The term concurrent disorders – formerly called dual diagnosis, or in layman’s terms ‘double trouble’ – refers to the combination of mental health and substance misuse issues. Examples of concurrent disorders include PTSD or clinical depression and alcohol addiction, ADHD and cocaine addiction, or Generalised Anxiety Disorder and Benzodiazepine dependency. It is often impossible to separate mental health and addiction because so many doctors misdiagnose addiction and confuse the symptoms. We know this because so many clients regain mental stability and normality once they address their addiction. Substance use is often regarded as “self-medicating” the symptoms of the emotional and mental disorders listed below:
It is common for people with Mental Health issues to turn to using addictive and illicit substances to improve coping abilities, feel better, or decrease and numb feelings. Some call it “putting out fires with gasoline”. The problem is that self-medicating may work at first, providing the person with relief from their restless brains. However, the pain and the problems are now burning out of control and the gasoline ultimately makes the problems worse.
How Frequently do Mental Health Issues Coexist with Substance Misuse?
While there are variations as to the degree that substance abuse and mental health disorders coexist depending on the mental health diagnosis or type of substance abuse someone is struggling with, the general rule is that it is more likely than not that both are present at the same time.
What is the Link between Mental Health and Substance Use Problems?
The link between mental health and substance use problems is manifold:
A family history of either mental illness or substance abuse may translate into genetic vulnerability and susceptibility to alcohol and drug use, and/or mental health problems.
Research indicates that adverse childhood events, such as child sexual/physical/emotional abuse may predispose individuals to mental health and/or substance use problems in adulthood.
Prolonged or extensive substance abuse may cause, exacerbate, mimic or mask mental health symptoms. Mental health problems caused by substance abuse typically resolve once sobriety is achieved, although vulnerability for mental health problems may persist.
Mental health problems caused by substance abuse are often referred to as ‘substance-induced’ mental health disorders. For example, cocaine binges typically cause depression-like symptoms, often rendering an individual unable to get out of bed for about five days post-substance use.
Substances can compound or exacerbate mental health symptoms. For example, alcohol is a central nervous depressant, thus slowing down or sedating nervous system functioning and therefore worsening already existing symptoms of depression such as hypersomnia or lack of motivation.
Substance use tends to cause instability in regards to mood, physical energy, sleep, mental functioning, motivation, etc., all areas also impacted by mental health issues. As such, it is not uncommon for substance users to have inaccurate mental health diagnosis, most commonly a diagnosis of bipolar disorder. Additionally, some symptoms are common to both mental health and substance misuse, such as insomnia, or problems focusing or concentrating. It is therefore often difficult to ascertain whether reported symptoms stem from substance abuse, or are instead a reflection of mental health difficulties.
Mental health issues are known to increase the brain’s vulnerability to harmful effects of drugs, as posited in the super sensitivity model. This model simply suggests that the brains of individuals suffering from a mental illness are more strongly and more negatively impacted by even minor amounts of alcohol and drugs as compared to individuals free from mental health problems.
Alcohol or drug dependency make it more difficult to recover from a mental illness such as depression or anxiety, as it interferes with an individual’s commitment and adherence to treatment (including attending medical or counselling appointments or taking prescribed medications). Another reason is that it impacts their ability to learn coping skills helpful in countering mental health symptoms.
Mental health problems typically interfere with an individual’s day to day functioning as it pertains to work, relationships, general productivity and leisure, often causing significant problems in these areas of functioning. The longer these difficulties persist, the more likely individuals are to seek some sort of escape or relief by consuming alcohol or substances. The journey into alcohol addiction, for example, may very well and very innocently start with a ‘night cap’ to help with insomnia caused by anxiety and depression.
A relapse of mental health symptoms may provoke a relapse into substance use and vice versa.
It is therefore important to understand that Mental Health and substance problems interact with one another in multiple and complex ways, and these interactions changes both the course and the outcome of the problems individuals experience. In short, it’s complicated!
Why is it Important to Know about Concurrent Disorders?
