Dual Diagnosis Rehab Centers

Medically reviewed by

John Schaffer, LPCC

February 1, 2019

An individual with both a mental illness and a substance abuse issue, whether alcohol or drugs, is considered to have dual diagnosis. It’s impossible for this type of patient to recover fully without treatment for both disorders. Although many people may think this type of diagnosis is rare, it’s actually very common. According to a report published in The Journal of the American Medical Association, approximately 37 percent of alcohol abusers and 53 percent of drug abusers also have a serious mental illness.

Often, depressive disorders are associated with a substance abuse problem, including both depression and bipolar disorder. Other common mental illnesses associated with substance abuse include anxiety, panic, obsessive-compulsive disorder, phobias, schizophrenia, and personality disorders. Those already diagnosed with a mental illness of any sort are at a higher risk of becoming an abuser of alcohol or drugs.

Unraveling The Stigma: Myths Vs. Facts

There is an unfortunate number of myths which revolve around addiction and mental illness. These myths can be disabling for a person struggling from a dual diagnosis and also for their loved ones who are trying to get them help. Understanding the truth is empowering as it grants you more information to make the right treatment choices.

Mental illness and addiction are weaknesses of character and moral failings.
FALSE. Addiction is a disease and actually a mental illness itself.

Only certain people who make bad choices or aren’t strong enough struggle with mental illness and addiction.
FALSE. Both addiction and mental illness can impact anyone from any walk of life.

Mental illness and addiction aren’t related.
FALSE. Mental illness and substance use disorders share certain underlying causes.

If you have a mental illness you can drink or use drugs safely.
FALSE. Substance abuse isn’t safe, period. But having a mental illness increases your chances of developing a substance use disorder.

Drugs make me function better.
FALSE. Drugs only mask the effects of what is a serious, underlying problem which requires expert medical treatment.

Self-medication with drugs or alcohol can help relieve a mental illness.
FALSE. Self-medication actually creates the opposite of the intended effect by making the mental illness(es) worse. It can also lead to addiction.

Treating only one disorder is always enough to make you well.
FALSE. You can and should treat both at the same time. Doing so increases the likelihood of a successful recovery.

Willpower alone is enough to overcome these disorders.
FALSE. Individualized treatment is your best chance for long-lasting sobriety and balanced mental health.

Any treatment program can treat these concerns.
FALSE. The most effective treatment programs offer comprehensive and compassionate dual diagnosis care.

Is Addiction A Mental Illness?

Yes. Addiction isn’t just a disease of the brain. It is also a mental illness. While this may surprise some, the National Institute on Drug Abuse (NIDA) offers a compelling explanation of why:

“Addiction changes the brain in fundamental ways, disturbing a person’s normal hierarchy of needs and desires and substituting new priorities connected with procuring and using the drug. The resulting compulsive behaviors that override the ability to control impulses despite the consequences are similar to hallmarks of other mental illnesses.”

How Does A Mental Disorder Impact A Person?

A mental disorder shapes a person’s life, altering their ability to carry out tasks and responsibilities which are essential to their well-being, health, and fulfillment. They can even affect the way a person processes and respond to certain circumstances, people, and choices.

What Causes Mental Illness And Addiction?

Though each disorder may exist independently of the other, and have numerous risk factors unique to each, they do share certain overlapping causes, as outlined by NIDA, including:

• Early exposure to stress or trauma
• Genetic vulnerabilities
• Underlying brain deficits

Which Happens First: Substance Abuse Or Mental Illness?

As with so many facets of addiction, the answer to the question varies person to person, but here are the basics below.

• Substance abuse exacerbates mental illness. If a person suffers from a mental illness, a substance use disorder can aggravate their preexisting condition, causing it to worsen.
• Mental illness can lead to addiction. As a person’s mental illness is left untreated and becomes more unmanageable, they may use drugs or alcohol to self-treat the condition. As this use continues they could become addicted.
• Substance abuse can cause a mental illness. In certain instances, some forms of substance abuse or addiction have actually been shown to lead to the development of a new mental illness.

