One of the most common questions that a family will ask when a loved one is suffering from drug and alcohol addiction is “Why?” Why did their loved one choose to use drugs? Why can’t they simply stop using drugs? Why are they forced to suffer so terribly?
Unfortunately, there is seldom an answer to this painful question. Sometimes, however, the answer comes from the discovery of a dual-diagnosis condition that may have developed long before the drug abuse started. A dual diagnosis occurs when an individual suffers from drug or alcohol addiction as well as another co-occurring condition that requires treatment.
There are two distinct types of dual-diagnosis conditions – those that involve behavioral problems and those that involve mental illnesses. Mental illnesses are treatable conditions that have been either undiagnosed or inadequately treated in the past, and which may have contributed significantly to the drug abuse and addiction issues the individual is currently facing.
How Common Is a Dual Diagnosis?
Dual diagnoses occur more often than one might think. While it is not possible to say exactly how often the conditions of addiction and mental illness occur simultaneously because the mental conditions are often overlooked during the treatment for addiction, some estimates place that rate of dual diagnosis as high as 50 percent. People with mental illness will suffer from drug or alcohol addiction at a rate twice as high as those without mental illness. Comparatively, people who suffer from alcohol or drug addiction will also suffer from mental illness at a rate double that of the general population.
Why Is Mental Illness Linked to Drug Addiction?
There are a few theories concerning the co-existence of mental illness and addiction. The National Institute on Drug Abuse offers four possibilities.
The first possibility concerns genetics. Studies have found that the same genetics that may lead to a hereditary likelihood of addiction can also predispose an individual toward mental illness. Because of this, an individual who abuses drugs or alcohol may be more likely to also develop a mental illness, or vice versa.
Another possible reason for the correlation comes from how both conditions develop. Drug addiction and mental disorders are both developmental in nature. They often begin in early adolescence when the brain is still developing. A young person who does not suffer from a mental illness may still have a difficult time making well thought out decisions. Learning from one’s mistakes is often an adage applied to the developing mind of a young adult; however, if a mental disorder already exists, the decision-making process if further affected. This can lead to a destructive decision to abuse drugs, which can then lead to addiction. If an otherwise mentally sound young person decides to use drugs, that drug abuse can then lead to the mental illness later in life.
The environment in which a child or adolescent lives may contribute to the use of drugs or the development of a mental illness, particularly if the individual is genetically vulnerable. For instance, if a child has uncommon stress or is the victim of sexual, physical or emotional abuse, he or she may be more likely to escape into the misleading comfort of drug use. These same factors can contribute to depression and anxiety disorders. The possibility of both addiction and mental illness coexisting with these conditions is increased as one disorder plays off the other.
Finally, the same parts of the brain are indicated in both addiction and some mental disorders. Drug abuse can drastically affect the neurotransmitters that control reward and pleasure; this is the reason that many drug users choose to abuse drugs as it creates a euphoric “high” that displaces real emotion and sensory perception. Some mental disorders can also affect the pleasure and emotional neurotransmitters, such as depression or anxiety. Since both drug use and mental disorders overlap in these sections of the brain, it is likely that the conditions will either play off or spawn one another.
Which Comes First: Mental Illness or Drug Addiction?
Many mental illnesses develop prior to the drug abuse that leads to addiction. In some cases, an individual may suffer from anxiety which leads them to seek a means to alleviate their fears. A physician may prescribe Xanax or Valium to combat this anxiety. When drugs such as these are prescribed, there is an adjustment period wherein the patient may experience the euphoric effects of the drug. In a matter of time, generally a few days, the euphoric feelings dissipate. This is referred to as “tolerance.”
The medication is continuing to work as it is supposed to; however, the patient may choose to increase their dosage without consulting with their doctor as they believe that the drug is no longer having the desired effect — to control anxiety. In truth, this is the beginning of drug abuse and can easily lead to addiction.
On the other hand, there are times when drug abuse and addiction leads to the dual-diagnosis mental illness. Use of many drugs, such as heroin or cocaine, can create anxiety or aggression in the individuals who abuse them. These mental conditions may be permanent. Additionally, the use and abuse of drugs can often lead the addict to lose family ties and suffer great financial losses. These factors can lead to feelings of guilt and depression which may also be permanent.
Most Prevalent Mental Illnesses Are Associated with Addiction
A host of mental illnesses are common among those suffering from drug addiction and alcoholism. Some of them are mild while others can be severe enough to drastically alter one’s perception and reality. The following is a list of some common mental disorders that affect drug abuse and addiction:
- Major depression. Depression is a disorder of the brain. It is marked by sadness, changes in appetite, mood swings, mania, sleeping too much or insomnia, loss of enjoyment in activities one previously enjoyed and suicide ideation. It is not “the blues” and it will not go away without treatment that might include medication and counseling.
