You were struggling through the most difficult battle of your life. You couldn’t handle it on your own, so you sought help. Now the doctor tells you that you actually have two problems to battle instead of one.
Is this normal?
Actually, yes, it is. It’s quite common for those with either mental illness, substance abuse, or another addiction to develop a secondary mental health condition with it.
Will this make recovery harder?
It will in some ways, but in more ways, it makes things easier. Not all facilities are equipped to deal with dual diagnosis. But this only narrows your recovery options, allowing you to find proper and effective treatment more easily.
As in all cases, you’d never receive the treatment you need without the proper diagnosis. In a way, your dual diagnosis is good news: it’s another big step toward recovery.
Keep reading to learn ‘what is dual diagnosis?’
What Is Dual Diagnosis?
Dual diagnosis is the diagnosis given to individuals who have a mental disorder and an addiction occurring at the same time. It may also be referred to as co-occurring disorders.
There are endless ways a dual diagnosis can develop. Dual diagnoses include any combination of every type of substance abuse and mental disorder. Sometimes the mental disorder develops first. Sometimes the substance abuse develops first.
For this reason, no two dual diagnoses are the same.
This can make treatment more challenging. While a doctor may be experienced in treating dual diagnoses, each person they treats is a unique case he hasn’t encountered before.
Dual Diagnosis Means More Attentive, Specialized Care
That last part’s the bad news. The good news is a dual diagnosis demands more attentive, specialized care from your doctor.
Because every dual diagnosis is unique, you’re unlikely to get improper treatment or neglect from your doctor. It’s not possible for doctors to give you the brush-off treatment with a generic, textbook remedy that won’t help. A dual diagnosis is never generic, and the remedy won’t be in any textbook.
Instead, you’ll receive special, careful attention from your doctor. They’ll need to find out more. They’ll be monitoring the progress of treatment methods closely and make sure they finds what works best for your situation.
How Does Dual Diagnosis Develop?
Typically, the co-occurring disorders develop one after the other, follow-the-leader style. For example, a patient who has a drinking problem may suffer guilt and shame over their self-destructive behavior. This can lead them into a chronic depression that exists alongside the alcoholism.
A drug-addicted teen may fear the discovery of their substance abuse habit by their friends and family. This could lead to a co-occurring social anxiety disorder.
Conversely, the mental disorder may come first. A chronically depressed individual may begin self-medicating their negative feelings with substance abuse.
However it happens, one thing is clear to see. Each disorder feeds off of and sustains the other.
Treatment Without a Dual Diagnosis Doesn’t Work
That’s why, if you do have co-occurring disorders but only treat one of them, neither disorder will get better. Unfortunately, this happens a lot, but only because one of the conditions was never diagnosed.
When this happens, the disorder that remains undiagnosed and untreated continues to thrive and to sustain the disorder being treated. This totally nullifies the effectiveness of any treatment the doctor attempts.
In some cases, a treatment that’s normally effective for the diagnosed disorder can make the other disorder worse. An obvious example is a patient who’s diagnosed with depression but harbors an undiagnosed prescription drug abuse problem. Prescribing the antidepressants that would normally be effective can worsen the hidden substance abuse problem.
For this reason, the only effective way to treat co-occurring disorders is together.
Why Is Dual Diagnosis Treatment Often Misdiagnosed?
It’s often difficult to “come out of the closet” about such sensitive issues as substance abuse and mental health issues. Many times, when an individual is ready to admit they need help for one disorder, they may not be ready to come clean about the other.
In fact, many patients only develop the secondary problem to hide the first. It’s common for a patient to keep one condition hidden out of denial.
Still, other patients simply aren’t aware of any co-occurring mental disorder.
How Common Is Dual Diagnosis?
More than 1 in 4 adults suffering from mental illness develop a co-occurring substance abuse problem. According to statistics, those with depression, personality disorders, anxiety disorders, and schizophrenia are most at risk.
There were 7.9 million adults in the U.S. struggling with a dual diagnosis in 2014. And those are only the ones we know about.
More than half of these (4.1 million) were adult males. As you can see, the medical/mental health industry has been documenting, studying, and treating dual diagnosis cases by the millions for many years.