But, as NIDA reminds us: “The high prevalence of comorbidity between drug use disorders and other mental illnesses does not mean that one caused the other, even if one appeared first.”

Substance Abuse Alters Your Brain Chemistry

Prolonged and chronic drug use actually changes the way your brain functions, by altering its crucial neurotransmitters (namely dopamine). These chemical changes impact your ability to experience reward and pleasure and make it harder to make sound decisions. This can make it harder to limit your consumption of or to completely abstain from drugs.

Addiction Can Cause Symptoms Of Mental Illness

Drugs imbalance a person’s neurochemistry to the extent that these characteristics develop either suddenly or over time. As explained by the Substance Abuse and Mental Health Services Administration (SAMHSA) symptoms of mental illness, and certain forms of substance abuse, may manifest by:

• Auditory or visual hallucinations
• Decreased ability to focus
• Extreme anxiety
• “False beliefs about basic aspects of reality”
• Inappropriate behaviors
• Supremely variable moods
• “Unwanted, intrusive thoughts”

“But If Alcohol And Drugs Make Me Feel Better, Why Are They Bad?”

The “feel good” and pleasurable effects of alcohol and drugs are fleeting, and they’re only the tip of the iceberg. Beneath this seemingly positive facade lies a darker truth: substance abuse opens the door to a host of very unpleasant and dangerous effects, including a heightened risk for mental illness.

Instead of seeking help, a number of individuals may turn to drugs and/or alcohol to numb the feelings associated with their mental disorder. Others may do so to create feelings they’re no longer able to encounter on their own, such as a sense of fulfillment or pleasure. What might seem like a harmless drink after a long day can very easily accelerate into abuse and even full-blown addiction? Why is this?

How Is Self-Medication Connected To Mental Illness And Addiction?

As a person self-medicates they often slip into a dangerous pattern marked by rapidly declining emotional, mental, and physical states. This can be so extreme that an addiction or mental illness worsens or forms. Here are the ways self-medication negatively affects a person:

• Psychological: When stress or adverse emotional states peak a person becomes conditioned to use drugs to relieve these negative states.
• Emotional: As a person’s chemical equilibrium malfunctions further from chronic drug use, an individual may find that they are struggling to experience positive emotions or fulfillment on their own. This leads to further drug use.
• Physical: As use continues and accelerates, a person’s body can become dependent on the drug. This means that it is unable to function on its own without the substance.

The University of Utah’s Genetic Science Learning Center provides us with a good example of this:

“Depression can result from an under-active reward pathway that receives little pleasure from natural rewards. People with depression may turn to drugs to stimulate their reward pathways to more “normal” levels.”

How Are Addiction And Mental Illness Similar?

Addiction exhibits many characteristics which echo features of common mental illness. As explained by SAMHSA,“Mental disorders involve changes in thinking, mood, and/or behavior.” As a mental illness, addiction affects a person in these key areas as well.

Cognitive Changes

Drugs, including alcohol, alter the way your brain operates, impairing key cognitive functions. So do certain forms of mental illness. These functions are critical to self-care, safety, and all-around functionality in day-to-day living. These changes include:

• Decision-making ability
• Inhibition
• Impulse control
• Judgment
• Logic
• Planning
• Problem-solving
• Memory
• Reasoning
• Risk evaluation

Behavioral Changes

Self-preservation is typically hardwired into our brains. But for an addicted individual or a person with another mental illness, it’s no longer this simple. As a person’s ability to carry out these cognitive tasks declines, it becomes even more difficult for them to differentiate between what is good for them and what is harmful to their health.

Mental illness can reduce your inhibitions and increase risky behaviors, both of which can make it easier for an individual to engage in substance abuse.

Mood Changes

Many mental illnesses cause intensely variable moods. Additionally, as your brain continues to change under the influx of drugs and/or alcohol, your emotional state becomes seriously compromised.

