Dual Diagnosis

Addiction is a mental health condition that is caused by a combination of genetic and environmental factors. Because addictions do not develop in a vacuum, addiction is often only part of the problem. In addition to being the result of a range of possible life circumstances, addiction can also cause individuals to develop other mental health issues. Regardless of which occurs first, this is known as dual diagnosis in addiction and mental health medicine. Some of the mental health disorders or problems that might co-occur with addiction are discussed briefly below.

Mental Health Disorders That May Co-Occur With Addiction

Depression

It is relatively common for a person to struggle with both depression and addiction.  Depression can result from biological factors, distorted thinking, or a combination thereof. If a person feels hopeless, worthless, anxious, and/or chronically exhausted and does not seek treatment, there is a good chance that he or she will look for alternative ways to feel better.  Drugs are often used to either temporarily dull these negative feelings (in the case of downers like opiates) or give the person a short-lived high that commonly produces a cycle of highs and lows when the substance wears off.  Behavioral addictions (e.g., video games, gambling, sex) function similarly by giving the person a reprieve and/or a thrill.  The effects of some drugs can mimic depression or actually cause it after prolonged use. 

Bipolar Disorder

Bipolar disorder is characterized by alternating periods of depression (see above) and mania.

Post-Traumatic Stress Disorder (PTSD)

In the media, PTSD is commonly discussed in the context of war veterans, many of whom have experienced trauma and suffer from this condition.  However, anyone who has been through an event that threatened their life or the life of another person could develop PTSD. Because the primary diagnostic criterion for PTSD is having experienced a traumatic event, addiction evolves out of PTSD (and not the reverse).  The connection is relatively straightforward; memories of the trauma often haunt the survivor who may opt to avoid these painful thoughts with substances if they are not equipped with other healthy coping strategies.

Suicidal Ideation and Attempts

Suicide is a very serious consequence of untreated mental health problems.  Although thoughts and attempts are commonly linked to depression, the use and abuse of certain substances (like barbiturates) have been linked to increased risk for suicide attempts.  Hallucinogens can produce scary sensory experiences that may lead to panic in a user; some people have attempted suicide while under the influence of these substances.

Eating Disorders

Eating disorders—including binge eating disorder, anorexia, and bulimia—are considered to be addictions themselves in some circles.  However, people with eating disorders may also be addicted to substances or may engage in compulsive behaviors like exercising excessively.

Substance-Induced Psychosis

As the name suggestions, this mental health problem is directly caused by the use of one or more substances. This condition differs from unusual behaviors that may result from drug use in that the symptoms will persist long after the person’s body should have metabolized the substance. Learn more about substance-induced psychosis.

Schizophrenia

Schizophrenia is one of the more complex and difficult to treat mental health conditions.  The severity of a patient’s symptoms can fall on a continuum.  People who have been diagnosed with schizophrenia often have a hard time distinguishing between unreal experiences and reality.  They may also have difficulty with logical reasoning, social situations, and appropriate emotional reactions. Some studies put the rates of schizophrenia and lifetime substance abuse (meaning that, at some point in their lives, a schizophrenic patient has abused or been addicted to drugs or alcohol) at 50%.  Scholars hypothesize that the connection is related to self-medicating (i.e., people with schizophrenia have a limited number of prescription drug options and if these are ineffective, they may look for other ways to cope with this challenging illness), shared biological mechanisms (i.e., people who are genetically predisposed to schizophrenia may also be predisposed to addiction), or, likely, a combination thereof.

Treatment for Dual Diagnosis Patients

Depending on which condition or conditions a patient presents with, a psychiatrist may recommend psychotherapy and/or a prescription medicine.  If you do not have access to a psychiatrist, dual diagnosis is common enough that many primary care doctors could also offer treatment options, or you could ask to be referred to a telepsychiatry practice.  In most situations, the patient will first need to go through detox before beginning simultaneous treatment for all conditions.  In terms of prescriptions, most physicians will first require patients to try less addictive medications before attempting to treat a recovering addict with a potentially addictive substance.