In the United States, approximately 23.5 million people struggle with substance abuse issues and addiction. That’s about one in every 10 Americans over the age of 12. At the same time, almost 43.8 million Americans suffer from some form of mental illness. Falling in between these two categories—people who suffer from a substance abuse issue and a mental illness—are about 7.9 million U.S. citizens who have what’s called “Dual Diagnosis,” or “Co-Occurring Disorders.”
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What is a Dual Diagnosis?
Patients who receive a Dual Diagnosis suffer from a simultaneously occurring substance abuse problem and mental health disorder. In some cases, one condition precedes and leads to the other, but often they arise independently of each other.
A Dual Diagnosis can be especially pernicious because one disease—depression, for instance—typically makes the other disease, such as alcoholism, significantly worse. The symptoms will compound and make patients feel the negative effects of each disease in a more intense way than they otherwise might. For this reason, those who receive a Dual Diagnosis should enter a dual diagnosis treatment facility as soon as possible to begin the process of recovery.
- According to the National Survey on Drug Use and Health, in a given year around 7.9 million Americans receive a Dual Diagnosis. Over half—around 4.1 million—are men.
- Sadly, over 50% of those who suffer from a Dual Diagnosis never receive treatment for their illnesses
- Less than 15% of Americans who receive a Dual Diagnosis residential treatment typically receive the integrated Dual Diagnosis treatment that’s necessary to achieve a full recovery
- It’s possible to maintain the outward appearance of a normal life while suffering from a Dual Diagnosis. While employed men are more likely than women to struggle with substance abuse (13.2% compared to 6.9%), employed women are more likely to struggle with mental illness (14.2% compared to 7.3%.)
Types of Dual Diagnosis Disorders
Of the mental health disorders that are most commonly coupled with a substance abuse disorder, the 8 most common include bipolar disorder, PTSD (Post-Traumatic Stress Disorder), depression, anxiety disorder, panic disorder, OCD (Obsessive-Compulsive Disorder), ADHD, and schizophrenia.
In the majority of cases, bipolar disorder is coupled with alcohol or cocaine use; post-traumatic stress is associated with alcohol or benzodiazepines use; anxiety is linked with alcohol, benzodiazepines, or cocaine; ADHD is usually paired with alcohol or a stimulant drug; OCD is often grouped with marijuana or alcohol; depression is most often associated with alcohol abuse; schizophrenia is often linked to stimulants, which may include nicotine and caffeine, and panic disorder is most often associated with alcohol abuse or the improper use of medications like benzodiazepines.
While these are the most common combinations, there are variations that exist beyond the limitations of this list.
How to Diagnose
Identifying a case of Dual Diagnosis can be tricky. The symptoms associated with a single drug abuse issue or a mental health problem are often intense and can mask the symptoms of a second health condition. This can be problematic because it’s imperative to treat a dually diagnosed patient for both of their illnesses. Treating one without treating the other can make the recovery process both lengthy and difficult.
In many cases, while making their diagnosis for a single issue, doctors will notice that mental health symptoms are more intense than normal. This is generally the red flag which leads to a Dual Diagnosis. They will then extrapolate the symptoms and try to determine which mental issue the patient might be simultaneously suffering from.
Treating a Dual Diagnosis can be complicated, but just because there are additional challenges doesn’t mean that they should be skipped over. The first thing patients should know is that they may need to see more than one doctor and attend more than one support group. These doctors and support groups specialize in a single illness, and can better help patients target root issues.
Treatment for mental health issues typically involve counseling, psychotherapy, and attending support groups which help build a nurturing and encouraging network of people. Treating the substance abuse problem is generally a two-step process. In the first, patients are assisted through the often-challenging detox and withdrawal process. The second step is recovery, which involves therapy and support groups in the form of inpatient or outpatient treatment.
- Inpatient: Inpatient treatment is a comprehensive recovery program, in which patients live in a dual diagnosis treatment facility for several months while enjoying access to 24/7 medical care, therapy, and counseling sessions.
- Outpatient: Outpatient programs are less intensive than inpatient programs, but still aim for the same goal: full recovery while building a support network. Patients commute to a facility several times a week for various forms of treatment but do not live in the treatment center.
Cost & Insurance Options
In many cases, private insurers offer coverage for both mental health and substance abuse treatment. However, policies differ from person to person and may include one but not the other. Employee insurance may also cover these two diseases, but again the extent of the coverage is at the discretion of the policyholder, who is typically the boss.
Because it can be difficult to fully parse your insurance policy, many affordable dual diagnosis residential treatment centers keep an insurance expert on retainer to help patients navigate their policy.
Helping a Loved One
It can be difficult to watch someone you love struggle with simultaneous, challenging illnesses. The best thing anyone can do is to educate themselves, to the best of their ability, about the issues that the loved one might be facing. Extensive research will help an individual determine the best way to approach their loved one, the things they should say and not say, and how to suggest individualized treatment.
It’s also important to stay optimistic. In many cases, negativity can drive an individual deeper into their problems. Remember that both illnesses, while they are undoubtedly severe, are treatable, and can be cured. And both must be treated if that’s to occur.
National Alliance on Mental Health. Diagnostic and Statistic Manual of Mental Disorders. 2015.
Substance Abuse and Mental Health Services Administration. Behavioral Health Treatments and Services. 2019.
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