Depression and alcoholism
- Depression and heroin addiction
- Bipolar disorder and alcoholism
- Psychotic disorder and opioid addiction
While individuals with a mental health disorder may abuse drugs or alcohol and develop an addiction, the disorder is not necessarily a causal factor. There may be a genetic component that is present in some individuals that predisposes them to both a mental health disorder and addiction. Also, environment factors can be causal factors for both, such as a history of trauma or abuse.
Symptoms of Mental Illness
Each particular mental health disorder will have its own diagnostic criteria, outlining the signs and symptoms present with the disorder. Therefore, someone with a depressive disorder will have distinctly different presenting symptoms than someone with an anxiety disorder. However, there some general signs of mental distress or mood disorders that can signal the need for both a physical examination, because medical issues can cause these changes, and a psychological evaluation.
Signs of a possible mental health disorder include:
- Cognitive changes, memory problems, confused thinking, lack of concentration
- Extreme and unexplainable mood swings
- Sleep disturbances, hypersomnia, insomnia
- Fatigue or lethargy
- Changes in eating habits, unintended weight gain or loss
- Isolating behaviors
- Loss of interest in activities once enjoyed
- Suicidal thoughts or attempts, self-harming behaviors
How is the Dual Diagnosis Treated?
Once someone with a mental health disorder becomes dependent on alcohol or drugs the need for expert treatment is elevated. An untreated dual diagnosis is destined to only get worse over time. However, treatment for a dual diagnosis should be carefully selected.
The dual diagnosis treatment milieu offers an integrated approach to treating both of the co-existing disorders using multiple types of therapy.
The treatment elements will often include:
- A thorough psychological evaluation and interview during the intake process, including review of the individual’s medical and psychological history.
- A medical detoxification, where vital signs will be continually monitored and medical interventions are provided to help ease withdrawal symptoms.
- Individual psychotherapy, allowing for a confidential examination of underlying emotional issues or past traumas, and careful processing of these painful issues.
- Group therapy, where small groups of clients gather and discuss topics guided by a therapist, allowing for a safe, supportive peer setting to share challenges and experiences.
- Family counseling, providing an opportunity for family members to heal following treatment, to communicate more effectively, to resolve conflicts better, and learn how to support their loved one in recovery.
- Medication management. Most dual diagnosis clients will be prescribed antidepressants or other psychotropic drugs to ease symptoms from the mental health disorder.
- 12-step programming, which involves active participation in a recovery group and working through the steps outlined in Alcoholics Anonymous.
In a dual diagnosis treatment program, the individual will be treated for both disorders at the same time, allowing for the most effective, successful recovery outcome.