Decoding dual diagnosis: The intersection of mental health and substance use challenges
Dual diagnosis, also known as co-occurring diagnosis, is a term that's gained more attention in recent years, but remains widely misunderstood.
"When we talk about dual diagnosis, we're referring to the coexistence of a mental health disorder and substance use disorder," says Daniel Neff, MD, an addiction psychiatrist at Main Line Health. "It's important to note that these two conditions often go hand in hand, influencing and magnifying one another."
While it may seem like a straightforward concept, the reality is much more complex and requires a deeper understanding.
The importance of understanding a co-occurring diagnosis
Substance use can often be a way for individuals to attempt to "self-medicate" and cope with mental health issues, but it can also lead to further deterioration of a person's mental well-being. As addiction develops as a result of attempts to self-medicate, underlying mental health concerns can actually worsen, leading to a pernicious cycle of increased use and worsening mental health.
When it comes to treating mental health conditions, medical care tends to steer clear of addictive substances. On the other hand, those who self-medicate often find that their usage of such substances increases over time. This is due in part to the development of tolerance, which means that higher and higher quantities of the substance are needed to achieve the same desired effect.
"As an example, no doctor would rightly recommend alcohol as a treatment for anxiety for exactly this reason," says Dr. Neff.
"This vicious cycle makes it even more challenging for individuals to seek help and break free from their struggles," says Dr. Neff. "But understanding dual diagnosis is crucial because it has significant implications for treatment and recovery."
Without proper diagnosis and intervention, individuals with a dual diagnosis may struggle to achieve lasting recovery and experience poorer outcomes. The treatment approach for dual diagnosis involves addressing both the mental health disorder and the substance use disorder simultaneously through a combination of therapy, medication, support groups and lifestyle changes.
Common misconceptions about dual diagnosis
There are many common misconceptions about dual diagnosis that contribute to its misunderstandings. One misconception is that addiction is solely a result of weak willpower or a lack of moral character. This assumption ignores the fact that addiction is a complex disease that involves structural and chemical changes in the brain in response to underlying behaviors, genetics and environmental factors. It fails to recognize the real mental health concerns that often coexist with addiction.
Another misconception is that treating one condition will automatically resolve the other. In reality, mental health concerns and addiction are intertwined and must be addressed simultaneously. Treating only one aspect of dual diagnosis can leave the door open to relapse or the worsening of symptoms.
"There is also a misconception that individuals with dual diagnosis cannot recover or lead fulfilling lives," says Dr. Neff. "This stigma is harmful and perpetuates a cycle of shame and hopelessness. With the right support, treatment and coping strategies, individuals with dual diagnosis can recover."
Effects of co-occurring conditions on individuals
Living with co-occurring conditions can hinder a person's ability to function at work or school, maintain healthy relationships and participate in meaningful activities.
"The presence of both a mental health disorder and a substance use disorder can cause significant distress and increase the risk of other problems, such as legal consequences or physical health issues," says Dr. Neff.
Addressing both the mental health disorder and the substance use disorder simultaneously is crucial for successful recovery. Like most complex illnesses, treating only the symptom rather the underlying causes leaves the individual vulnerable to ongoing harm.
"One easy way to conceptualize this need to treat underlying causes is to compare dual diagnosis to an infection. While giving Tylenol for an infection might treat the symptom, no one would dispute the importance of antibiotics to treat the cause. Similarly, treating dual diagnosis requires treating the symptom of addiction while simultaneously targeting the root causes," says Dr. Neff.
Treating only one aspect of dual diagnosis can lead to relapse or the worsening of symptoms. Integrated treatment, which combines therapy, medication, support groups and lifestyle changes, is the most effective approach.
Overcoming co-occurring diagnoses on the path to holistic recovery
Appropriate treatment for dual diagnosis should involve a non-judgmental and compassionate support system. Those with dual diagnosis often face stigma and shame, which can hinder their progress and discourage them from seeking help. Creating a safe and supportive environment is essential in helping individuals with dual diagnosis achieve recovery and lead fulfilling lives.
"Additionally, access to qualified professionals and resources is paramount. Dual diagnosis requires specialized knowledge and expertise to provide effective treatment," says Dr. Neff. "Seeking help from professionals — like the multidisciplinary team at Main Lines Health's Mirmont Treatment Center and Mirmont Outpatient Centers — who understand the complexities of dual diagnosis and can offer tailored support is crucial."
"It's important to be patient and kind to yourself as you navigate the ups and downs of managing dual diagnosis," says Dr. Neff. "With the right support, treatment, and determination, it is possible to lead a fulfilling life and achieve lasting recovery."
If you or someone you know is struggling with co-occurring conditions, seek help from qualified professionals who can provide the necessary support and treatment.
Next steps:
Schedule an intake at Mirmont Treatment Center
Learn more about relapse prevention at Mirmont Treatment Center
Breaking the cycle: Mirmont Treatment Center's Relapse Prevention Program
The connection between trauma and substance use