A dual diagnosis occurs when a patient has both a mental disorder and a substance abuse problem, according to the National Institutes of Health. Mental Health America (MHA) states that a dual diagnosis is not uncommon, as 37 percent of people who abuse alcohol and 53 percent of people who abuse drugs have a mental disorder. A patient with a dual diagnosis can be difficult to treat, as the treatment should deal with both problems at the same time.
Types of Mental Disorders
MHA states that seven disorders are seen the most in dual diagnosis, and if a person has one of these disorders, she has a higher risk of developing a co-occurring substance abuse problem. For example, a patient with an antisocial personality disorder has a 15.5 percent risk of a dual diagnosis. Other mental disorders that have an increased risk of a substance abuse problem include mania (14.5 percent), schizophrenia (10.1 percent), panic disorder (4.3 percent), major depression (4.1 percent), obsessive-compulsive disorder (3.4 percent) and phobias (2.4 percent).
Development of Disorders
When a patient has a dual diagnosis, either problem can be developed first. For example, if the patient has a mental illness first, he turns to drugs or alcohol to self-medicate, though this leads to more and more being used. If the patient has the substance abuse first, the patient develops symptoms like depression, suicidal thoughts and hallucinations from use, according to MHA.
Complications
The National Alliance on Mental Illness, or NAMI, notes that "persons with a co-occurring disorder have a statistically greater propensity for violence, medication noncompliance and failure to respond to treatment than consumers with just substance abuse or a mental illness." A patient with both a mental disorder and substance abuse also has poorer functioning and a greater chance of relapse. The two problems can also interfere in the person's ability to develop social relationships.
Substance Abuse Signs
Helpguide.org notes that "denial is common in substance abuse," which can make it difficult to diagnose the problem. A person with an alcohol abuse or drug abuse problem cannot cut down on the amount she uses, lies about her usage and puts alcohol and drugs in front of other obligations. A person with a family history of either substance abuse or mental illness also has an increased risk of developing a substance abuse problem.
Treatment
MHA recommends simultaneous treatment, which treats both of the problems found in the dual diagnosis. Detoxification is the first step for substance abuse, which is safer under medical supervision. Once the patient is no longer under the influence of drugs or alcohol, the rest of the treatment begins. The organization notes that a 12-step program can help with substance abuse, and psychotherapy and medication can help with the mental illness; however, the patient should not be given a medication that has a risk of abuse, like benzodiazepines.
