In the realm of mental health, a dual diagnosis is a case where a mental illness – typically a mood disorder – is coupled with a substance abuse problem. But while the substance abuse is obviously a medical problem, its origins are usually as a form of self-medication – a coping mechanism built to “adapt” to the difficulties of the original diagnosis by masking the symptoms with whatever drug of choice someone happens to be addicted to, from alcohol to harder stuff.
A dual diagnosis, when made, calls for a careful and comprehensive solution. We understand and believe that it’s impossible to treat a person’s illnesses one at a time – every patient requires a holistic approach, that examines their whole mental health and puts together a distinct and unique treatment plan that addresses every little diagnosis made.
This is especially important when people couple their illness with addiction. To better understand how and why dual diagnoses occur, it helps to understand how substance abuse ties into psychiatric disorders, and why the two are so commonly linked.
What is Substance Abuse?
There are a few substances out there that, by their design and reputation, are obvious signals of an addiction. Hard, illicit drugs like cocaine and methamphetamine produce such a powerful, artificially high, that their allure is extremely hard to resist once experienced.
But alcohol and prescription medication – especially the kind that’s prescribed to you – can be just as dangerous, and entirely legal. A moderate intake of these substances can be beneficial, or at least not harmful – but there’s something unique about the situation a dual diagnosis patient is in, specifically insofar that they use their substance of choice not solely for recreation, but also as medication.
Why Addiction and Mental Health Tie Together
There are a lot of reasons why mood disorders are typically tied with alcoholism or another form of addiction. Outside factors, such as genetics and environmental traits, play a large role, but the inner reasoning is also partially to blame. In manic-depressive disorder patients, and cases of bipolar disorder increased risk-taking from either an emotional high or low may lead to risky behavior like drug use.
At the same time, however, being manic isn’t necessarily a state of enjoyment. Some people can be manic and terrified of the speed and pace at which their emotions are racing, and they seek the comfort of alcohol – a depressant – to try and calm things down and mellow out. That can quickly turn into a problem, where an affinity to alcohol or a reliance on it to control moody behavior can quickly turn into an abusive problem, where the patient loses all control over their consumption while initially still seeing their behavior as a form of adaptation, or self-medication.
Alcohol isn’t the only issue. Another common correlation lies between sufferers of clinical depression or schizophrenia and tobacco use. Tobacco contains nicotine, an addictive substance which causes a brief dopamine release and powerful symptoms of withdrawal, including increased anxiety and strong cravings.
No matter what your condition and drug of choice, another danger is the perceived success of self-medicating through substance abuse. Because it allows you to manage the symptoms of your disorder, mood disorders can go undiagnosed for long periods of time until an addiction grows too powerful, and dangerous.
Having a dual diagnosis is often a vicious cycle. The disorder feeds the addiction, and vice versa – what might have originally felt like a temporary solution, isn’t a solution at all. It’s just another problem thrown into the mix.
Addressing a Dual Diagnosis
There is no cookie-cutter way to treat any mental health issue, and that rule goes for a dual diagnosis as well. However, treatment will always include a form of psychotherapy and group therapy. The group element becomes important with time, not just as a source of motivation, but as a source of support and an accepting space for when a relapse occurs or a troubling moment triggers your disorder, and addiction.
Talk therapy and behavioral therapies are important to help address mood disorders – they help a person gain a different perspective of their condition, and create the mental rationale needed to take a disorder apart. Medication such as antidepressants is still prescribed, although it’s important to be diligent and take daily note of your dosages, feelings, and any other notes you might have. There are different kinds of antidepressants and not all might work for you – and side effects may persist initially (if they continue, seek other medication).
Medication is always a temporary solution – even when administered professionally. That’s why we ultimately focus on using our treatment options to create a long-term, permanent solution – with treatment options like talk therapy, mindfulness training, meditation, and more.
Treating the Problem, Not Just the Symptom
While we do take some pride in our ability to be flexible and adjust our different treatment options to create a comprehensive solution for our patients, we do also understand that we have to prioritize when helping a person tackle their inner demons – and we do so by getting to the root cause of the problem (usually the initial diagnosis, or an underlying condition), focusing on unraveling that while systematically undoing and replacing maladaptive coping mechanisms with healthier alternatives.
Understand that, in its simplest form, reaching for the bottle or going out for a smoke is a coping mechanism that people adopt to mask their deeper issues or gloss over their emotional problems – which can be symptoms of a much more dangerous underlying disorder. Coping mechanisms can be harmful or effective – and the harmful ones are never effective. Healthy lifestyle choices, new hobbies, socialization and a change of scenery can be healthy ways to cope with a mental disorder and assist in its long-term treatment. Other behaviors, like risk-taking, gambling, and drinking, only provide minor relief and further complicate your situation.
We see substance abuse as, in many cases, a natural progression of a rapidly deteriorating mental health situation. Undoing it, then, has nothing to do with villainizing or demonizing the behavior, or utilizing willpower and brute force alone to cut the habit – instead, we remove the need to rely on a substance and then help you find treatment and support to drain and suffocate the addiction.
No matter what your situation may be, there’s still hope. In the case of a dual diagnosis, you’re always looking at two problems that, while massive and horrible to deal with together, are still entirely treatable – and beatable. Let’s beat your problems together.