Overview of Dual Diagnosis

  It is common for substance abuse to develop simultaneously with certain types of mental illness such as schizophrenia, depression, bipolar disorder and anxiety. In fact, more than 50 percent of drug abusers are also diagnosed with a mental health disorder and it is estimated that nearly 30 percent of individuals with a mental illness also have a substance abuse problem. Among individuals with severe mental disorders like bipolar disorder, the number of people addicted to drugs can rise as high as 60 percent. Understanding of dual diagnosis has grown since the 1980s, but experts still do not agree on what causes drug addiction to develop alongside mental illness.

• Drug Abuse and Mental Illness Fast Facts (PDF Document): This U.S. Department of Justice brochure provides a brief overview on the relationship between mental illness and drug addiction.
• On Co-Occurring Addictive and Mental Disorders: This page contains the text of a letter to the editor of the American Journal of Orthopsychiatry in response to that journal’s special section on dual diagnosis.
• Mental Illness: The Challenge of Dual Diagnosis: This page offers a simple overview of dual diagnosis along with sound files containing further details.

Theories of Dual Diagnosis Etiology

  There are several theories on what causes a dual diagnosis condition to develop. Causality theory holds that the long-term effects of substance abuse are the direct cause of mental illness symptoms. In contrast, dysphoria theory suggests that drug addiction results from an individual’s attempts to self-medicate symptoms of mental illness. In some cases, neurological changes can occur prenatally when a fetus is exposed to medications or other harmful substances. Another idea is that multiple environmental risk factors such as poverty and trauma work together to make an individual more likely to have co-occurring mental illness and drug addiction. Finally, the supersensitivity theory states that some individuals are biologically and developmentally predisposed to be vulnerable to drug addiction.

• Big Mystery: What Causes Addiction?: This MSNBC article explores selected theories about why some people become addicted others do not.
• Dual Diagnosis (Medline Plus): This page gives a summary of the process by which a dual diagnosis condition can develop.
• Addiction (eMedicineHealth.com): This article explains the potential causes of drug addiction and how it can be treated.

Dual Diagnosis Treatment Approaches

  In 1984, an outpatient treatment facility in the state of New York was the first organization to begin implementing an integrated treatment model for dual diagnosis cases. The following year, this program model was used at multiple treatment centers nationwide. An integrated approach to treatment gained national attention with the publication of a Time Magazine article in 1987. Despite disagreements about how dual diagnosis conditions develop, there is a consensus that integrated treatment models are more effective with this population. Integrated treatment begins with a detoxification process in which an individual ceases use of addictive substances. It is generally believed that focusing on the mental disorder first, rather than the addiction, is ineffective. After detoxification, treatment can include a mixture of individual psychotherapy, group counseling, peer support groups and psychiatric medication. Medications used for dual diagnosis cases vary depending on the nature and severity of an individual’s mental disorder.

• Integrated Treatment of Mental Illness and Substance Abuse Disorder (National Alliance on Mental Illness): This page describes why an integrated treatment approach to dual diagnosis is most effective.
• Dual Diagnosis and Recovery: This site by the Depression and Bipolar Support Alliance gives a summary of how dual diagnosis can be treated with a combination of talk therapy, medication and support groups.
• Co-Occurring Mental and Substance Abuse Disorders (PDF Document): This guide by the U.S. Department of Health and Human Services discusses some of the difficulties faced by dual diagnosis treatment programs.