- Thirty-seven percent of alcohol abusers and fifty-three percent
of drug abusers also have at least one serious mental illness.
- Of all
people diagnosed as mentally ill, 29 percent abuse either alcohol
or drugs.
What Kind of Mental or Emotional Problems are Seen in People with Dual
Diagnosis?
The following psychiatric problems are common to occur in dual diagnosis
- i.e., in tandem with alcohol or drug dependency.
· Depressive disorders, such as depression and bipolar disorder.
· Anxiety disorders, including
generalized anxiety disorder, panic disorder, obsessive-compulsive disorder,
and phobias.
· Other psychiatric disorders, such as schizophrenia and personality disorders.
The following table based on a National Institute of Mental Health study,
lists seven major psychiatric disorders and shows how much each one increases
an individual’s risk for substance abuse.
Psychiatric Disorder |
Increased Risk For Substance Abuse |
Antisocial personality disorder |
15.5% |
Manic episode |
14.5 |
Schizophrenia |
10.1 |
Panic disorder |
4.3 |
Major depressive episode |
4.1 |
Obsessive-compulsive disorder |
3.4 |
Phobias |
2.4 |
Thus, someone suffering from schizophrenia is at a 10.1 percent higher-than-average
risk of being an alcoholic or drug abuser. Someone who is having an episode
of major depression is at a 4.1 percent higher-than-average risk of being
an alcohol or drug abuser…and so on.
Which Develops First - Substance Abuse or the Emotional Problem?
It depends. Often the psychiatric problem develops first. In an attempt
to feel calmer, more peppy, or more cheerful, a person with emotional symptoms
may drink or use drugs; doctors call this “self-medication.” Frequent
self-medication may eventually lead to physical or psychological dependency
on alcohol or drugs. If it does, the person then suffers from not just one
problem, but two. In adolescents, however, drug or alcohol abuse may merge
and continue into adulthood, which may contribute to the development of emotional
difficulties or psychiatric disorders.
In other cases, alcohol or drug dependency is the primary condition. A
person whose substance abuse problem has become severe may develop symptoms
of a psychiatric disorder: perhaps episodes of depression, fits of rage,
hallucinations, or suicide attempts.
How Can a Physician Tell Whether the Person’s Primary Problem
is Substance Abuse or an Emotional Disorder?
At the initial examination, it may be difficult to tell. Since many
symptoms of severe substance abuse mimic other psychiatric conditions, the
person must go through a withdrawal from alcohol and/or drugs before the physician
can accurately assess whether there’s an underlying psychiatric problem
also.
If a Person Does Have Both an Alcohol/Drug Problem and an Emotional
Problem, Which Should Be Treated First?
Ideally, both problems should be treated simultaneously. For any
substance abuser, however, the first step in treatment must be detoxification
- a period of time during which the body is allowed to cleanse itself of alcohol
or drugs. Ideally, detoxification should take place under medical supervision.
It can take a few days to a week or more, depending on what substances the
person abused and for how long.
Until recently, alcoholics and drug addicts dreaded detoxification because
it meant a painful and sometimes life-threatening “cold turkey” withdrawal.
Now, doctors are able to give hospitalized substance abusers carefully chosen
medications which can substantially ease withdrawal symptoms. Thus, when
detoxification is done under medical supervision, it’s safer and less
traumatic.
What Is Next After Detoxification?
Once detoxification is completed, it’s time for dual treatment;
rehabilitation for the alcohol or drug problem and treatment for the psychiatric
problem.
Rehabilitation for a substance abuse problem usually involves individual
and group psychotherapy, education about alcohol and drugs, exercise, proper
nutrition, and participation in a 12-step recovery program such as Alcoholics
Anonymous. The idea is not just to stay off booze and drugs, but to learn
to enjoy life without these “crutches.”
Treatment for a psychiatric problem depends upon the diagnosis. For most
disorders, individual and group therapy as well as medications are recommended.
