Dual diagnosis is a term that refers to the comorbidity, or co-occurring condition, of both substance addiction and mental illness within the same person at the same time. A dual diagnosis is considered more difficult to treat than a mental illness or drug addiction alone. There is controversy in the field of psychiatry about what causes a dual diagnosis and how it can best be treated. This guide provides an introduction to some of the key issues regarding dual diagnosis.
It is common for substance abuse to develop simultaneously with certain types of mental illness such as schizophrenia, depression, bipolar disorder and anxiety. In fact, more than 50 percent of drug abusers are also diagnosed with a mental health disorder and it is estimated that nearly 30 percent of individuals with a mental illness also have a substance abuse problem. Among individuals with severe mental disorders like bipolar disorder, the number of people addicted to drugs can rise as high as 60 percent. Understanding of dual diagnosis has grown since the 1980s, but experts still do not agree on what causes drug addiction to develop alongside mental illness.
There are several theories on what causes a dual diagnosis condition to develop. Causality theory holds that the long-term effects of substance abuse are the direct cause of mental illness symptoms. In contrast, dysphoria theory suggests that drug addiction results from an individual’s attempts to self-medicate symptoms of mental illness.
In some cases, neurological changes can occur prenatally when a fetus is exposed to medications or other harmful substances. Another idea is that multiple environmental risk factors such as poverty and trauma work together to make an individual more likely to have co-occurring mental illness and drug addiction. Finally, the supersensitivity theory states that some individuals are biologically and developmentally predisposed to be vulnerable to drug addiction.
In 1984, an outpatient treatment facility in the state of New York was the first organization to begin implementing an integrated treatment model for dual diagnosis cases. The following year, this program model was used at multiple treatment centers nationwide. An integrated approach to treatment gained national attention with the publication of a Time Magazine article in 1987. Despite disagreements about how dual diagnosis conditions develop, there is a consensus that integrated treatment models are more effective with this population.
Integrated treatment begins with a detoxification process in which an individual ceases use of addictive substances. It is generally believed that focusing on the mental disorder first, rather than the addiction, is ineffective. After detoxification, treatment can include a mixture of individual psychotherapy, group counseling, peer support groups and psychiatric medication. Medications used for dual diagnosis cases vary depending on the nature and severity of an individual’s mental disorder.
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