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Dual Diagnosis and Co-Occurring Conditions

If you have a substance abuse disorder and also have another mental illness, such as depression, anxiety, bipolar disorder or PTSD, you are not alone.

According to the National Alliance for Mental Illness (NAMI), 37% of alcohol abusers and 53% of drug abusers also have at least one additional mental illness. Mental health professionals describe this condition of having a substance abuse disorder along with another mental illness as “co-occurring disorders” or “dual diagnosis.”

Co-Occurring Conditions

The most common mental illness diagnoses that accompany a diagnosis of substance abuse include depression, anxiety and bipolar disorder. In many cases, substance use can be viewed as a form of “self-medication” by the substance user, who attempts to use alcohol or drugs to lessen or numb the uncomfortable symptoms of an underlying mental health condition. Unfortunately, using substances as a coping tool only adds to the problem, rather than alleviating it. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), if one of the co-occurring disorders goes untreated, both conditions are likely to worsen, and more complications arise.

Signs that an underlying co-occurring mental illness may also be affecting substance use are:

  • Social withdrawal
  • Anger or violent behavior
  • Difficulty holding a job
  • Erratic behavior or mood swings
  • Using drugs or alcohol as a coping tool

Symptoms of Common Co-Occurring Conditions

Substance users should be aware of the signs of mental health conditions that may accompany substance abuse.

Symptoms of Depression

  • Feelings of helplessness or hopelessness
  • Feelings of worthlessness or guilt
  • Loss of interest in daily activities
  • Sleep changes (too much or too little)
  • Loss of energy
  • Poor concentration

Symptoms of Anxiety

  • Excessive worry
  • Restlessness, fidgeting
  • Irritability
  • Nausea, racing heart or shortness of breath
  • Trembling
  • Trouble concentrating
  • Insomnia

Symptoms of Bipolar Disorder

  • Unexplained euphoria or extreme irritability
  • Unrealistic, grandiose beliefs
  • Increased energy, hyperactivity
  • Decreased need for sleep
  • Impaired judgment
  • Impulsivity
  • Anger or rage

Risk Factors for Co-Occurring Disorders

According to the U.S. government Drug Facts publication “Comorbidity: Addiction and Other Mental Disorders,” substance use and co-occurring mental illness share the following risk factors:

  • Overlapping genetic vulnerabilities – Predisposing genetic factors may make a person susceptible to both addiction and other mental disorders or to having a greater risk of a second disorder once the first appears.
  • Overlapping environmental vulnerabilities – Stress, trauma (such as physical or sexual abuse), and early exposure to drugs are common environmental factors that can lead to addiction and other mental illnesses.
  • Involvement of similar brain regions – Brain systems that respond to reward and stress are affected by drugs of abuse and may also show abnormalities in patients with certain mental disorders.
  • Developmental factors – Emotional or mental instability, or stress or trauma during childhood or teen years may predispose a person to both substance use and mental illness. Early exposure to drugs of abuse may change the brain in ways that increase the risk for mental disorders. Also, early symptoms of a mental disorder may indicate an increased risk for later drug use.

Treating Dual Diagnosis or Co-Occurring Disorders

Co-occurring disorders require a comprehensive treatment approach that addresses both the substance abuse and the additional mental health issue at the same time.

Behavioral Therapies are often used to treat dual diagnosis conditions. Such therapies focus on helping the client become proactive, and not only think about changes they would like to make, but also to plan out and strategize actions that can bring their ideas to fruition. Working with a counselor or therapist, client efforts are focused on following through with specific behavioral goals that were created. The change plan is reviewed periodically and adjustments made as necessary.

Life Skills and Sober Lifestyle Training are important for persons with co-occurring disorders, as they often have trouble managing work and family commitments. Treatment programs for dual diagnosis often include assistance for gaining needed lifestyle skills, such as addressing employment issues, providing education regarding how to apply for a job, training in time management and scheduling, practice in effective communication and social skills.

Sober Living Strategies such as developing a plan for coping with cravings, creating new, positive lifestyle practices (developing friendships that don’t involve substance use, identifying and using support groups, etc.) are also an important part of a dual diagnosis treatment plan.

Alternative Therapies that take a more holistic approach are often appropriate to address the comprehensive needs of dual diagnosis treatment. Nutritional therapy, relaxation therapy (massage, meditation, yoga, etc.) and other alternative therapies may be utilized.

Peer Support Groups are an important part of dual diagnosis treatment programs. 12-Step programs, such as Alcoholics Anonymous (AA), Narcotics Anonymous (NA) or others are often standard treatment options.

Tips for Managing a Dual Diagnosis Condition

Here are some additional tips to help you manage a dual diagnosis or co-occurring disorder condition:

  • Tip 1:  Commit to a Healthy LifestylePracticing healthy lifestyle choices can help you manage your substance use and mental health issues by providing you with a stronger body and mind that are resilient and resistant to stress. Eat balanced meals at regular intervals, exercise 30 minutes 4-5 times per week, and get a full night’s sleep (approximately 8 hours).
  • Tip 2:  Learn and Practice Stress Management StrategiesStress can easily derail your sobriety goals and wellness plans. Since you can’t turn to substance use to relieve stress, you’ll need to have acquired some replacement stress reduction strategies that you can quickly and easily implement when stress escalates. Don’t wait until you need them – it will be too late. Decide on and practice, before you need them, a few stress reduction strategies that feel right for you (meditation, yoga, reading inspirational literature, etc.).
  • Tip 3:  Have a Plan and Work Your PlanWhether or not you are working with a counselor or therapist, you should develop and follow a behavioral plan that leads you consistently toward your goals. Having structured, written guidelines can be both motivating and reassuring. You can review your plan whenever you feel vulnerable or overwhelmed. Knowing that you only need to focus on a certain set of specific steps at one time can help you regain your focus and recognize that your goals are attainable. As you move through each step on your plan, you will gain confidence and feel more successful, which will then serve to propel you further with greater ease.

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