Dual Diagnosis – A complex treatment program

In treatment, specialists refer to a patient as being Dual Diagnosis when they have a mood disorder, such as bipolar disorder or depression that co-occurs with an addiction to drugs or alcohol. Such individuals require an integrated treatment plan to address both disorders and one that acknowledges they are interconnected.

Therefore, a dual diagnosis patient is not easy to treat and treatment may become a catch 22. Both conditions may be worsened by the interaction or triggering effect of the other. It’s often difficult to figure out which came first.

Substance abuse usually worsens the symptoms of a mental illness and doctors are sometimes uncertain of which to treat first. A mental condition such as bipolar disorder may cause manic behaviour, which can lead to a person binging on drugs, alcohol or engaging in a gambling or shopping addiction. On the other hand, use of drugs can also trigger a manic episode in someone with bipolar disorder.


Genetics and environmental stress and trauma are the two most common risk factors for dual diagnosis patients.

According to the National Survey on Drug Use and Health (NSDUH), 45% of people in the United States struggle with a dual diagnosis. If you have a mental illness diagnosis, you are about twice as likely as the general population to have a substance use disorder. On the opposite side of the scale, those who frequently abuse drugs or alcohol are more likely to develop a co-occurring mental health or behavioural disorder.


Experts say that the effect of ADD drugs such as Adderall or Ritalin are very similar to speed or cocaine and can be habit- forming. For those already on these ADD meds, it can lead to abuse of the prescription meds, as well as some people moving from the “legal” stimulants to the illegal ones. Alternatively, someone with untreated ADD or ADHD may be more inclined to abuse drugs as a way to cope with or minimise their symptoms. They may find that illegal drugs such as cocaine or methamphetamines, initially calm their hyperactive brains and helps them to focus, which often leads to addiction.

For people with Bipolar disorder, It’s also very tempting to self-medicate. Drugs and alcohol provide a temporary relief from high emotions and manic behaviour. Over two-thirds of people with Bipolar disorder have experienced substance abuse issues at some point in their lives.

Borderline Personality Disorder is another mental disorder that often occurs simultaneously with substance abuse and is very complicated to treat. The symptoms of BPD can be quite similar to when a person is high, which makes BPD even harder to recognize. Abusing substances can lead to extremely volatile behaviour for someone with BPD. People with BPD also have high rates of cutting and suicidal behaviour which is exacerbated by drug and alcohol use.

Other mental health disorders that may cooccur with substance abuse are: PTSD and Schizophrenia. Most people who have experienced trauma (usually violent) in their lives, may turn to drugs or alcohol. Schizophrenia is characterized by delusional thinking and hallucinations – two symptoms that are often brought on by abuse of drugs such as methamphetamine.

Someone with depression or anxiety, may turn to alcohol or drugs to give them that serotonin or dopamine rush and to improve their mood temporarily. This unfortunately usually leads to a crash where they feel more depressed or anxious after – and so it
becomes a vicious cycle of chasing the high, followed by an extreme crash.


A successful treatment program for dual diagnosis patients normally includes CBT or Cognitive Behavioral therapy. This is a form of psychotherapy that has many benefits in both the treatment of addiction, as well as mental illness. CBT identifies the thought patterns that lead to the impulsive behaviour. CBT also teaches patients how to manage their emotions, which enables them to cope better without turning to drugs or alcohol to escape.

Another therapy which has been helpful in dual diagnosis treatment, particularly with borderline patients, is DBT or Dialectical behavior therapy. DBT encourages self-acceptance and helps individuals with major psychiatric disorders, build stable and meaningful lives. It also works on the premise of self-regulation of emotions & motivates the patient to change destructive behaviors.


Relapse prevention is also vital in treating dual diagnosis patients, especially since the relapse rates in these individuals are high. Relapse prevention sessions usually take place within a peer support group. Patients can share their challenges of living with a co-occurring disorder, as well as share their coping strategies.

It’s important for a professional to devise an integrative plan that involves individual and group therapy, as well as medication. The disorders are often the underlying causes of the addiction, which makes it important to identify any mental health or behavioural disorders as early on in life as possible. Substance use can also change the structure of the brain and
affect the various synapses which can lead to a mental disorder or trigger a genetic disorder that may only manifest once the person starts to abuse substances.[/vc_column_text][/vc_column][/vc_row]

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