Dual diagnosis is the term used when an individual has both a mood disorder and a substance addiction. Mood disorders include depression, bipolar disorder, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and others. Also included under the umbrella of dual diagnosis are conditions like anxiety, eating disorders, and other psychiatric conditions. It is common for addiction and mental health conditions to coexist and one often exacerbates the other. Dual diagnosis is becoming increasingly common, with co-existing mental illness and substance abuse affecting anywhere from 9 to 14 million Americans each year.
Anxiety and Addiction
The limbic system is the area of the brain most involved in addiction, it also happens to be the part of the brain that governs our “fight or flight” response. Anxiety is more common in those with addiction than it is in the population at large, with about 20% of individuals seeking treatment for anxiety having a dual diagnosis that includes a substance use disorder. Because anxiety arises in the limbic system, addiction to alcohol and other drugs that help to reduce limbic activity may be a response to an overactive limbic system. Simply put, alcohol, benzodiazepines, and other tranquilizers may inadvertently provide over-anxious individuals with a kind of relief that can’t find elsewhere. Though unintentional, this may increase the risk of addiction in these individuals.
Eating Disorders and Addiction
Eating disorders fall close to anxiety on the spectrum of limbic system activity. At least part of the reason that people develop eating disorders revolves around intense anxiety related to body image. More than that, however, drug and alcohol use can facilitate an eating disorder, making it easier to lose weight and keep it off. Abuse of laxatives, stimulants, and alcohol can all improve weight control and eventually lead to addiction.
OCD and Addiction
Like anxiety, OCD is driven primarily by limbic activity. Approximately 25% of individuals who seek treatment for OCD also meet criteria for a substance use disorder. People with OCD recognize that their fears are unreasonable, but are powerless to control those fears. Substance use may provide some relief from the relentless obsessions that plague these individuals. In fact, substance use may best be thought of as just another compulsion designed to lessen the anxiety that obsessions produce.
PTSD and Addiction
Many individuals with PTSD say that they turn to drugs and alcohol as either a means of numbing the pain they feel or as a way to gain some measure of control in their lives. It is important to keep in mind that PTSD is not just associated with military combat. It may arise as a result of violent assault, a natural disaster, sexual assault, or childhood abuse. PTSD is characterized by anxiety, depression, emotional duress, and physical pain. These symptoms occur in part as a result of endorphin (the body’s natural pain killers and mood elevators) withdrawal. Drugs and alcohol can help to counteract endorphin withdrawal in the short term, but worsen it over the long term.
Bipolar and Addiction
The link between bipolar disorder (once called manic depression) and addiction is the strongest of all with 56% of individuals with bipolar disorder struggling with substance addiction at some point during their lives. At any given time, 46% of those with bipolar disorder are addicted to alcohol and 41% are addicted to drugs. Bipolar disorder is associated with loss of inhibition and risk-taking behavior.
The core of treating any dual-diagnosis disorder is to address the underlying psychological factors that increase propensity for addiction. Addressing these factors can help to decrease the impulse to self-medicate and make it easier to control substance use. In many cases, proper medical treatment, including medication regimens, can provide the kind of relief that those suffering from a dual diagnosis once sought from drugs and alcohol. The keys to behavioral treatment are behavioral counseling, social support, and motivational therapy aimed at rewarding individuals for abstaining from drugs and alcohol.
Common Addictions with Mental Health Disorders
The connection between substance abuse and mental health disorders is often defined by a kind of “chicken and egg” conundrum. Though some people use alcohol and drugs to treat anxiety and depression, it is also true that both alcohol and drugs increase risk of mental health disorders and, in the long run, make mental health disorders worse. The use of drugs and alcohol to treat any mental health condition almost always leads to a vicious cycle in which the alcohol and drugs worsen the condition and thus prompt heavier substance abuse. Anxiety, bipolar disorder, PTSD, and OCD are the disorders most commonly associated with substance abuse. Approximately 37% of alcohol abusers and 53% of drug abusers have at least one serious mental illness. About 65% of individuals with mental illness will be affected by substance abuse.
Programs for Management of Dual Diagnosis
Co-occurring mental health conditions and substance abuse disorders affect roughly 9 million Americans each year. Only about 7.5% of those individuals receive appropriate treatment. It turns out that poorer outcomes are associated with attempting to treat these disorders separately. The most effective mechanism of addressing a dual diagnosis is an integrated program designed to treat the whole patient and not a single disorder. These programs focus on motivation, counseling, and long-term support.
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