Living with Dual Diagnosis

When a person with mental illness is also diagnosed with substance abuse and/or dependency issues, he/she is said to have dual diagnosis. Two common examples of dual diagnosis are that of major depression with marijuana addiction, and alcohol addiction with panic disorder.

Because the symptoms a person with dual diagnosis has are identified in two parts, it’s sometimes common for one diagnosis to be missed; the symptoms associated with any major psychiatric disorder, such as schizophrenia, bipolar mood disorder or personality disorder are often identified first, while the issues associated with abuse of alcohol and other drugs are identified last.

Symptoms of Dual Diagnosis

• Significant impairment or distress resulting from substance abuse
• Failure to fulfill roles at work, home or school
• Persistent substance abuse in physically hazardous situations
• Continued substance abuse despite relationship or financial problems

Drug and/or alcohol 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
• Continued use despite negative consequences
• Tendency for relapse after period of abstinence
• Drug induced behavior (aggression, irritability, changes in thinking or mood)
• Increased tolerance and withdrawal

Oftentimes, a person with dual diagnosis experiences more severe and chronic medical, social and emotional problems than if they were to have just one diagnosis. They’re more susceptible not only to alcohol and/or drug relapse but also a relapse of their mental health problems.

The evidence that people with mental health illness are more likely to abuse alcohol and other drugs, or that those who abuse alcohol and other drugs are more likely to develop some form of mental health illness, indicates that the causes of psychiatric illness and drug and alcohol abuse are complex. This conclusion is best 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 behaviors can mimic drug use problems
• Drug and alcohol abuse can make side effects from medication worse and more likely to occur

Treatment Options at Rose Hill

The term dual diagnosis is also used to refer to people with both a mental health illness and an intellectual disability. At Rose Hill, treatment options for those with a primary diagnosis of mental illness include a range of medication and both cognitive and behavioral programs, such as the Residential Rehabilitation Program, which is designed to help patients struggling with mental illness regain psychiatric stability. The program is built around a multi-stage format that allows staff and patient to work together to create and then follow a customized treatment plan. Based on this plan, patients may participate in one or more of the therapy options offered at Rose Hill, including Dialectical Behavioral Therapy (DBT).

DBT is a therapeutic methodology that is used primarily to treat patients with borderline personality disorder, although it can be applied to other types of psychiatric conditions. DBT combines behavioral techniques, cognitive therapy and acceptance to provide skills which help a patient regulate their emotions, tolerate stress and have meaningful interpersonal relationships.

Other therapy options include:  Behavioral Therapy, Cognitive Therapy, Group Therapy, and Individual Mental Health Counseling.

Treatment for people with dual diagnosis may be more effective if the two diagnoses are treated at the same time as the two are often related.  It has been recommended that during treatment administration, both conditions be regarded as primary without one being seen as the cause of the other.

In our residential setting we can focus the time and attention on finding the most effective treatment options for each individual so they can learn to manage their symptoms, achieve their highest level of independence and go on to lead rewarding lives.

Information provided by the Mental Health Association NSW, Inc.