“What is Dual Diagnosis?”
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Dual diagnosis commonly refers to co-occurring mental illness, drug addiction and/or alcoholism in various combinations.
Two common examples are that of major depression with marijuana addiction, and alcohol addiction with panic disorder.
Often the two disorders are treated separately or people may only be referred to one specialist, either in the mental health service or the addiction recovery service.
Considering the large numbers of people affected by dual diagnosis it may be more effective to treat people using a more integrative approach i.e. whereby people can receive treatment for both disorders at the same time.
What are the symptoms?
The symptoms that a person with dual diagnosis displays are identified in two parts which sometimes makes it common for one diagnosis to be missed.
First are the symptoms associated with any major psychiatric disorder, such as schizophrenia, bipolar mood disorder, or personality disorder (Mental Health Information Service has fact sheets on all of these).
Second are the issues associated with abuse of alcohol and other drugs. These are listed below:
Significant impairment or distress resulting from use
Failure to fulfil roles at work, home, or school
Persistent use in physically hazardous situations
Ongoing legal problems related to use
Continued use despite relationship or financial problems
DA abuse may or may not involve physiological dependence or tolerance. The symptoms that do indicate dependency or addiction are as follows:
Compulsion and preoccupation with obtaining a drug or drugs
Loss of control over use (losing track of how much has been consumed)
Continued use despite negative consequences
Tendency for relapse after period of abstinence
Drug induced behaviour eg aggression, irritability, changes in thinking or mood
The main symptom is increased tolerance and withdrawal. This means the same amount of the drug or alcohol has less effect, the person can tolerate greater amounts without feeling the effects. Withdrawal symptoms occur after physiological dependence has been established and the person cannot acquire the drug or alcohol, or stops taking it for some reason.
What is the impact of dual diagnosis?
The impact of having not one but two diagnoses means that a person often experiences more severe and chronic medical, social and emotional problems than if they were to just have one. They are vulnerable of not only an Alcohol and other drugs relapse but also a relapse of their mental health problems. The occurrence of either of these is likely to affect the other in a negative way. Treatment and relapse prevention must therefore be specifically catered towards the person, and will often take longer, come across more obstacles, and progress only gradually.
What are the causes?
The causes of psychiatric illness and abuse of alcohol and other drugs are complex. The evidence that people with mental illness are more likely to abuse Alcohol and other drugs, or vice versa, that those people who abuse Alcohol and other drugs are more likely to develop some form of mental illness indicates that the causes are likely to be complex. This is outlined in the statements below:
Drug use can cause psychiatric symptoms and mimic psychiatric syndromes
Drug use can initiate or worsen a psychiatric disorder
Drug use can mask psychiatric symptoms and syndromes
Drug withdrawal can cause psychiatric symptoms and mimic psychiatric disorders
Psychiatric behaviours can mimic drug use problems
Drug and alcohol abuse can make side effects from medication worse, and more likely to occur.
What does the assessment include?
Before any treatment takes place it is necessary to obtain a detailed history of both the psychiatric and substance abuse symptoms. Important information on psychiatric status includes: chief complaint/presenting symptoms; family history; personal history; medical history; psychiatric history; history of present illness; and assessment of current mental state. The important information on substance abuse includes: types of drugs used; age of onset; amount now being used; maximum amount; frequency; route; last used; maximum clean time; number of detoxes; history of withdrawal symtoms. This information will be necessary to construct an individual treatment programme.
What is the treatment?
Our present mental health service has evolved to address single disorders. However many treatments for specific illnesses can be adapted to address other problems. Treatment for people with dual diagnosis may be more effective if the two diagnoses are dealt with at the same time as the two are often related (e.g. drug use to cope with symptoms of mental disorder).
It has been recommended that during treatment administration, both conditions need to be regarded as primary, without one being seen as the cause of the other. Some of the treatment options available (dependent on the severity of symptoms and the leading needs) are as follows:
Drugs prescribed by a psychiatrist can be tailored to reduce side effects and control symptoms of mental illness. Honest discussion of prescribed and recreational drug use can be a good first step in controlling overall drug use.
Counselling and psychotherapy involves working with a therapist on developing inner strengths, capabilities, resources and potential. It looka at developing personal strategies to reduce drug use.
Cognitive-behaviour therapy uses a number of strategies to change behaviour. These might include changes in thinking about drug use, rewards for positive changes and strategies to help reduce drug use. This therapy doesn’t look at why the person is using.
Working towards the person wanting to stop abusing and helping people to recognise the greater benefits in changing behaviour. It focuses on increasing the use of internal resources.
Self help for dual diagnosis
Learning to recognise personal 'high-risk' situations and applying specific coping skills and strategies to avoid re-abusing.
Avoiding environments where substance abuse occurs eg parties where people are likely to drink heavily, friends who are heavy drinkers
Joining a self-help group. This enables individuals with dual diagnosis to talk to each other about their experiences and provide mutual support.
Enlisting and using the support of family and friends
Mental Illness and Intellectual Disability
‘Dual diagnosis' has also been associated with people with both a mental health problem and an intellectual disability. There are different types of intellectual disability. Some types od disability increase vulnerability to psychotic illness. But many people with an intellectual disability do not develop mental health problems.
Between 1.5 and 2.0 % of Australians have an intellectual disability and they have two to three times the prevalence of psychiatric problems as the rest of the community. Intellectual disability increases vulnerability to psychotic illness. For people with this form of dual diagnosis there have also been difficulties in obtaining an accurate diagnosis, and finding effective treatment methods and care.
Treatment options include a range of medication and both cognitive and behavioural programmes.
Book list
www.dualdiagnosis.org website has a list of recommended books. Check out Dual Recovery Anonymous also www.draonline.org
For help
Mental Health Association NSW Inc ph (02) 9816 5688 or 1800 674 200 (outside Sydney Metro) for services in your area
Contact your local Community Health Centre or Mental Health Team (see ’Emergency, Health and Help’ section of the White Pages)
Make an appointment with your G.P
Lifeline on 13 11 14 for counselling
Contact a counsellor or psychologist either through the Australian Psychological Society or through the Yellow Pages
Alcohol and Drug Information Service on 1800 422 599/ 02 9361 8000
Al-anon (a twelve step programme with support groups and literature) on 02 9663 1206. Joynton Avenue, 1st floor, Main Building, Old South Sydney Hospital, Zetland NSW 2017
Narcotics Anonymous on 02 9212 3444. 1st floor, 204 King Street, Newtown NSW 2042
Private Hospitals
For more information
Mental illness, drug addiction, and alcoholism – www.users.erols.com
Dual diagnosis recovery network for advocacy, self-help, information and referral - www.dualdiagnosis.org/
Alcoholism, addiction and mental health resources – www.soberrecovery.com
An association for persons with developmental disabilities and mental health needs - www.thenadd.org
Dual diagnosis email group - www.angelfire.com/journal/bipolaralcoholic/
MIDAS- www.midas.com.au
Disclaimer
The information provided is to be used for educational purposes only. It should not be used as a substitute for seeking professional care in the diagnosis and treatment of mental health disorders. Information may be reproduced with an acknowledgement to the Mental Health Association NSW. This, and other fact sheets are available for download from www.mentalhealth.asn.au. This fact sheet was last updated in Autumn, 2002.
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