Sometimes the sadness, uncertainty, and anxiety which surface continue to more serious extremes.

What Is A Dual Diagnosis?

A dual diagnosis occurs when a person has a substance use disorder and a mental illness. This is also referred to as a co-occurring disorder.

Symptoms of dual diagnosis may include a person:

• Withdrawing from their loved ones.
• Claiming they need the drug to function “normally,” or to be calm, happy, focused, etc.
• Exhibiting sudden and drastic changes in their behavior.
• Ignoring responsibilities relating to their job, schooling, or family life.
• Losing interest in activities which previously brought them enjoyment or fulfillment.
• Engaging in risky behaviors. (e.g. unsafe sex, operating a vehicle under the influence)
• Losing touch with reality. (e.g. experiencing delusions, paranoia, or hallucinations)

How Widespread Are Co-Occurring Disorders?

The National Institute of Mental Health (NIMH) published a shocking statistic on the prevalence of co-occurring disorders in America. They report that of the 20.2 million adults who had a substance use disorder in 2014, over a third had a co-occurring mental illness.

Percentage of people addicted to drugs with mental disorders:

• Average in population: 10%
• Schizophrenia: 46%
• Major Depressive Disorder: 27%
• Bipolar I Disorder: 61%
• Bipolar II Disorder: 48%

The University of Utah has compiled some sobering information on the prevalence of addiction within groups of individuals who suffer from serious mental illness. They found that a high percentage of people with mental disorders are also addicted to drugs.

Further, NIDA reports that:

1. People with substance use disorders are two times more likely to have a mood and/or anxiety disorder.
2. People with anxiety, mood, or conduct disorders or antisocial syndrome are two times more likely to struggle with a substance use disorder.

What Are Examples Of Common Co-Occurring Disorders?

Mood Disorders

• Bipolar disorder
• Dysthymic disorder
• Major depressive disorder
• Depression and substance abuse

Personality Disorders

• Antisocial personality disorder
• Borderline personality disorder
• Histrionic personality disorder
• Narcissistic personality disorder

Eating Disorders

• Bulimia
• Anorexia nervosa
• Binge eating disorder
• General eating disorders

Anxiety Disorders

• Generalized anxiety disorder
• Obsessive-compulsive disorder
• Panic disorders
• Post-traumatic stress disorder (PTSD)
• Intermittent explosive disorder

Other Disorders

• Attention deficit hyperactivity disorder (ADHD)
• Schizophrenia
• Sleep disorders
• Impulse control disorders
• Dissociative identity disorder

Do any of these look familiar? If you haven’t experienced one of these mental illnesses yourself, you’ve likely known someone who has. Trauma can also deeply affect an individual in a way which leads them to substance abuse, for this reason it is often considered, and treated as, a dual diagnosis.

Are Certain People At A Greater Risk For Developing A Dual Diagnosis?

The hard fact is that any person can be adversely impacted by a mental illness or addiction. However, research does illustrate that certain groups of people are more prone to co-occurring disorders.

According to NAMI, “Men are more likely to develop a co-occurring disorder than women. Other people who have a particularly high risk of dual diagnosis include individuals of lower socioeconomic status, military veterans and people with more general medical illnesses.” The NIMH elaborates further, noting that in 2014 over half of those who had a co-occurring disorder were men.

Why Do I Need To Treat Both Disorders?

Regardless of how or why it happens, the dysfunctional relationships between substance use disorders and mental illness fuel each other. For instance:

• Untreated mental health disorders are one of the most common causes of relapse. If someone with a drug or alcohol problem becomes sober, but fails to treat their depression, they’re at a higher risk for relapse. The persistent feelings of sadness which accompany this disorder may act as a trigger which initiates a return to drug or alcohol abuse.
• Treating the mental illness on its own, while helpful, is not enough. Substance abuse and its adverse effects will continue to trigger negative feelings of despondency, frustration, poor self-worth, isolation, and others which contribute to imbalanced mental states. Alcohol and drugs will continue to ravage brain chemicals which are critical to good mental health.