Compared to an individual suffering from either an addiction OR a mental illness alone, individuals suffering from concurrent disorders are more likely to:
Experience more significant problems in major areas of functioning, including work, relationships, productivity and leisure.
Have difficulties with maintaining housing, employment and the law.
Require prolonged and skilled treatment, including a recovery plan that takes into account that relapse of mental health symptoms will likely trigger relapse into addictive behaviours, and vice versa.
How are Concurrent Disorders assessed?
Given the complexity and multiple ways in which mental health and substance use problems interact, an assessment of such problems requires skill and time, and it is rarely complete or accurate if completed in one short session. Not surprisingly, individuals are often misdiagnosed and therefore at risk for receiving inadequate, unnecessary or insufficient treatment for their problems. A comprehensive assessment by a skilled clinician trained in the areas of mental health and substance use is therefore highly recommended. At Hope Rehab Center, we provide skilled care through our multidisciplinary team, and we often work in collaboration with clients’ physicians to guarantee best possible treatment outcomes for our residents.
A Word about Medication
Many individuals suffering from anxiety or depression enter rehab with prescribed medications, such as antidepressants for depression or anti-anxiety medication. All too often, residents are eager to stop taking such medication in an attempt to be completely ‘drug-free’. It is, however, very important to distinguish between medications prescribed by a medical professional for the treatment of a diagnosed mental health problem on the one hand, and illegal substances often taken excessively on the other hand. While the former often brings about mood stabilisation and increase levels of day to day functioning, illegal substances tend to have the opposite effect: they destabilise, make for unpredictable moods and behaviours, and interfere with individuals’ functioning in all areas of life.
We Work in Careful Collaboration with Residents’ Prescribing Physicians
While a desire to rely on non-pharmacological tools such as mindfulness and thought challenging to manage one’s moods is very much desirable, making changes to established medication regimes typically results in at least temporary instability and should, therefore, be carefully timed, planned and monitored. At Hope Rehab, we work in careful collaboration with residents’ prescribing physicians prior to considering making any changes to established medication regimes. Naturally, there are exceptions to this rule considering the potential for misuse or abuse of some prescription medications, most notably benzodiazepines, opiate medication and ADHD medications.
We Suggest a Planned Gradual Cessation of These Types of Medications
While these types of medications may alleviate suffering if taken as prescribed and for the general population, they are potentially dangerous in the hands of an addict. For these reasons, we at Hope Rehab suggest a planned gradual cessation of these types of medications, ideally prior to entry into treatment, or as part of early recovery.
The most common types of mental health problems that people tend to experience with addiction would include:
Depression (most often with alcohol addiction)
Anxiety disorder (most often with alcohol, sedative or stimulant addiction)
Schizophrenia (most often with stimulant addiction)
Obsessive-compulsive disorder (most often with alcohol addiction)
Attention deficit disorder (most often with alcohol or stimulant addiction)
Bipolar disorder (most often with alcohol or stimulant addiction)
Post-traumatic stress disorder (most often with sedatives or alcohol addiction)
Personality disorders (most often with alcohol and stimulant addiction)
Psychosis (can be induced by alcohol, hallucinogens, or stimulants)
How Concurrent Disorders are treated at Hope Rehab
As mentioned before: Misdiagnosis happens in some cases, as substance abuse and mental health conditions can be confused due to similar symptoms and consequences. This usually means that when the addiction is treated successfully the client stabilises.
At Hope Rehab, firstly we take away the drugs or alcohol and only allow safely prescribed medications. We provide individualised care – this means the treatment path you follow will be based on an assessment of your exact needs. Our team is experienced at working with clients who have a concurerent disorders.
The addiction treatmen program here at Hope Rehab Thailand includes a number of approaches that have a good track record for helping people with dual diagnosis:
After a successful treatment of the concurrent disorders and a recovery program to follow up, many sufferers find their symptoms subside, and life takes on a healthy direction.
What is Dual Diagnosis? By Simon Mott