Tue. May 17th, 2022

Dual Diagnosis: Substance Abuse and Mental Illness

“Double Trouble and More”

Researchers estimate that 30% of individuals with mental illness and 50% of those with severe mental illness abuse alcohol or drugs. Those suffering from mental illness and substance abuse are often overwhelmed by the challenges they face. Managing either disorder requires commitment, focus, and a supportive environment. Trying to manage both disorders is a huge challenge because substance abuse and mental illness feed off each other to undermine treatment and recovery.

Most individuals with co-occurring disorders “self-medicate” their painful moods and feelings with substances, but these very substances make their symptoms worse over time. This creates a vicious downward spiral into chaos and pain as symptoms become more severe, fueling more intense cravings and substance abuse, causing increasingly unstable emotions, leading to even more desperate substance abuse, ultimately resulting in hospitalization, jail, homelessness, and even death by accidental overdose or suicide.

But recovery from dual diagnosis is possible. I have witnessed many clients with co-occurring disorders progress from chaos into recovery and achieve manageable lives. The recipe for recovery is simple: Do not abuse substances, stay in treatment, take your medications as prescribed, and your life will become manageable. But any significant deviation from this path will lead you back into chaos. This formula is easy to recite but difficult to live, because the dually diagnosed client has many obstacles to overcome on the path to recovery.

The number one obstacle is denial, which is common with mental illness and almost always present with substance abuse. The road to recovery requires that dually diagnosed clients accept that they have two disorders, both in need of treatment. If only one illness is treated, the untreated illness will most certainly undermine recovery. Thus, early treatment focuses on helping clients understand and accept that they have two separate and intertwined disorders that must be treated. This is the crucial first step in recovery – the client must accept and own both illnesses.

Another obstacle to recovery is the complicated issue of diagnosis.  Since chronic substance abuse can cause symptoms that mimic anxiety disorders, depressive disorders, bipolar disorders, and even psychotic disorders, treatment providers must be careful when giving strictly mental health diagnoses. Even when clients are honest about their substance abuse, clinicians have to wait until clients are clean and sober for months before confidently giving a diagnosis of a mental disorder – unless there is evidence of the existence of a mental disorder before the substance abuse began. And when clients hide substance abuse, accurate diagnosis and effective treatment are nearly impossible. So, diagnosing a dual diagnosis client is often a series of hypotheses that play out over time as treatment progresses.

Stigma and hopelessness are other barriers to recovery. In our society, substance abuse and mental illness are frequently misunderstood and stigmatized. Suffering from both disorders geometrically increases the stigma and ultimately the social isolation for dual diagnosis clients, who are often seen as lazy, immoral, and irresponsible parasites rather than human beings who are suffering from two severe chronic illnesses.  Even some treatment providers and physicians will shun and avoid working with these clients, who can easily become scapegoats for families, society, and even governments.  Thus, many individuals with co-occurring disorders become mired in loneliness, hopelessness, and shame, and have little motivation for trying to improve their lives.

The medical system itself can be an obstacle to recovery. Traditionally, the treatments for addiction and mental illness have been provided in different settings with different philosophies. Although the philosophies are more integrated now, some professionals still see dual diagnosis clients through the filters of their own professional biases. Thus, addiction counselors might assume substance abuse to be the primary disorder, which when resolved will eliminate the mental health symptoms. And mental health professionals might see the mental illness as primary, which when resolved will fix the addiction. In reality, mental illness and substance abuse are two separate primary disorders that must be treated simultaneously using an integrated approach  Thus, it is important that a prospective client find a counselor and psychiatrist who offer such an integrated approach to treating co-occurring disorders.


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