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FC Home Symptoms & Warning Signs Dual Diagnosis (Co-Occurring Disorders)

DUAL DIAGNOSIS (CO-OCCURING DISORDERS) | Print |

Below is information that has been re-printed from Mental Health America (www.nmha.org) on Dual Diagnosis, also commonly called Co-Occurring Disorders.   If you are concerned that you, or someone that you know, may have a dual diagnosis, please call the Fulton County Department of Behavioral Health & Developmental Disabilities at (404) 613-3675.   Our Behavioral Health Access & Information Line is available Monday thru Friday from 8:30 AM to 5:00 PM.   If you need assistance after those hours, please call the Georgia Crisis & Access Line at 1-800-715-4225.

 Young manWHAT IS A DUAL DIAGNOSIS?

According to Mental Health America, a person who has both an alcohol or drug problem and an emotional/psychiatric problem is said to have a dual diagnosis.   To recover fully, the person needs treatment for both problems.

HOW COMMON IS DUAL DIAGNOSIS?

Dual diagnosis is more common than you might imagine.   According to a report published by the Journal of the American Medical Association:

  • Thirty-seven percent of alcohol abusers and 53% of drug abusers also have at least one serious mental illness
  • Of all people diagnosed as mentally ill, 29% abuse either drugs or alcohol

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

Upset woman

 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% 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% higher-than-average risk of being an alcohol or drug abuser...and so on.

WHICH DEVELOPS FIRST - SUBSTANCE ABUSE OR EMOTIONAL PROBLEM?

According to Mental Health America, the answer is - 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, then person then suffers from not just one problem, but two.     In adolescent, 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 is safer and less traumatic.

WHAT IS NEXT AFTER DETOXIFICATION?

Once detoxification is completed, it's time for dual treatment; rehabilitation for 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.    

HOW CAN FAMILY AND FRIENDS HELP WITH RECOVERY FROM THE SUBSTANCE ABUSE?

According to Mental Health America, 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 a 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.      

Woman talkingGET HELP

If you have questions about dual diagnosis (co-occurring disorders), or wish to make an appointment for yourself or a loved one, please contact our Behavioral Health Access & Information Line at (404) 613-3675.     A clinician from the Fulton County Department of Behavioral Health & Developmental Disabilities is  available Monday thru Friday from 8:30 AM to 5:00 PM, and can assist you.   After hours, please call the Georgia Crisis and Access Line at 1-800-715-4225.

 

 

 

 

 

 
 

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