A dual diagnosis means someone has both a substance use disorder and a mental health disorder. Dual diagnosis is also called co-occurring disorders, with a wide range of interactions between conditions possible. People with alcohol and drug problems have a greater rate of mental illness than the rest of the community, with mental health patients also more likely to suffer from substance abuse problems. A wide array of psychoactive substances can be abused in a dual diagnosis scenario, including alcohol, prescription opioids, marijuana, benzodiazepines and methamphetamine.
The connection between mental health and substance use disorders can be hard to define, with vague links existing between some disorders and specific causal connections between others. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), 17.5 million Americans have had a serious mental health disorder at some point in the last year. Almost one quarter of these people, or roughly four million, have also struggled with a co-occurring substance use disorder. While the number of people seeking help for a dual diagnosis has risen over the last six years from 12 to 16 percent of all patients in drug rehab, more than 50 percent of people with co-occurring conditions still go untreated. Alcohol is the primary drug of choice for dual diagnosis patients, representing 45 percent of all patients. Prescription opioids are represented in 21 percent of cases, up from 13 percent in 2000.
A growing body of scientific literature suggests there is a connection between eating disorders and substance use disorders. Addiction is a learned response, with the special reward centers of our brains stimulated in a similar way through substances or behaviors. People who suffer from a substance addiction may have a personality type that is prone to impulsive behavior and anxiety, with people with eating disorders facing a similar problem. According to the National Eating Disorders Foundation, nearly half of all people with an eating disorder also suffer from substance abuse problems. The lack of control evident with eating disorders often translates to alcohol and drug problems, with both disorders also linked to a history of trauma. Amphetamines and methamphetamine have a close link with eating disorders, with these drugs sometimes used to suppress the appetite.
There is a clear connection between opioid abuse and depression disorders, with long-term opioid use known to increase the risk of developing depression. According to the Journal of General Internal Medicine, people who use prescription opioids for 90 days or more increase their chance of developing depression by 25 percent. Those who use opioids for 180 days or more increase their chances of developing depression by 53 percent. People with existing depression disorders are also at a greater risk of developing drug problems, with opioids often used by depressed people to provide temporary euphoria and relief from their condition. This form of self-medication has been recognized in many dual diagnosis cases, with patients using drugs or alcohol as a way to feel otherwise inaccessible emotions.
Before treating a patient with co-occurring disorders, doctors will attempt to differentiate between pre-existing disorders and substance-induced conditions. While clear lines of causality are not always apparent, this evaluation will often shed light on diagnosis and treatment. If a primary disorder can easily be recognized, doctors may initiate a primary treatment plan. Sequential treatment is another option, where the secondary disorder is also treated once the primary disorder has been evaluated and stabilized. Parallel treatment is also available at our treatment centers. In this case, both conditions are treated at the same time. Integrated treatment is perhaps the most refined way to deal with dual diagnosis scenarios, where no distinction is made between primary and secondary disorders and a single treatment plan used to treat both conditions.