Dual diagnosis treatment is required when someone is suffering from both a mental health disorder as well as an alcohol or drug addiction. Comorbid conditions are very common and both must be treated through a regime of detoxification, rehabilitation, and counseling. Typically dual diagnosis treatment also includes support groups and extensive talk therapy.
What Kind of Mental or Emotional Problems are Seen in People With Dual Diagnosis?
The following psychiatric problems are common to occur in dual diagnosis, i.e., in tandem with alcohol or drug dependency.
- Depressive disorders, such as depression and bipolar disorder.
- Anxiety disorders, including generalized anxiety disorder, panic disorder, obsessive/compulsive disorder, and phobias.
- Other psychiatric disorders, such as schizophrenia and personality disorders.
Which Develops First – Substance Abuse or the Emotional Problem?
It depends. Often the psychiatric problem develops first. In an attempt to feel calmer, more peppy, or more cheerful, a person with emotional symptoms may drink or use drugs; doctors call this “self-medication.” Frequent self-medication may eventually lead to physical or psychological dependency on alcohol or drugs. If it does, the person then suffers from not just one problem, but two. In adolescents, however, drug or alcohol abuse may merge and continue into adulthood, which may contribute to the development of emotional difficulties or psychiatric disorders.
In other cases, alcohol or drug dependency is the primary condition. A person whose substance abuse problem has become severe may develop symptoms of a psychiatric disorder: perhaps episodes of depression, fits of rage, hallucinations, or suicide attempts.
How Can a Physician Tell Whether the Person’s Primary Problem is Substance Abuse or an Emotional Disorder?
At the initial examination, it may be difficult to tell. Since many symptoms of severe substance abuse mimic other psychiatric conditions, the person must go through a withdrawal from alcohol and/or drugs before the physician can accurately assess whether there’s an underlying psychiatric problem also.
If a Person Does Have Both an Alcohol/Drug Problem and an Emotional Problem, Which Should be Treated First?
Ideally, both problems should be treated simultaneously. For any substance abuser, however, the first step in treatment must be detoxification – a period of time during which the body is allowed to cleanse itself of alcohol or drugs. Ideally, detoxification should take place under medical supervision. It can take a few days to a week or more, depending on what substances the person abused and for how long.
Until recently, alcoholics and drug addicts dreaded detoxification because it meant a painful and sometimes life-threatening “cold turkey” withdrawal. Now, doctors are able to give hospitalized substance abusers carefully chosen medications which can substantially ease withdrawal symptoms. Thus, when detoxification is done under medical supervision, it’s safer and less traumatic.