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Dual diagnosis refers to the situation where an individual has been diagnosed to be suffering from two disorders at the same time.

Introduction to Dual Diagnosis

In general, the phrase dual diagnosis is used to refer to a condition where an individual is suffering from a mental disorder as well as an addiction problem (such as addiction to alcohol or other drugs). The term “comorbidity” is also used to refer to this condition in certain instances. The order of occurrence of these two types of disorders in the same person may vary. One may develop the addiction problem first which may be followed with depression, or vice versa. Treating only one of these disorders is not helpful and individuals with dual diagnosis need a combined or a two-step treatment plan to obtain complete relief.


The occurrence of this condition is not rare. It has been estimated that about 37% of alcohol abusers and about 53% of drug abusers also tend to suffer from a minimum of one serious mental illness. Careful evaluation and a comprehensive treatment plan are necessary for resolving both these conditions. Complete recovery is possible with medications and other supportive therapy while, the affected individual’s will to get cured is quite important for recovery to occur.
 

How does dual diagnosis occur?

The presence of one of the disorders increases the risk of developing the other by varying percentages. Individuals who abuse drugs or alcohol are at a higher risk of developing different types of psychiatric or mental disorders as the abuse progresses. Some of these disorders can include anxiety, depression, and other disorders such as schizophrenia or personality disorders. Similarly, individuals who are suffering from some type of mental disorders are prone to develop drug or alcohol abuse over a period of time. The National Institute of Mental Health study suggests that individuals suffering from antisocial personality disorder are at a 15.5% higher risk of developing drug abuse when compared to a healthy person. Individuals suffering from major depression on the other hand, are at a 4.1% higher risk of developing drug abuse problems.

Some studies have suggested that the psychiatric illnesses develop first and, consumption of alcohol or drugs is initiated in an attempt to relieve the symptoms of the underlying illness. Gradually as this habit progresses, individuals tend to become dependent upon alcohol or drugs and begin abusing them. The contrary is also possible wherein, an individual who abuses drug or alcohol for prolonged durations, become addicted and develops symptoms of mental illness due to the dependence over the drug.

The dual diagnosis is arrived at based on the history of the condition and a detailed review of the signs and symptoms of both, mental illness and drug abuse.
 

What is the treatment plan for dual diagnosis?

The dual diagnosis requires a dual treatment approach. Both the underlying disorders are treated simultaneously with different or similar approaches based on the severity of the condition. While individuals with severe symptoms may required to be treated after being admitted to the hospital for a few days, others with mild to moderate symptoms may be treated as outpatients.


Detoxification

The first step in the treatment for dual diagnosis is detoxification. This refers to self cleansing of the body of alcohol or other drugs over a period of time. Depending on the severity of the addiction, this process may take a few days or few weeks before the body is considered cleansed of these substances.


Dual treatment

Following detoxification, dual treatment is initiated in order to rehabilitate the individual suffering from an abuse and also provide treatment for the underlying mental illness. Several different types of treatment approaches are followed during the rehabilitation phase. Some of these approaches include: individual and group psychotherapy sessions, providing education about the ill effects of alcohol and drug abuse, physical exercise, proper nutrition, and participation in recovery programs such as Alcoholics Anonymous. The psychiatric therapies are collectively termed as behavior therapies, which are tailor-made to suit the individual needs. Medications may also be advised to prevent withdrawal symptoms (symptoms such as depression or anxiety that develops when a person addicted to alcohol or a drug stops using them).

At the same time, therapy for the underlying mental illness is also initiated. The therapy for the mental illness may vary based on the type and severity of the illness. Behavioral therapy with or without medications is commonly advised in the treatment for dual diagnosis. Involvement in support groups, relaxation therapies and many other modalities are advised to help the individuals to overcome the mental symptoms. Participation in occupational therapy is also advised in certain instances to help such individuals develop problem-solving or decision-making skills.
 

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Role of family and friends in dual diagnosis

Family members and friends of the individuals with dual diagnosis often have an important role as supporting members during and after the treatment phase. Emotional support to overcome the situation is of great importance in individuals with dual diagnosis. Encouragement from family members and friends, to stop the abuse and take steps to overcome the mental illness, can be quite helpful in individuals with dual diagnosis.


Recovery

Even though treatment may be prolonged in individuals with ‘dual diagnosis,’ recovery is possible. Persistence is the key to success in such treatments. The chance of recovery is high in individuals who undergo dual treatment protocols. Although some cases of relapse have been reported, it is much easier for the individuals to restart the treatment and overcome the relapse. Regular encouragement from family members and friends rather than force, is required for faster recovery. The recovering individuals need support and hope during the recovery process, and this is expected from the ones who are close. Additional support can be obtained from individuals who have been successful in overcoming similar problems. In conclusion, the treatment of dual diagnosis equally depends on treatment options as well persistence and determination of the affected individuals to overcome the problems.
 

  • www.nlm.nih.gov/medlineplus/dualdiagnosis.html
  • en.wikipedia.org/wiki/Dual_diagnosis
  • mentalhealth.samhsa.gov/cmhs/communitysupport/toolkits/cooccurring/consumers.asp
  • www.nmha.org/go/information/get-info/co-occurring-disorders/dual-diagnosis
  • www.nida.nih.gov/Infofacts/Comorbidity.html