- Anxiety disorder. Fear is a good thing in most circumstances. Fear tells us when something is wrong or if we need to take precautions. When fear turns to anxiety, however, the symptoms can last for months at a time. In some cases, irrational fear can overwhelm an individual to the point they are paralyzed in their daily lives. When this occurs, anxiety disorder may become panic disorder. Medications are available to treat anxiety and, when taken properly, can have a profound positive effect. In most cases, therapy is also used in conjunction with medication. Other types of anxiety disorders may include post-traumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD).
- Schizophrenia. This disorder is one of the most severe dual-diagnosis conditions. It is marked by visual and auditory hallucinations, panic or paranoia. Because of these devastating symptoms, many individuals who do not have access to proper treatment will become involved in drug abuse as a means to “make the voices stop.” They are, in effect, self-medicating to avoid the chilling effects of their mental disease. Some drugs can lead to schizophrenia-like symptoms; although researches are unconvinced that drug abuse actually causes the disorder. Because of the similar symptoms, however, some addicts suffering from schizophrenia will remain undiagnosed as their drug addiction masks the disorder.
- Personality Disorders. An individual who suffers from a personality disorder will often have a difficult time making or keeping friends. For instance, in the case of borderline personality disorder, an individual may react strongly to the issue of abandonment by growing angry with the person who left them, even if that person simply went to work or on vacation. The reason the individual left is not important; the issue of being abandoned causes the triggering of sometimes violent emotion. Because the suffering individual may have experienced the loss of friends due to their illness, they may be more susceptible to peer pressure when the opportunity to use drugs and alcohol presents itself. Other factors involved in personality disorders include depression and poor self-image which can lead to drug abuse and addiction.
How Is It Diagnosed?
When an individual seeks treatment for drug and alcohol abuse, they are often subjected to a battery of tests to determine any underlying contributors to the addiction. Information is gathered concerning the individual’s childhood, including any abuse patterns such as sexual abuse, physical abuse, or emotional abuse or neglect. Family histories are also very important during the diagnosis phase since many mental illnesses tend to run in families.
Once the history has been recorded, the recovering addict will begin their addiction treatment. Because it is important to spend time with the recovering addict, an official dual diagnosis may not occur immediately. It is also possible that the recovering addict, for reasons that range from guilt to shame, may not provide completely honest answers during the intake process. As tendencies and truths reveal themselves during the counseling sessions, a complete diagnosis can be made.
An individual seeking recovery can speed the process and begin living in recovery much sooner if he or she is totally honest during the initial interview and all counseling sessions.
Which Is More Important to Treat: Addiction or Mental Illness?
Both drug and alcohol addiction and the co-occurring mental illness make up a dual diagnosis. Neither is more important or acute than the other, except in cases of overdose. Once the immediate needs of an addict are met through the detoxification phase of recovery, attention should shift to the dual diagnosis.
If the addiction treatment is to be successful, the treatment must co-exist with therapy for the other half of the diagnosis, and vice versa. For instance, seeking treatment for paranoia will not negate the fact that the individual suffering from the condition has developed an addiction to heroin. The drug abuse will continue even if the paranoia is controlled with other medications. If an individual successfully eliminates cocaine or methamphetamine from their system and vows to never use again, but they fail to treat their bipolar disorder that includes bouts of mania, they are more likely to begin using stimulants again in the near future.
How Is It Treated?
The most important aspect of treatment for a dual diagnosis is to tailor the treatment to the individual. The US National Library of Medicine in conjunction with the National Institutes of Health published findings that indicate “creative” combinations of therapies including medication, counseling and Cognitive Behavioral Therapy (CBT) offer the highest chances of success.
These types of therapies are available in two settings – inpatient and outpatient facilities. Both offer advantages and drawbacks, so the determination of which type of care is needed should be thoroughly discussed by all involved parties, including the addict, their primary care provider, family members and treatment center staff.
A few factors to consider might include:
- How long the individual has suffered from addiction
- The severity of the addiction
- Whether the recovering addict has a job they cannot leave
- Whether insurance benefits are contingent upon continuation of work
- Whether the addict’s children will have adequate care if their parent were to leave for several months
- The likelihood of continued drug abuse in an outpatient setting
- The severity of the dual-diagnosis mental illness and the possibility of self-injury or suicide
Each individual is different. No two addicts will have the same reactions to treatment and no two treatments will provide the same benefits to individual addicts. How and when a person decides to seek treatment is a personal one; however, once they have made the decision, proper treatment can make all the difference.