Dual diagnosis describes the presence of both
mental health issues and the addiction to drugs or alcohol, the
impact on daily functioning, complications related to a problem left
untreated, and the impact on others. Understanding co-occurring
disorders also poses questions for both the professional and the
patients on determining what came first, the chicken or the egg?
By definition, patients with dual diagnosis have one
or more disorders (substance use and mental or physical health
related). A diagnosis of dual diagnosis occurs when at least
one of the recognized disorders exists independently and is not
part of a cluster of symptoms.
Substance use and addiction can be a means to deal with mental
health symptoms (self-medication), the reason why clinical
issues worsen, or set the foundation for developing mental health
disorders. Some of the most common mental health disorders
found in chemically dependent people include mood- and anxiety
disorders. An even higher percentage of people with severe mental
illness also have co-occurring substance use disorders.
We already know there is a biological vulnerability as well as situational
stressors – life challenges – that trigger the onset of symptoms. Many
of the patients diagnosed with dual diagnosis use alcohol and
substances as a mean to cope with MH symptoms and facilitate social
connections. There are many consequences of undiagnosed, untreated, or
poorly treated dual diagnosis including higher probabilities
of experiencing: (1) Homelessness, (2) Incarceration, (3) Physical
health conditions, (4) suicide or self-injurious behaviors, and (5)
Patients with dual diagnosis many times go untreated due to the health care
systems focus on only one of the extremes of the complex. Many
people with dual diagnosis end up receiving services
through emergency rooms to avoid the stigma associated with
formal treatment for substance abuse and mental health issues.
A large percentage of the population with dual diagnosis receive inadequate
treatment or even seek treatment. Providing resources beyond
primary health care settings support successful outcomes.
The ideal continuum of care would include the identification and
structured screening for dual diagnosis, the collaboration and communication
among clinical providers, and the integration of both mental health
and substance abuse issues. Integrated treatment has shown to
be more effective, featuring a client centered approach, assuring
that only one provider works on a comprehensive treatment plan.
Patients with dual diagnosis not only need clinical treatment but also an array
of services from housing, employments, family psycho-education,
to case management, among others.
The onset of mental illness is disrupting to the family, their
cognitions, and social-emotional development. Combined with
substance use problems, dual diagnosis interferes with the patient’s ability
to complete schooling, establish and maintain healthy relationships,find and
However, we have to be strong believers that change is possible
and treatment is available.
Hitting bottom and the other negative consequences of cooccurring
disorders can lead to death; providers and sources of
support are key in the reduction of harmful consequences and
taking steps into increasing motivation to change and work towards
recovery. Targeting the patient’s motivation for recovery is a must,
the process of engaging and persuading the person to actively
participate in treatment and focus on relapse prevention.
Without the appropriate treatment both extremes of the disorders
would lead to a loss of control over thinking and behaviors, causing
a decreased ability of self-regulation and loss of will power to make
the steps to change and work towards recovery.