It’s true that each such case is unique and, therefore, uncharted. But this data still helps mental health professionals know how best to approach a dual diagnosis patient for treatment.
How Is Dual Diagnosis Treated?
You’ve seen how complications arise when treating each condition separately. Because of this, the only effective treatment for any dual diagnosis is an integrated intervention. This approach integrates treatments for both conditions at the same time.
Integrated Intervention Divides and Conquers
Integrated intervention helps the patient and doctors see the problem for what it really is: two problems.
It’s hard to tell how well treatment is doing on a single disorder while it’s still so heavily influenced by the other. But when both disorders are treated together, the doctors can start to see which symptoms are caused by which disorder. This makes it easier to monitor the progress of the treatment.
The patient can see the distinction, too. Instead of facing one giant problem they don’t understand, the problem starts to become more clear.
Seeing it as separate conditions with separate treatments makes it organized and definable instead of vague and intimidating. This can make recovery a more encouraging journey for the patient.
Integrated Treatment Stops the Feedback Loop
An integrated approach also gets in the way of the symbiotic relationship between the two disorders.
As we mentioned before, each of the two disorders is sustained by the other. Substance abuse leads to depression, which leads to more self-medication through substance abuse, and so on.
So when only one condition is treated at a time, the other remains free to keep wreaking havoc on the patient. The unchecked condition will thwart all attempts to treat the other.
Integrated intervention is the only approach that stops the two conditions from feeding off each other. When the doctors and the patient can clearly see the dual diagnosis as two separate problems, they can begin to segregate them.
Awareness of both disorders and the relationship between them allows doctors and patients to actively and intentionally interrupt this symbiosis. The patient will be educated on how the disorders are negatively affecting one another and learn what they can do about it.
What Does Dual Diagnosis Treatment Include?
Treatment for dual diagnosis is as varied as the diagnoses themselves. A quality, integrated treatment regimen for dual diagnosis may contain these care methods.
Depending on the type of substance abuse involved, a period of detoxification may be necessary. This usually requires inpatient care where medical professionals are present to ensure success in a safe, controlled environment. Because outpatient detox takes place without professional supervision, it’s less controlled, less reliable, and usually less successful.
Also, detox from extreme cases of substance abuse will require medical assistance. Patients detoxing from very heavy substance abuse, a long abuse period, and/or abuse of powerful drugs like heroin usually receive medically assisted detox.
Inpatient vs Outpatient Care
After the detox period is complete, patients deemed safe to return to home and work will do so. These will receive outpatient care for the remainder of their treatment unless relapse requires another round of detoxification.
Patients whose dual diagnosis puts them or others in danger will continue to receive inpatient care.
The patient will learn coping strategies to cope with each disorder and to mediate between them. This training will be in the form of cognitive behavioral therapy or other psychotherapeutic training.
Support groups provide patients with a welcoming, encouraging environment and others they can relate to about these difficult issues. The group is a helpful vocal outlet where dually diagnosed individuals can express all facets of their recovery process among comrades.
Attendees listen to, sympathize with, celebrate, and encourage each other. Attacking these issues as a group instead of isolated can equip them with more strength to power through.
The patient may receive medication for their mental illness as long as the medication doesn’t complicate withdrawal symptoms. Likewise, medication may be necessary to aid detoxification or ease withdrawal symptoms depending on the severity of the substance abuse.
Will Dual Diagnosis Treatment Interfere with My Job?
According to the Family and Medical Leave Act (FMLA), you’re legally entitled to an adequate leave of absence for any medical treatment. This includes treatment for a dual diagnosis.
The FMLA grants you 12 workweeks of unpaid leave within any 12-month period.
As long as you give appropriate notice to your employer, it is illegal for them to terminate you because of a medical leave of absence. It is, however, still legal for them to fire you for the substance abuse itself if it violates an established work policy.
Dual Diagnosis Isn’t Hopeless
A dual diagnosis is not hopeless. It is not incurable or untreatable. It is not the end.
What is dual diagnosis? It’s an immense challenge made more manageable. It’s one step closer to freedom.
Now read “What Is Dual Diagnosis Treatment for Addiction and Who Can It Help?”.