Dual Diagnosis

Drug addiction is both the psychological and physical dependence on one or more substances. Commonly abused substances include marijuana, crystal meth, heroin, cocaine, synthetic drugs and prescription drugs. Drug addiction is characterized by an inability to stop using despite a desire to quit, uncontrollable cravings, and an experience of withdrawal symptoms when users try to stop getting high. Drug addiction is considered a medical disorder, which merits both medical and psychotherapeutic treatments for recovery.

There are various reasons why people develop addictions, but the general consensus among the medical community is that there is no single cause contributing to the development of addiction.

The National Institute on Drug Abuse identifies several factors contributing to addiction including genetic predisposition, drug-permissive environments, access to drugs and developmental issues. However, the existence of a dual diagnosis is one of the greatest risk factors associated with the development of addictive behaviors.

What is Dual Diagnosis?

When an individual is diagnosed with both a substance abuse disorder and a mental health issue, it is termed a dual diagnosis. The most common mental health disorders which occur alongside drug addiction include: anxiety and mood disorders, personality disorders, depression, and schizophrenia. Most often, symptoms of mental illness appear first. As those symptoms become more severe, people attempt to ameliorate symptoms by using different drugs.

Someone struggling with depression, for example, may try prescription drugs or even heroin to improve mood. Individuals struggling with anxiety may start smoking marijuana to calm down. Those struggling with an eating disorder may try to augment weight loss by abusing stimulants like Adderall, meth or cocaine. Conversely, there are times when drug addiction precedes mental illness. Due to chronic drug abuse, mental disorders can develop as drug use alters brain function over time. There are many combinations of drug abuse and mental health disorders, but there are several which appear often. Let’s look at the five most common dual diagnoses.

Alcoholism and Antisocial Personality Disorder

A number of mental health issues are associated with alcohol abuse, but the National Institute on Alcohol Abuse and Alcoholism (NIAAA) reports that antisocial personality disorder (ASPD) has the closest link to alcoholism. People who regularly drink in excess are 21 more times likely to suffer from ASPD than those who do not have alcoholism. ASPD is a condition belonging to a larger group of mental health disorders, also known as personality disorders. Individuals suffering from ASPD exhibit manipulative and exploitative behaviors, which violate social norms. Statistics show the greater majority of those with ASPD abuse drugs and especially, alcohol.

What triggers the onset of antisocial personality disorder is still relatively unknown. However, most evidence points to genetic inheritance and childhood abuse as significant contributors to its development. Additionally, having a parent with ASPD and/or alcoholism and being male triple the likelihood of being diagnosed with ADPD.  Substance abuse programs report an overwhelming 40-50% of all participants in treatment display enough ASPD symptoms to merit an antisocial personality diagnosis. The simultaneous existence of substance abuse and ASPD is known as comorbidity—a term which refers to the presence of two or more health conditions, each of which intensifies and changes the other’s effects on the body. In the case of ASPD and alcoholism, individuals with personality disorders tend to start abusing alcohol at an earlier age than those without. They also develop serious abuse-related problems faster than those without ASPD. Although there is no known treatment which consistently addresses ASPD symptoms, those in substance abuse programs often benefit from Cognitive Behavioral Therapy. This type of treatment focuses on stress management and cognitive adaptation to tackle each element of this dual diagnosis.

Cocaine Addiction and Anxiety

Cocaine induced feelings of euphoria, energy and power. However, research shows that long-term cocaine use often leads to mental illness, especially anxiety. The co-existence of a cocaine addiction and a mental illness, like anxiety, have much more severe effects than either in isolation. In fact, the co-existence of a cocaine addiction and an anxiety disorder is now one of the leading dual diagnoses in America.

Extended cocaine use can also precipitate an anxiety disorder in those who did not previously suffer from it. Conversely, for those who already suffer from anxiety, cocaine can further aggravate symptoms. In many cases, people turn to cocaine to deal with their anxiety— cocaine triggers neurotransmitters in the brain, which cause excitement and energy. When an individual tries to beat their addiction and cuts down on cocaine intake, neurotransmitters drop substantially. The brain finds it difficult to process this drop, causing the individual to be further susceptible to anxiety and/or depression.

