When an alcoholic or drug addict is also diagnosed with a mental illness, the individual is said to have a dual diagnosis disorder. Depression, anxiety, bipolar disorder, schizophrenia, borderline personality disorder, and other mental illnesses are common among substance abusers, either before substance abuse began, or as a result of continuous abuse of one or more substances.
For those who have been dually diagnosed, treatment that can address the substance abuse and the mental illness at the same time has proven most effective. For many others, a mental illness diagnosis, and therefore an applicable dual diagnosis disorder, is not made until the individual is participating in alcohol or drug treatment.
A good rehab will employ staff members who are trained in recognizing the symptoms of mental illness. In most cases the client must undergo detox and at least a week of sobriety before symptoms can no longer be attributed solely to the client’s substance abuse.
Once symptoms are present though, the treatment team can start ruling out certain mental illnesses until one diagnosis is applicable. At that point, a client can be said to have a dual diagnosis disorder, and it can be decided whether the current approach to treatment is best suited for that individual. If the current rehab does not provide simultaneous treatment for substance abuse and mental illness, than an external referral is generally made, so that the client can receive integrated treatment for both diagnoses.
To help illustrate the application of this process, here is an example: a fifty-year-old female alcoholic suffers from depression. She has battled depression throughout her entire life without ever receiving treatment, or even the correct diagnosis. When her family intervenes and she agrees to go to treatment for alcohol abuse, the treatment team at her rehab center identifies common symptoms of depression in her.
After a substantial period of sobriety from alcohol, this woman is communicating openly with her assigned individual counselor. While being treated for alcoholism, she is also being evaluated for mental illness, based on many surfacing symptoms not related to alcohol abuse.
When this woman speaks with her assigned individual counselor, she feels as though several of the symptoms of depression being presented to her are common of women in general; she does not understand that depression has had a hold on her for basically all fifty of her years on this planet.
This woman is fortunate; she is in the right treatment center for her. This particular facility treats dual diagnosis disorder. Concurrently, this woman’s alcohol abuse and depression are addressed. With the use of antidepressants when appropriate, and therapy tactics geared toward those with addiction and depression, she can work on identifying the reasons for her initial substance use, the reasons for her sustained substance use, her personal origin of depression (or other mental illness), and strategies for working through the co-occurrence of substance dependence and mental illness.
In this woman’s case, the integration of treatment for dual diagnosis disorder, and more specifically alcoholism and depression, her counselor and treatment team work to determine what symptoms of depression that were present before alcohol use, which symptoms of depression are still present after alcohol cessation, and which symptoms of depression were seemingly eliminated with alcohol use.
In other words, this woman and the rehab’s staff are trying to identify why this woman felt as though alcohol was medicating her depression and what alcohol use was really doing to the woman’s depression.
Once identified, the woman, her counselor, and her treatment team are able to come up with a treatment plan: goals, objectives, and methods to start the woman on a path to recovery.
As dual diagnosis disorder clients sustain from substances for longer periods of time, the mental illness can be even better treated long-term. Symptoms are managed with prescription drugs, when necessary, and with methods first learned and practiced during treatment for both diagnoses.
For this woman, understanding how depression provided a springboard into alcohol use allows her to take control of her behavior. When her depression is accurately addressed, her desire to drink is lessened and she is able to determine a better course of action to navigate the depressive symptoms.