Behavioral Problems

In many cases, an individual who suffers from drug addiction or alcoholism may also suffer from a co-occurring behavioral disorder.  When this happens, the individual has a dual diagnosis and both conditions, the disorder and the addiction, must be treated appropriately in order to increase the chances of a healthy recovery from addiction.

One of the best ways to help an individual who suffers from a behavioral problem from becoming addicted to drugs or alcohol is to discover the disorder early.  The overall signs and symptoms of behavioral problems vary between disorders; however, there are a few symptoms that are common:

• Frequently argumentative
• Deceitful
• Theft
• Unmotivated in school or poor grades not otherwise explained
• Sexual activity at an early age
• Uncooperative or deliberately disrespectful to authority figures
• Harming themselves or others
• Use of drugs or alcohol, or smoking

Seeking help for drug or alcohol abuse in combination with a behavioral disorder does not have to wait until the individual has developed an addiction.

Types of Behavior Problems

Behavioral problems can range from the mild to the severe, depending upon the child and the circumstances.  These problems can also extend into adulthood if they are not treated in a dual-diagnosis setting early in the drug addiction.

• Conduct Disorder.  Conduct disorder usually appears in early childhood. According to the American Association of Pediatrics, many children and adolescents who suffer from a conduct disorder will be unable to adjust the societal restrictions in adulthood.  They tend to break the law, for instance, and when coupled with alcohol or drug addiction, they may be unable to hold a job or focus on what is important for a successful life.

  Many individuals who suffer from conduct disorders have a high disregard for people in authority and this sometimes creates a barrier to treatment.  Lengthy treatment is often required to develop new habits and attitudes; however, early intervention for substance abuse and addiction can ease the process.

• Oppositional Defiant Disorder (ODD).  When an individual is persistently disruptive or resistant to rules and authority, he may suffer from oppositional defiant disorder.  ODD is marked by characteristic behaviors that everyone can exhibit from time to time; however, the ODD patient is more consistent in their defiance. The symptoms may include:
  • Refusal to comply with rules and regulations on a persistent basis
  • Deliberately annoying others
  • Easily annoyed by others
  • Vindictiveness
  • Unable to maintain friendships for long periods
  • Temper tantrums

It is easy to see how these types of behaviors can prolong the treatment process for drug and alcohol addiction.  Developing a specific treatment plan that includes addressing the ODD diagnosis is crucial for successful treatment of both conditions.

• Self-Injury or “Cutting.”  The practice of injuring oneself should never be confused with suicide ideation, although the two may co-exist.  Self-injury is generally practiced on an impulse basis, and may be associated with other impulse control disorders, according to the Mayo Clinic.  In this regard, the condition is also a mental illness; however, the explicit act of self-injury is a behavioral issue that can be addressed in dual-diagnosis treatment.

  In terms of alcohol or drug addiction, self-injury is specifically related to the use and abuse of substance.  Many times, the act of cutting or other self-injury is performed while under the influence.  This is not always the case, and use of drugs or alcohol may be coincidental to the behavior issue.

  There are several other risk factors for self-injury, including:

  • Age. Individuals will generally begin this practice during adolescence.
  • Abuse. People who suffered sexual, physical or emotional abuse in the course of their lives are more likely to self-injure.
  • Associations and Friends. Being exposed to the concept of self-injury can lead an individual to experiment with the process. Therefore, exposure through friends, acquaintances and even television programming can lead to the condition

Self-injury is not limited to cutting.  It can also include burning, piercing (other than ornamental), hitting or punching objects, breaking bones, pulling out hair and not allowing previous wounds to heal.

The treatment for self-injury is different for everyone.  The very personal factors surrounding the self-injury disorder are unique and treatment is tailored to include any and all underlying mental health issues that might include depression or anxiety.  In most cases, it is important to have ongoing treatment with a psychologist who has experience in self-injury modalities.

• Obsessive-compulsive disorder. Obsessive-compulsive disorder (OCD) is a condition identified by the repetition of specific thoughts, activities or speech in order to assuage morbid or “bad” thoughts.  Some individuals believe that if they do not perform certain rituals, something bad will happen to them, their family or even to complete strangers.  Little is known about the onset of the condition; however, more studies have been conducted that may identify it as a physical, rather than a mental or behavioral condition.

  In a study conducted by the National Institute of Health, the results showed that most of the participants realized symptoms of OCD at least one year prior to the onset of their substance abuse issues.  The average number of years that OCD preceded addiction issues was eight years.  Roughly one-quarter of the participants indicated that they developed OCD after they had started to abuse drugs or alcohol.

How Is a Dual Diagnosis Reached?

When an individual decides to seek treatment for drug and alcohol addiction, it is easy to believe that stopping the use of drugs or alcohol will solve all their problems.  The fact remains, however, that many people suffering from addiction will also suffer from a dual diagnosis.  In order to determine those who may suffer from such conditions, the treatment center should conduct a thorough psychological intake examination.

