Dual Diagnosis
What is Dual Diagnosis?
Dual diagnosis means that a person has two separate but very interrelated issues:
- A psychiatric problem
- An addiction problem
It is difficult to say which came first. What is essential is that the person currently has both problems, and both have to be addressed together. A relapse in one of the two areas can trigger a deterioration in the other.
Persons with Dual Diagnosis may have the following problems:
- Severe/major mental illness and a substance disorder(s)
- Substance disorder(s) and a personality disorder(s)
How common is dual diagnosis?
According to a report published by the Journal of the American Medical Association: 37 per cent of alcoholics and 53 per cent of drug abusers also have at least one serious mental illness.
Of all people diagnosed as mentally ill, 29 per cent abuse alcohol or drugs.
What are the mental or emotional problems in persons with dual diagnosis?
The following psychiatric issues are common in dual diagnosis, i.e., along with alcohol or drug dependency:
- Depression
- Bipolar disorder
- Anxiety disorder
- Panic disorder
- Obsessive-compulsive disorder
- Phobias
- Schizophrenia
- Personality disorders
Which develops first – addiction or psychological/ psychiatric problem?
It depends. Often, the psychiatric problem develops first. In an attempt to deal with existing psychiatric disorder symptoms, a person may drink or use drugs; doctors call this “self-medication.”
Frequent self-medication may lead to physical or psychological addiction to alcohol or drugs. If it does, the person suffers from one or two problems. Drug and alcohol abuse in teens, on the other hand, can sometimes happen together and continue into adulthood, which can lead to emotional problems or psychiatric disorders.
In other cases, addiction is the primary condition. A person whose substance abuse problem has become severe may develop symptoms of psychiatric disorders: perhaps episodes of depression, fits of rage, psychosis, or suicide attempts.
How can a therapist determine the primary problem – addiction or emotional disorder?
At the initial examination, it may not be easy to tell. Since many symptoms of severe substance abuse mimic other psychiatric conditions, the person must go through a withdrawal from alcohol and drugs before the therapist can accurately assess any underlying psychiatric condition present.
Which should be treated first?
Both problems should be treated simultaneously. When neither illness is treated, one condition can make the other worse. When more than one disease is treated, treatment is less effective.
When both illnesses are treated, the chances for a complete and lasting recovery are greatly improved, and it is easier to return to whole and productive life.
However, the client is first assessed by a psychiatrist and physician in a controlled therapeutic environment. The psychiatric condition has to be relatively stabilised (with medication) to be open to other inputs such as psychotherapy and counselling.