Welcome to day 19 in the #Write31Days series on mental health. I am terribly late to write my post today and not really motivated for it. You see, I came down with a terrible cold and an earache. Life must go on though. Today, I’ll discuss a topic that does not affect me personally, but does affect many people I know in the psychiatric institution: dual diagnosis.
Dual diagnosis describes the co-existence between an addiction and a mental illness. The relationship between substance abuse and mental illness is complex. There may be many reasons why addicts get mental illness and why people with mental illness become addicted. For instance:
- People with mental illness may use alcohol or drugs as a form of self-medication. This means that, when they experience undiagnosed or undertreated symptoms of mental illness, they turn to drugs or alcohol for a “quick fix”. They think they feel less anxiety or depression, for example, when high on durgs. Unfortunately, while this may temporarly seem true, substance abuse makes these conditions worse.
- Symptoms of mental illness can be worsened by substance abuse. For example, a person who is depressed might experience suicidality when intoxicated with alcohol, or a person with an anxiety dsorder may experience worse anxiety when withdrawing from opiates (eg. heroin).
- Substance use can cause symptoms of a mental illness to appear in otherwise healthy people. The most common example is maijuana leading to psychosis. This is often called a drug-induced psychosis. Unfortunately, drug-induced psychoses may set in motion a rollercoaster that leads to longer-lasting problems, ie. schizophrenia.
According to the Amercan Medical Association, 35% of people who abuse alcohol and 53% of those who abuse drugs have at least one co-occurring mental illnesss, and 29% of people diagnosed with a mental illness are substance abusers. Males and young adults are more likely to experience dual diagnosis than do females and older adults.
The treatment of co-occurring mental illness and addiction is harder than that of either condition alone. It may be hard to diagnose the individual with co-existing substance abuse and mental illness because of the interactions between the two. For instance, if a person abuses amphetamines, it may be hard to recognize they do so as a means of self-medication for undiagnosed ADHD.
Violence and suicidality are more common in the dually diagnosed than in those with a mental illness alone. People with mental illness who end up in jail for criminal behavior (not just drug-related crimes) are also more likely to have a co-existing addiction.
Because many psychiatric hospitals and drug rehab centers treat only those with either a mental illness or an addction, people with a dual diagnosis have a harder time accessing treatment for any of their problems. Fortunately for them, there are now dual diagnosis units in many psychiatric hospitals at least in the Netherlands. I say “for them”, because the larger population of dually-diagnosed people in psychiatric hospitals does cause at least some people with just a mental illness (ie. me) to feel unsafe.