Dual Diagnosis and Treatment: Substance Abuse and Co-Occurring Mental Health Disorders

Dual Diagnosis and Treatment: Substance Abuse and Co-Occurring Mental Health Disorders

Substance abuse disorders and mental health illness often occur together. This is known as co morbidity or dual diagnosis. Information on the occurrence of dual diagnosis is not well reported. Having said that, according to information published by the Journal of American Medical Association (JAMA) the following statistics apply to the United States population:

  1. About half of the inpiduals with mental disorders also suffer from a substance abuse problem.
  2. Thirty-seven percent of alcohol abusers and 53 percent of drug abusers also have at least one serious mental illness.
  3. Of all people diagnosed as mentally ill, 29 percent abuse either alcohol or drugs.


Are There Risks Associated with Severe Mental Illness and Drug Abuse?

Inpiduals with a co-occurring disorder are more likely to be involved in violent events such as crime associated with obtaining drugs. Accidents occurring while under the influence of substances are more common. Medication noncompliance leads to more risk for both of the occurrences listed prior. All of these problems affect the inpidual’s friends, family as well as the community at large.

Having a co-occurring disorder is detrimental from a health perspective because they often go undiagnosed. Health care providers, especially in the adult population, do not diagnose substance abuse disorders. This population is already at risk for lower functioning and spends much time moving in and out of hospitals. The mix of the two disorders tends to lead to more instance of substance abuse relapse.

Substance Abuse and Developing Relationships; What’s the Link?

Most inpiduals with severe mental illness find it difficult to develop relationships. The more erratic the inpidual’s behavior the more difficult it will be to connect with people who do not have a similar issue. Without proper social support, it is likely that these inpiduals will find themselves on a downward spiral which can include living in less affluent areas where drug use is more common. For some people, drug use may be a matter of forgetting their problems, but also just a matter of acceptance.

If social activity is based on drug use, inpiduals may be able to connect with his or her peers. Though the relationships may not be healthy or completely real, it gives these inpiduals a way to connect. Drug abuse can be a way to develop a bond, which is something this community is missing.

Are the Issues Involved in Co-Occurring Disorders Addressed Separately?

There is something called integrated treatment which incorporates treatment for both mental health and substance abuse disorders. Being that such inpiduals are faced with two distinct disorders it is unreasonable to try to treat one and not the other. Unfortunately, this type of treatment is still not used as widely as it should be. There are many reasons why using integrated treatment benefits the consumer.

For starters, using integrated treatment bridges the gap between the two sets of problems that occur. Appropriate treatment can stop a lot of the issues that arise with these disorders including:

  • Violence- domestic and otherwise
  • Crime

It can also help these inpiduals with self-care including: Developing proper social skills which help with every aspect of life.

Most literature demonstrates that if an inpidual with a dual diagnosis is able to overcome his or her substance abuse issue. They respond better to treatment for his or her mental health disorder.

What Does an Integrated Treatment Program Entail?

As the word implies, integrated treatment involves putting together different aspects of treatment and developing one all-encompassing program. This way practitioners work together to provide the most effective treatment plan for each inpidual.

Substance abuse and mental health treatment work interchangeably, they in effect, lean on each other. Practitioners will often work in one office so that they can communicate about each patient. This should result in a treatment plan that bundles together the right treatment for every patient. Effective integrated treatment consists of the same health professionals, working in one setting, providing appropriate treatment for both mental health and substance abuse in a coordinated fashion.

This type of treatment recognizes that counseling is going to be different for these inpiduals. There is the issue of poor relationship choices which is more complex for this type of treatment. One must teach the inpidual to avoid relationships that will feed substance abuse as well as help them recognize how their emotional or mental disorder may affect relationships. It is a tall order to be filled, not to be taken lightly.

Perhaps one of the most important pieces of information for providers to impart to patients is that every inpidual will make progress at his or her own pace. There is no set schedule and these parties are dealing with multiple issues. Some of the concepts one must remember in regards to this treatment is:

  • Providing social support
  • Making sure to properly motivate inpiduals in treatment.
  • Thinking of treatment as a long term goal, not something occurring quickly.
  • Counseling which is culturally competent should be used.

There are varying programs available for consumers. It is up to the inpidual experiencing issue and his or her social support group to pick a program most fitting and relevant to his or her disorder. Picking the right ‘fit’ for dual diagnosis can be the factor that determines the success of the inpidual in the program and is a factor that should be considered.

Rachel Hayon, MPH, RN

Works Cited
Jerrell, J.M Ridgely, S. (1999). Impact of Robustness of Program Implementation on Outcomes of Clients in Dual Diagnosis Programs. Psychiatric Services, 50: 109 - 112.
Reno, R. (2001). Maintaining Quality of Care in a Comprehensive Dual Diagnosis Treatment Program. Psychiatric Services. 52:673-675, May 2001
Sherer, M. (2003). Contemporary Dual Diagnosis: MH/MR: Service Models: Volume I: Residential and Day Services • Contemporary Dual Diagnosis: MH/MR: Service Models: Volume II: Partial and Supportive Services
Psychiatric Services, 54: 1421.
Wilson DC, Crisanti AS. (2008). Psychometric Properties of the Dual-Disorder Treatment Fidelity Scale: Inter-Rater Reliability and Concurrent Validity. Community Ment Health J.

Topic Discussion

  1. Addict

    The term dual diagnosis is used to describe the comorbid condition of a person considered to be suffering from a mental illness and a substance abuse problem. There is considerable debate surrounding the appropriateness of the term being used to describe a heterogeneous group of individuals with complex needs and a varied range of problems. The concept can be used broadly, for example depression and alcoholism, or it can be restricted to specify severe mental illness (e.g. psychosis, schizophrenia) and substance misuse disorder (e.g. cannabis abuse), or a person who has a milder mental illness and a drug dependency, such as panic disorder or generalized anxiety disorder and is dependent on opioids. Dual diagnosis is also a term used for people with an intellectual disability and diagnosed with a mental illness. Making a dual diagnosis in substance abusers is difficult as drug abuse itself often induces psychiatric symptoms, thus making it necessary to differentiate between substance induced and pre-existing mental illness.

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