Editorial Team

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MODULE 6:

6 What is Dual Diagnosis?

1. Dual Diagnosis (Co-Occurring Disorder) Explained

Dual diagnosis, also widely known as co-occurring disorder, is the presence of both a substance use disorder, such as AUD, and a mental health disorder, such as depression, bipolar or post-traumatic stress disorder (PTSD).

It is common for people with undiagnosed mental health disorders to attempt to “self-medicate” their symptoms by using substances, such as alcohol. Unfortunately, this alcohol use can lead to an AUD, particularly if the individual has other risk factors to consider, like genetics / family history or environment. However, dual diagnosis can also occur when a mental health disorder is a symptomatic consequence of their excessive alcohol consumption or AUD.

Dual diagnosis requires a more complex form of addiction treatment than normal, where both disorders need to be treated simultaneously. Failure to do so adequately can result in one of the disorders returning, and then triggering the re-emergence of the other.

According to data published in “Key Substance Use and Mental Health Indicators in the United States” from the Substance Abuse & Mental Health Services Administration (SAMHSA) 1 :

  • Approximately 1 in 10 people, aged 12 or older, will, at some point in their lives, suffer from either a SUD or AUD
  • 72% of those with a SUD and 45% of those with AUD will have dual diagnosis – at least one comorbid mental health disorder
  • Only about 40% of people receive any treatment for either disorder, and
  • Less than 5% receive treatment for both disorders

Furthermore, according to the NIDA publication “Common Comorbidities with Substance Use Disorders Research Report, Part 1: The Connection Between Substance Use Disorders and Mental Illness,” 2 recent research data shows high rates of comorbid SUDs and anxiety disorders, such as generalized anxiety disorder, panic disorder, and PTSD, and other mental health disorders, including depression, bipolar disorder, attention-deficit hyperactivity disorder (ADHD), borderline personality disorder, and antisocial personality disorder.

Serious mental illness (SMI) includes major depression, schizophrenia, and bipolar disorder, and other mental disorders that cause serious impairment. Around 1 in 4 individuals with SMI also have an SUD.

2. Mental Health in the U.S.

As shown above, around half of those suffering with AUD will also be suffering with a mental health disorder. Mental health disorders, like substance abuse, are becoming increasingly more common in the U.S. According to Mental Health America’s 2019 State of Mental Health in America3  report:

  • Over 44 million (18.07%)  of U.S. adults have a mental health condition, and
  • 56.4% of adults (over 24 million) with a mental illness received no treatment

The Most Common Mental Health Disorders in the U.S.

In order of prevalence:

  • Anxiety Disorders: 19%
  • Depression: 7%
  • Dual Diagnosis: 4%
  • Post Traumatic Stress Disorder (PTSD): 4%
  • Bipolar Disorder: 3%

3. Integrated Dual Diagnosis Treatment

Recovering from dual diagnosis is a complex and simultaneous professional treatment. An integrated dual diagnosis inpatient program needs to incorporate:

  • One-to-one counseling
  • Group support
  • Mental health and alcohol use education
  • Medication (if required), and
  • Relapse prevention strategies for both the mental health disorder and alcohol abuse

References:

  • 1 Substance Abuse & Mental Health Services Administration (SAMHSA). Key Substance Use and Mental Health Indicators in the United States. August, 2019. Available at SAMHSA.gov/.
  • 2 National Institute on Drug Abuse (NIDA). Common Comorbidities with Substance Use Disorders Research Report: Part 1: The Connection Between Substance Use Disorders and Mental Illness. April, 2020. Available at Drugabuse.gov
  • 3 Mental Health America. 2019 State of Mental Health in America. 2020. Available at MHANational.org.

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