Cocaine addictions have lasting side-effects, with the most common complications including insomnia, itching and other physical discomfort. These side effects further exacerbate issues of anxiety, which catapults users into a dangerous cycle of dependence. Excessive use of cocaine makes users psychologically dependent, compromising their ability to make good personal decisions and to cope with anxiety, naturally.

Opioid Addiction and PTSD

Post-traumatic stress disorder (PTSD) is a mental illness that follows in the wake of a very traumatic event. Sometimes, these events result in serious physical injury to the individual, which are subsequently treated with prescription painkillers. Although these drugs can induce feelings of calm and euphoria, as well as ameliorate pain, they also come with a substantial risk of addiction. Blending painkillers with PTSD has proven to have both serious and deadly side effects, making it one of the most difficult dual diagnoses being treated today.

Vicodin and OxyContin are two of the most common and powerful opioids prescribed for acute and chronic pain. Problems of addiction typically stem from long-term use or using the drugs outside of the prescribed manner. As individuals build tolerance, they take higher doses than prescribed to fight pain, which often leads to addiction. When opioids are combined with PTSD, the two conditions lead to a powerful dual disorder, which can leave individuals feeling helpless, angry and fearful.

Continued symptoms of PTSD leave individuals feeling stressed and anxious, which can be a major contributor to continued opioid use. Conversely, opioid addictions can lead people to lose control of their lives and promote stress, which fuels people to keep using. Unfortunately, there is still not a complete approach to addressing PTSD. When opioids are mixed into the equation, treating each illness can be especially difficult. Many dual diagnosis treatment centers are finding success in treating each illness individually, then using Cognitive Behavioral Therapy to supplement changes to the patient’s patterns of thinking.

Heroin Addiction and Depression

Heroin abuse and depression are often deeply intertwined. Heroin is a powerfully addictive opiate that changes a user’s brain chemistry and causes mood changes and psychological dependence. Research estimates that nearly half of opiate users also experience depression at some time in their lives. For many users, heroin induces a rush of euphoria and deep relaxation. However, in people with mental illness, the side effects of heroin are more substantially negative. For those struggling with depression, heroin may appear to be a solution to feelings of guilt and hopelessness. In fact, heroin worsens depressive symptoms, causing anxiety, nervousness, negative mood swings, isolation and suicidal thoughts. Additionally, heroin has debilitating effects, which can lead to job loss, relationship conflicts, and financial trouble.

Long-term use of heroin causes the brain to develop a dependence on the drug. The brain begins to rely on heroin to produce signals of pleasure and happiness. In time, users are physically incapable of feeling happy without the drug, causing a form of brain damage, which leads to depression and intensifying feelings of hopelessness and despair. Unfortunately, this dual diagnosis is remarkably common. However, dual diagnosis treatment is finding success by identifying and treating both conditions simultaneously for a successful recovery.

Marijuana Addiction and Schizophrenia

The American Journal of Psychiatry reports that nearly half of all people diagnosed with schizophrenia also have a substance abuse disorder. It is not uncommon for schizophrenics to develop addictions, but research shows a striking correlation between marijuana abuse and schizophrenia. It is less clear as to why schizophrenics would use marijuana, as it can induce similar symptoms as to those experienced in a schizophrenic episode. However, it is clear that marijuana abuse is very common for those living with schizophrenia.

Research shows that people with schizophrenia are more likely to abuse drugs and alcohol than those without, which contributes to higher death and disability rates among that demographic. Scientists are working on identifying the genetic bases of schizophrenia in tandem with substance abuse disorders in order to determine whether people develop addictions to “self-medicate” their schizophrenia or whether the onset of schizophrenia is spurred by drug use.

Dual Diagnosis Treatment

Individuals struggling with both a substance abuse disorder and a mental illness can be some of the most difficult to convince they need treatment. Often one disorder obscures the severity of the other in their minds, as they revolve in a vicious cycle of use, abuse and codependency. However, if individuals seek treatment early on, the chances of recovery are much greater.

The most effective treatments for dual disorders are those which treat them simultaneously, no matter which disorder developed first. Typically, the symptoms and effects of one disorder propels the other disorder, making comprehensive treatment the best option for recovery. Many dual diagnosis treatment centers now focus on implementing a multi-faceted approach to treatment, including Cognitive Behavioral Therapy, as well as family, group and individual therapies. Contact Blu by the Sea today to learn more about our dual diagnosis treatment programs.