NURSE’S NOTES: TREATMENT COMBINED FOR ‘DUAL DIAGNOSIS’

When a person suffers from a mental illness and has problems with
mood-altering substances - drugs such as prescription medications,
cocaine, ecstasy, heroin, marijuana, etc. and alcohol - we call this
"dual diagnosis."

Professionals often call this substance abuse or substance dependency,
depending on specific criteria. Mental illnesses that often occur with
substance abuse are mood disorders such as depression and bipolar
disorder, anxiety disorders such as panic disorder and post-traumatic
stress disorder, schizophrenia and personality disorders.

The American Medical Association notes that "roughly 50 percent of
individuals with severe mental disorders are affected by substance
abuse" and "37 percent of alcohol abusers and 53 percent of drug
abusers also have at least one serious mental illness."

Another study conducted by the Epidemiologic Catchment Area found that
47 percent of people with schizophrenia had a substance abuse disorder
and 61 percent of those with bipolar disorder had a substance abuse
disorder. Dual diagnosis is also widely seen in our veteran
population, homeless population, and jail and prison inmates.

It is uncertain which comes first - the mental illness or the
substance use.

Many believe the mental illness is first, leading the person to
self-medicate with mood-altering substances. For example, people with
anxiety disorders will find themselves relying on substances to cope,
which often makes the axiety disorder worse.

Other times, especially in adolescents and young adults, people find
themselves using increasing amounts of substances, resulting in
emotional and mental problems. While active in substance abuse, they
will often have unexplained anxiety and depressive symptoms, such as
beginning to isolate themselves and losing interest in activities they
once loved.

However, regardless of which comes first, both mental illness and
substance abuse must be treated. Most often, the conditions affect the
person simultaneously and feed off of each other. If only one problem
is treated, the other often becomes worse, hindering recovery and
preventing the person from addressing core issues.

When one abstains from substances, symptoms of the mental illness will
often become more noticeable and difficult to cope with, which can
result in the person using substances again. Those with dual disorders
are at much greater risk for relapse.

Due to the complexity of the disorders, integrated services need to
address substance use and mental health symptoms together. This is
critical for recovery.

Patients can use a long-term community-based process to aid in
recovery. When approached in stages and tailored to the individual,
services include peer and family support groups, consistent
motivational interventions and counseling. Furthermore, many who
struggle with dual disorders may have difficulty with medication
compliance, relationships, social activities and basic coping skills.
It is critical to address stress management, social networks, jobs,
housing and other activities.

There is hope for those struggling with dual disorders. Through
education and appropriate treatment, patients can learn the skills
necessary to live a healthy and fulfilling life.