Dual Diagnosis: Substance Abuse and Mental Illness
"Double Trouble and More"
Researchers estimate that 30% of individuals
with mental illness and 50% of those with severe
mental illness abuse alcohol or drugs. Those suffering from mental
illness and substance abuse are often overwhelmed by the challenges they
face. Managing either disorder requires commitment, focus, and a
supportive environment. Trying to manage both disorders is a huge challenge because
substance abuse and mental illness feed off each other to undermine treatment and
Most individuals with co-occurring disorders "self-medicate" their
painful moods and feelings with
substances, but these very substances make their symptoms worse over time.
This creates a vicious downward
spiral into chaos and pain as symptoms become more severe,
more intense cravings and substance abuse, causing increasingly unstable
emotions, leading to even more desperate substance abuse, ultimately
resulting in hospitalization, jail, homelessness, and even death by
accidental overdose or suicide.
But recovery from dual diagnosis is possible.
I have witnessed many clients with co-occurring disorders progress from chaos into
recovery and achieve manageable lives. The recipe for recovery is
simple: Do not abuse substances, stay in treatment, take your
medications as prescribed, and your life will become manageable. But any significant deviation from this path will lead
you back into chaos. This formula is easy to recite but
difficult to live, because the dually diagnosed client has many obstacles to overcome
on the path to recovery.
The number one obstacle is denial,
which is common with mental illness and almost always present with
substance abuse. The road to recovery requires that dually diagnosed clients accept that
they have two disorders, both in need of treatment. If only one illness is treated, the
untreated illness will most certainly undermine recovery. Thus, early treatment focuses on helping clients
understand and accept that they have two separate and intertwined
disorders that must be treated. This is the crucial first step in
recovery - the client must accept and own both illnesses.
Another obstacle to recovery is the
complicated issue of diagnosis. Since chronic substance
abuse can cause symptoms that mimic anxiety disorders, depressive
disorders, bipolar disorders, and even psychotic disorders, treatment providers must be careful when giving strictly mental health diagnoses.
Even when clients are honest about their substance abuse, clinicians have to wait until
clients are clean and sober for months
before confidently giving a diagnosis of a mental disorder - unless
there is evidence of the existence of a mental disorder before the substance abuse began.
And when clients hide substance abuse, accurate diagnosis and effective
treatment are nearly impossible. So, diagnosing a dual diagnosis client is often a series of
hypotheses that play out over time
as treatment progresses.
Stigma and hopelessness are other barriers to
recovery. In our society, substance abuse and mental illness
are frequently misunderstood and stigmatized. Suffering from both
disorders geometrically increases the stigma and ultimately the social
isolation for dual diagnosis clients, who are often seen as lazy,
immoral, and irresponsible parasites rather than human beings who are
suffering from two severe chronic illnesses. Even some treatment
providers and physicians will shun and avoid working with these clients, who
can easily become scapegoats for families, society, and even governments.
Thus, many individuals with co-occurring disorders become mired in
loneliness, hopelessness, and shame, and have little motivation for
trying to improve their lives.
The medical system itself can be an obstacle to recovery.
Traditionally, the treatments
for addiction and mental illness have been provided in
different settings with different philosophies. Although the
philosophies are more integrated now, some professionals still see dual
diagnosis clients through the filters of their own professional biases.
Thus, addiction counselors might assume substance abuse to be the primary
disorder, which when resolved will eliminate the mental health symptoms.
And mental health professionals might see the mental
illness as primary, which when resolved will fix the addiction. In
reality, mental illness and substance abuse are two
separate primary disorders that must be treated simultaneously using an
integrated approach Thus, it is important that a prospective
client find a counselor and psychiatrist who offer such an
integrated approach to treating co-occurring
If you are ready to begin the road
to recovery from co-occurring disorders, or if you're already on it and
need extra support, then click on the picture below and see if online
therapy might be right for you.