Expressive therapies and education about the particular psychiatric condition
are often useful adjuncts. A support group of other people who are recovering
from the same condition may also prove highly beneficial. Adjunct treatment,
such as occupational or expressive therapy, can help individuals better
understand and communicate their feelings or develop better problem-solving
or decision-making skills.
Must a Dual Diagnosis Patient Be Treated in a Hospital?
Not necessarily. The nature and severity of the illness, the associated
risks or complications, and the person’s treatment history are some
of the facts considered in determining the appropriate level of care. There
are several different levels or intensities of care including full hospitalization
or inpatient treatment, partial hospitalization, and outpatient treatment.
What is the Role of the Patient’s Family in Treatment?
With both rehabilitation for substance abuse and treatment for a
psychiatric problem, education, counseling sessions, and support groups for
the patient’s family are important aspects of overall care. The greater
the family’s understanding of the problems, the higher the chances the
patient will have a lasting recovery.
How Can Family and Friends Help with Recovery from the Substance
Abuse?
They need to learn to stop enabling. Enabling is acting in ways that
essentially help or encourage the person to maintain their habit of drinking
or getting high. For instance, a woman whose husband routinely drinks too
much, might call in sick for him when he is too drunk to go to work. That’s
enabling. Likewise, family members or friends might give an addict money which
is used to buy drugs, because they’re either sorry for him or afraid
of him. That’s enabling also.
When family and friends participate in the recovery program, they learn
how to stop enabling. If they act on what they’ve learned, the recovering
substance abuser is much less likely to relapse into drinking or taking
drugs.
How Can Family and Friends Help with Recovery from a Psychiatric
Condition?
They should be calm and understanding, rather than frightened or
critical. They should be warm and open, rather than cool or cautious. Although
it is fine to ask the person matter-of-factly about the psychiatric treatment,
that shouldn’t be the only focus of conversation.
If Someone I Know Appears To Have A Substance Abuse Problem And
The Symptoms Of A Psychiatric Disorder, How Can I Help?
Encourage the person to acknowledge the problems and seek help for
themselves. Suggest a professional evaluation with a licensed physician, preferably
at a medical center that’s equipped to treat addiction problems and
psychiatric conditions. If the person is reluctant, do the legwork yourself
- find the facility, make the appointment, offer to go with the person. A
little encouragement may be all it takes. If you talk to the physician first,
be honest and candid about the troubling behavior. Your input may give the
doctor valuable diagnostic clues.
There Is Hope
As a relative or friend, you can play an important role in encouraging
a person to seek professional diagnosis and treatment. By learning about dual
diagnosis, you can help this person find and stick with an effective recovery
program.
The more you know about dual diagnosis, the more you will see how substance
abuse can go hand-in-hand with another psychiatric condition. As with any
illness, a person with dual diagnosis can improve once proper care is given.
By seeking out information, you can learn to recognize the signs and symptoms
of dual diagnosis - and help someone live a healthier or more fulfilling
life.
For More Information:
Contact your local Mental Health Association,
community mental health center, or:
National Mental Health Association
2001 N. Beauregard Street, 12th Floor
Alexandria, VA 22311
Phone 703/684-7722
Fax 703/684-5968
Mental Health Resource Center 800/969-NMHA
TTY Line 800/433-5959
National Clearinghouse on Alcohol and Drug Information
Phone: 800-729-6686
http://findtreatment.samhsa.gov/facilitylocatordoc.gov
Dual Recovery Anonymous World Services Central Office
P.O. Box 8107
Prairie Village, KS 66208
Phone: 877-883-2332
http://draonline.org
Alcoholics Anonymous
475 Riverside Drive
11th Floor
New York, NY 10115
Phone: 212-870-3400
www.aa.org
Narcotics Anonymous World Service Office in Los Angeles
P.O. Box 9999
Van Nuys, CA 91409
Phone: 818-773-9999
www.na.org
Alanon and Alateen Family Group Headquarters Inc.
1600 Corporate Landing Parkway
Virginia Beach, VA 23454-5617
Phone: 888-425-2666
www.al-anon.alateen.org
04/30/03
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