Dual Diagnosis Definition

To many people, the term “dual diagnosis” is confusing.  However, we will review the dual diagnosis definition below as well as talk about treatment.

Dual Diagnosis Definition

The dual diagnosis definition describes a condition in which someone has a mental health disorder and is struggling with a drug and/or alcohol abuse problem at the same time.

The term “dual diagnosis” is used for these two specific diagnoses because the relationship between substance abuse and mental health disorders is quite complex. One condition can worsen the other, making treatment of each or both conditions much more challenging.

The support systems (family, friends, etc) for people suffering with dual diagnosis also suffer.

The Scope of the Dual Diagnosis Problemdual diagnosis definition

The most common substances that are abused by those with major mental health issues are:

  1. Alcohol
  2. Marijuana
  3. Cocaine

Approximately 18 million adult American have a serious mental illness and about one quarter to one half of those individuals also have substance abuse issues.

That means that between four and nine million Americans are afflicted with dual diagnosis disorders.

Looking at it from the other side:

  • A third of all people that abuse alcohol have at least one other serious mental illness
  • Over one half of all drug abusers have a dual diagnosis.

In short, dual diagnosis is a major mental health problem.

Which Came First: Mental Illness or Substance Abuse Disorder?

It is often difficult to determine whether someone with mental illness later developed a problem with drugs or alcohol or if substance abuse laid the groundwork for mental illness to emerge.

The answer is as complex as the human brain.what is dual diagnosis

Certain drugs can change the chemistry and even structure of the brain.

  • Ecstasy or MDMA is a potent neurotoxin that kills serotonin neurons in the brain. Once these brain cells die, MDMA users develop severe depression that is very difficult to treat with standard drugs. 
  • Cocaine and amphetamines can alter the way in which the brain senses pleasurable experiences. Because these drugs affect the dopamine system, they can lead to symptoms that seem like schizophrenia, namely hallucinations and delusions.

What about when mental illness came first?

People with severe anxiety disorder are much more likely to also suffer from alcohol abuse disorder.

  • Could it be that patients learn that alcohol soothes nerves and they therefore self-medicate?
  • Or could the genetics of the brain make it so that sufferers are inclined to both?

Regardless of cause, dual diagnosis patients find it difficult to function without alcohol—both because they are dependent on the chemical and because they need the soothing effects to get through the anxiety of day.

Interestingly, dual diagnosis patients do not often choose a drug to use to treat a specific symptom of mental illness, but rather they report using substances for the same reasons that those in the general public do, namely to counteract boredom, insomnia, loneliness or social anxiety.

Dual Diagnosis Treatment Must Address Both Disorders

It is not always important to know which dual diagnosis disorder came first. What is critically important is that both dual diagnosis illnesses are treated at the same time.

Attempting to treat one without the other is ineffective; it is like trying to save a sinking boat by only plugging one of its two holes.

What is even more troubling is that traditional psychiatric treatments often do not  work in dual diagnosis patients.

For example, using antidepressants alone to treat depression and substance abuse disorder is ineffective and can even be dangerous.

Likewise, using benzodiazepines like Ativan and Valium to treat anxiety in someone that misuses alcohol could greatly worsen both diseases.

Fortunately psychiatrists and psychologists are beginning to have a better understanding of the dual diagnosis definition and the fact that effective treatment requires a complex approach.

Medications are only one part of the treatment plan and are strengthened by adding psychotherapy and behavioral interventions.

The threshold for hospitalization for patients with dual diagnosis is lower.

In other words, while someone that has moderate depression or moderate alcohol abuse disorder would not necessarily be hospitalized, when patients seek help for these disorders together, physicians may push to have the patient admitted to the hospital for a short time in order to provide intensive psychiatric treatment.

 

References For Dual Diagnosis Definition Article

1.         Lehman AF, Myers CP, Dixon LB, Johnson JL. Detection of substance use disorders among psychiatric inpatients. J Nerv Ment Dis. Apr 1996;184(4):228-233.

2.         Kuehn BM. Integrated care key for patients with both addiction and mental illness. JAMA. May 19 2010;303(19):1905-1907.

3.         Drake RE, Mueser KT. Psychosocial approaches to dual diagnosis. Schizophr Bull. 2000;26(1):105-118.

4.         Freudenmann RW, Schonfeldt-Lecuona C, Spitzer M, Hermle L, Gron G. Electroconvulsive therapy in the treatment of depression in a former ecstasy user. J Psychopharmacol. Nov 2006;20(6):860-862.

5.         Kuzenko N, Sareen J, Beesdo-Baum K, et al. Associations between use of cocaine, amphetamines, or psychedelics and psychotic symptoms in a community sample. Acta Psychiatr Scand. Jun 2011;123(6):466-474.

6.         Kushner MG, Maurer E, Menary K, Thuras P. Vulnerability to the rapid (“telescoped”) development of alcohol dependence in individuals with anxiety disorder. J Stud Alcohol Drugs. Nov 2011;72(6):1019-1027.

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