Substance Abuse - Dual Diagnosis

What is Dual Diagnosis?

A person who has both an alcohol or drug problem and an emotional/psychiatric problem is said to have a dual diagnosis. To recover fully, the person needs treatment for both problems. How Common Is Dual Diagnosis?

Dual diagnosis is more common than you might imagine. According to a report published by the Journal of the American Medical Association:

Thirty-seven percent of alcohol abusers and fifty-three percent of drug abusers also have at least one serious mental illness.
Of all people diagnosed as mentally ill, 29 percent abuse either alcohol or drugs. 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.
The following table based on a National Institute of Mental Health study, lists seven major psychiatric disorders and shows how much each one increases an individual's risk for substance abuse.

Psychiatric Disorders

Increased Risk For Substance Abuse Antisocial personality disorder 15.5%
Manic episode 14.5
Schizophrenia 10.1
Panic disorder 4.3
Major depressive episode 4.1
Obsessive-compulsive disorder 3.4
Phobias 2.4
Thus, someone suffering from schizophrenia is at a 10.1 percent higher-than-average risk of being an alcoholic or drug abuser. Someone who is having an episode of major depression is at a 4.1 percent higher-than-average risk of being an alcohol or drug abuser... and so on.

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.