While it is true that co-occurring disorders complicate treatment and recovery, help exists. With the right treatment it is possible to obtain and maintain a balanced and fulfilling, sober life.

Understanding The Importance Of Dual Diagnosis Treatment

Effective dual diagnosis care gets to the root of the problem. This comprehensive approach identifies and treats the maladaptive behaviors, thoughts, and emotions which may contribute to both states. Every person arrives at and experiences their substance use and mental health disorders differently. That is, each case arises and is perpetuated by circumstances which are distinct to each person’s life.

For these reasons, the best dual diagnosis treatment programs deliver individualized care which is tailored to the unique needs of each individual who enters the program.

How Are Dual Diagnoses Treated?

Dual diagnoses are best treated in a residential, inpatient drug rehab. Many of the modalities used serve a dual-purpose as they can be adapted to treat both a substance use and mental health disorder. Compassionate and highly-trained physicians, nurses, therapists, counselors, and other addiction specialists will support you as you heal from both the addiction and mental illness.

How Can a Physician Treat a Person With Both a Mental Illness and Substance Abuse?

Most physicians will treat both issues simultaneously, since they are often linked. The first step in the treatment process, which is common for any substance abuser, is detoxification. This process will allow the body to cleanse itself of the alcohol or drug and physically heal. Ideally, the process of detoxification will take place with medical supervision, and it can take many days or even weeks to complete. With new developments in medication, doctors can reduce the pain of going “cold turkey” and ease substance abusers through the withdrawal period.

It’s very common for a dual diagnosed patient to relapse, and many believe this is part of the recovery process. Setbacks happen and patients must remember that it’s not about the setback, but how he or she will recover. Many physicians recommend peer support, which is proven to help with the recovery process.

What Modalities Are Used Within Dual Diagnosis Programs?

Medical Detox

A medical detox supports a person as they go through withdrawal from alcohol, benzodiazepines, or opioids. Withdrawals from alcohol and benzodiazepines can be deadly if not managed by a trained medical professional.

Medication-Assisted Treatment

Medications (pharmacotherapies) and behavioral therapies are often used jointly within medication-assisted therapies to treat symptoms of both disorders. A common example would be the use of buprenorphine (Suboxone, Zubsolv) to treat an opioid addiction.

Behavioral Therapies And Counseling

A combination of individual and group therapy and counseling helps individuals to learn the interpersonal and coping skills which protect their mental health and sobriety. These methods also work to instill a greater sense of self-care, self-confidence, self-reliance, and self-love, all of which are foundational to a healthy recovery.

• Motivational interviewing
• Cognitive behavioral therapy
• Dialectical behavior therapy
• Twelve-step facilitation therapy
• Family therapy and support

Behavioral therapies are supported by other dynamic treatment modalities which further enforce the positive healing and coping skills taught in therapy. Examples include:

• Adventure therapy
• Art therapy
• Equine therapy
• Holistic therapies
• Life skills management
• Mindfulness and stress management
• Nutritional education and support
• Self-help groups
• Wilderness therapy

The Importance Of Aftercare

Addiction and recovery take you on a lifelong journey, one which requires constant vigilance, nurturing, upkeep, and a relapse prevention plan. For those with co-occurring disorders, aftercare is even more vital. A good aftercare plan will help you to maintain your sobriety goals while continuously addressing your mental health needs. Counseling and therapy often extends beyond treatment for these purposes.

Find an aftercare program now to better help maintain sobriety.

Find Mental, Physical, And Emotional Wellness Today

If you’d like more information on how a dual diagnosis program could help you or a loved one address your addiction and mental illness, contact us today. We understand these are sensitive subjects. Because of this, the compassionate staff at RehabCenter.net is standing by to offer you a confidential assessment today.