The process for such an examination will include an in-depth and comprehensive history provided by the patient.  In order for this process to be successful, it is imperative that the patient be completely honest with the staff of the treatment center.

Having a dual diagnosis is nothing of which to be ashamed.  It is possible that the co-existing condition has played a significant role in the abuse and addiction to drugs and alcohol.  For instance, when an individual suffers from disorders that cause self-injury, the act of cutting or otherwise mutilating can bring about a sense of calm and control.  Almost always, those feelings are soon replaced with shame, guilt or self-loathing, which can then lead to additional drug use and abuse.

Treatment Programs

There are several types of treatment programs available for drug and alcohol addiction.  The two main categories of treatment are inpatient and outpatient care.  When an individual has a dual diagnosis, he or she must decide which type of treatment center will work best for their situation.

The determination of the kind of care will often depend upon several factors:

• The severity of the addiction
• The severity of the dual-diagnosis behavioral issue
• Responsibilities for family or career
• Cost of treatment

A dual diagnosis does not automatically mean that an individual will need to be admitted to a treatment center for a specific period of time.  It generally does require a longer period of treatment, regardless of whether that treatment is provided on an inpatient or outpatient basis.

Inpatient residential care will immerse the individual in a home-like atmosphere of healing.  No promises are made that the time will be stress-free, as recovery from both addiction and learning to manage a behavioral problem can bring its own form of stress.  However, the resident will not be required to wake each morning and rush off to a stressful job or face the temptation of using to assuage feelings of inadequacy or guilt.

Many residential treatment centers are designed to bring peace and relaxation into the treatment model which can help counteract the stress of recovery and withdrawal.  Experienced staff members can teach alternative means of coping with stress, including martial arts, yoga and meditation.

An outpatient treatment program can offer many of the same treatment models and experience as an inpatient facility.  The difference lies in the daily activities and constancy of care.  A patient who chooses an outpatient program may be subjected to random or daily drug screenings because they are living in normal society with access to their drugs of choice.  They will continue to work and care for their families, which may alleviate stress that would come if they weren’t working or around their family.

The key to treating a dual diagnosis is recognizing it early and incorporating the treatment into the overall plan for recovery.

Are Treatment Programs Successful?

Like any other chronic condition, relapse is always a possibility for the recovery addict.  This process of getting and staying sober can be affected by the dual-diagnosis condition.  However, like any other chronic condition, both diagnoses can be managed successfully with the right conditions, medication and determination.

Addiction is a chronic recurring brain disease.  There are other diseases which are also chronic, such as high blood pressure or cancer.  When these diseases are managed properly, the symptoms lessen and the patient lives normally.  When the symptoms return, treatment programs are modified, medications are adjusted and sometimes, treatment programs must be repeated.

The same is true for addiction and the treatment of dual-diagnosis conditions.  There are cases where an individual completes treatment for drug or alcohol addiction and is never faced with a relapse situation; however, these cases are rare.  Most individuals will stumble along the road to recovery at one time or another.  This does not mean that the treatment has been unsuccessful.  It simply means that the treatment program needs to be adjusted, just like medication sometimes does.

When a recovering addict is faced with the symptoms of a dual diagnosis, he or she must immediately seek treatment for the co-occurring disorder.  If the treatment program for the dual diagnosis can be refreshed and reestablished before addiction relapse occurs, the individual is more likely to continue their sobriety for longer periods of time.

How Behavioral Problems Affect Addiction

The difficult question of whether an individual is more likely to suffer from an addiction disease if they also suffer from a behavioral disorder is an important one.  There are many indicators that answer that question with a resounding, “yes!”  In truth, there is little information on the exact science of the issue.

Most behavioral problems that would qualify for a dual diagnosis begin in early childhood or adolescence.  Of the many behavior problems that can plague a young person, a compulsive need to thwart rules, regulations, laws and societal norms is common.  This can lead a young person to commit violent and non-violent crimes, feel disassociated from society and therefore become exposed to other individuals or groups with which he or she feels more comfortable.  Many of these friends will have similar disorders of their own, and it is possible that they may give one another even more fortitude for illegal and self-destructive behavior, such as alcohol and drug abuse.

A recent report by the National Center on Addiction and Substance Abuse at Columbia University looked at juvenile justice systems in the United States.  Among other aspects, they studied the rate of drug and alcohol use coupled with mental illness — the makings of dual diagnoses.  They found that a whopping 80 percent of juveniles who had been incarcerated in the United States presented with a diagnosable conduct disorder.

Without proper treatment, which the juvenile system often does not provide adequately, these adolescents continue to use drugs and alcohol, as well as manifest their behavioral disorders through crime and violence.

Most of these young people were not living in a situation where they had access to proper dual-diagnosis treatment before the conditions took over their lives.  Had treatment been made available, it is quite possible that they could have eliminated the risky behaviors in their lives before they fell into the penal system.

With proper diagnosis and treatment, dual-diagnosis behavior problems are manageable.  Nobody has to suffer in silence and face the debilitating consequences of addiction.