Dual Diagnosis
Substance abuse and mental illness often go hand in hand.
When diagnosing and treating mental illness, a substance abuse assessment
can be an important tool.
When living with the symptoms of depression, anxiety, or more severe
mental disorders, it's not uncommon for sufferers to turn to alcohol,
or some other substance, to ease the pain. It happens all
too often when a mental disorder is undiagnosed and untreated, or
if long-term substance abuse has contributed to the development
of a mental illness.
What is dual-diagnosis?
Dual diagnosis refers to the co-occurrence of
substance abuse with a mental illness. Substance abuse is a common
problem among people with mental illness and, if undiagnosed can
interfere with treatment and recovery.
How common is it?
Mental illness and substance abuse often go hand-in-hand. They
may occur at the same time, or one may develop before the other.
In any case, it is important to recognize both conditions in order
to affect the best possible treatment outcome.
According to the Alcohol, Drug Abuse and Mental Health Administration
a significant percentage of the 1.5 to 2 million Americans with
severe mental illness abuse substances, as compared to the general
population.
The Journal of the American Medical Association (JAMA) reported that of all people diagnosed with a mental illness, 29%
abuse either alcohol or other drugs. Thirty-seven percent of alcohol
abusers and 53% of drug abusers also have a serious mental illness.
In any twelve-month period, an estimated 10 million people throughout
the United States have a combination of at least one mental health
and substance use disorder. (SAMSHA)
People with serious mental illness are 4-5 times as likely to develop
a substance abuse disorder as the general population. (SAMHSA)
Co-occurring substance use and mental disorders can occur at any
age. Research suggests that as many as half of the adults who have
a diagnosable mental disorder will also have a substance use disorder
at some point during their lifetime. ( President's
New Freedom Commission on Mental Health)
A National Association of Mental Health study shows the increased
risk for substance abuse for the following psychiatric disorders:
- Antisocial personality disorder 15.5% increased risk
of substance abuse
- Manic episode 14.5%
- Schizophrenia 10.1%
- Panic disorder 4.3%
- Major depressive episode 4.1%
- Obsessive compulsive disorder 3.4%
- Phobias 2.4%
Special populations
Older adults with depression are at a higher risk of alcohol abuse
and dependence. Older depressed persons are three to four
times more likely to have alcohol problems than older adults who
are not depressed. And, although alcohol is the most common
drug of abuse among all people with serious mental illness (18%),
abuse of prescription drugs and / or street drugs (9.6%) is not
unusual. Prescription drugs are more commonly abused among
older adults, while younger adults are more likely to abuse street
drugs.
Why is it so common?
When someone suffers from a mental illness, it is not uncommon
for the sufferer to self-medicate with alcohol or other drugs to
ease the symptoms. As use becomes more frequent, the person can
become dependent upon the substance. Conversely, substance abuse
can trigger symptoms of depression, anxiety, psychosis or suicidal
thoughts. In addition, substance abuse which begins in adolescence
and continues into adulthood may contribute to the development of
emotional difficulties or psychiatric disorders (NAMI) .
How is it diagnosed?
Diagnosing a co-occurring substance abuse disorder can be a challenge
for a number of reasons. As one of the most common symptoms of addiction
is denial, an accurate self-report of alcohol or drug use may be
difficult to attain. Also, some of the symptoms of addiction mimic
those of certain mental illnesses, and vice-versa. The best way
to determine if there is a co-occurring disorder is to find out
as much as possible about the person, and to conduct a thorough
mental and physical health assessment that includes a substance
abuse screening.
How is it treated?
Both conditions can be treated at the same time. However, the predominant
diagnosis should be addressed first. If an addiction is present,
the first step is to detoxify the patient if possible. This is important
because accurate assessment of the nature and severity of a psychiatric
disorder is difficult in the presence of alcohol or drug dependency.
Drug and alcohol rehabilitation can occur on an inpatient or outpatient
basis. The best option for treatment can be determined by the patient
and his or her treatment team. Following detoxification, regular
counseling and attendance at a 12-step or other recovery support
group should be included in the overall treatment plan. Attention
to exercise, nutrition, housing and other lifestyle issues will
also enhance recovery.
Only 19% of people with a serious mental illness and drug or alcohol
dependency are treated for both disorders, and 29% are not treated
for either problem. For people with less serious mental illnesses
and substance dependence problems, the pattern of under-treatment
is even worse. Seventy-one percent receive no treatment, and only
4% receive treatment for both disorders. ( President's New Freedom
Commission on Mental Health)
Treatment outcomes are improved for both substance abuse and psychiatric
disorders when the presence of both are detected and treated.
Assessments can be scheduled by calling 800.560.5900 or
530.332.5250, or one can simply walk in and request an assessment.
Contact Us
Enloe Medical Center
Behavioral Health
560 Cohasset Road
Chico, CA 95926
Open twenty-four hours a day, seven days a week.
|
