Dual Diagnosis
Kimberly Holston
CRIS 305-B05
Liberty University
02/22/2016

Dual Diagnosis
There is an extremely difficult life path for a person the experiences substance and or alcohol abuse. That addiction journey can be riddled with anger, pain, loss, shame, anguish along with a host of many other agonizing and heart wrenching emotions. When the addicted person also carries a mental health disorder along this journey, it can become an even more treacherous and dangers path. These are indeed two very complex struggles for one human being. The combination of a person suffering an alcohol or substance abuse disorder and a mental illness disorder are identified has having a dual diagnosis. Dual diagnosis has different causes, difficulty in trying to diagnose and difficult to treat and it affects many in our world today. Most importantly, a dual diagnosis is most difficult on the individual who suffers with the disease.
Dual Diagnosis Definition and Types
What does dual-diagnosis actually mean? A dual diagnosis disorder occurs when an individual is affected by both chemical dependency and an emotional or psychiatric illness. Both chemical dependency and psychiatric illness may affect an individual physically, psychologically, socially and spiritually (The Dual Diagnosis Recovery Book, 1993). The most common mental health issues that coincide with addictions are ADHD, anxiety, depressions, bi-polar, schizophrenia, personality disorders, eating disorders and PTSD. The combination of a mental health illness and an addiction can exasperate the symptoms and triggers of the individual’s illness to dangerous physical and mental levels. These disorders combined can effect each disease and interact with each other dramatically because they are closely intertwined. It is difficult to determine which of the co-occurring disease is happens. Alcohol and drug abuse utilization can give a person the unhealthy belief that they can escape pain, ease anxiety and salve past traumatic events. This abuse can also mask the pain associated with their mental illness as well. Each has their own unique symptoms that they are trying to medicate. Estimates vary, but it appears that up to 50 percent of all alcohol and substance abuse problems mask other psychiatric problems (Gilliand & James, 2013).
Substance Abuse or Mental Health? Some individuals may have symptoms of mental health prior to their substance or alcohol abuse. Addictions and mental health disorders both originate in the brain. Alcohol and drugs are being used and abused to help one mask some of the symptoms of mental illness. Drugs do have the capability to worsen some of the symptoms of mental illness. Sometimes the symptoms of mental illness are contributed to the person being diagnosed with substance or alcohol abuse. Substance abuse and mental illness can occur in individuals simultaneously. Chemical dependency does not always appear first (The Dual Disorders Recovery Book, 1993). The symptoms of both diseases have a tendency to mimic each other. Each disorder can influence the progression of the other, a fact that complicates the treatment of both conditions (Doweiko, 2015). So, it is extremely difficult to identify which of these diseases may have pre-empted the other.
Dual Diagnosis Statistics
Currently 4 million individuals in the United States are thought to have a concurrent substance abuse and mental illness problem (Doweiko, 2015). The following chart spells out the risk associated with some of the major psychiatric illnesses in relation to the likelihood of substance abuse (The Dual Disorders Recovery Book, 1993):

If you have a diagnosis of …… | Your risk of substance abuse is: | Phobia | 2.4 times as great | Obsessive Compulsive disorder | 3.4 times as great | Major Depressions | 4.1 times as great | Panic Disorder | 4.3 times as great | Schizophrenia | 10.1 times as great | Manic Depressive disorder | 14.5 times as great | Antisocial personality disorder | 15.5 times as great |

Challenges in Diagnosis
Dual diagnosis can certainly present its challenges to the mental health care workers. When two serious illnesses exist in one person as the same time, each can complicate the other (The Dual Disorders Recovery Book, 1993). This fact can be attributed to making the front line mental health servers very difficult. When you look at the symptoms of drug and alcohol abuse, the can appear to mimic the symptoms of mental illness. These symptoms of both diseases are interchangeable and for the most part they exist together. It can be very difficult to differentiate between the diagnoses as to what the core illness may be. It can be very frustrating for the individual with the dual diagnosis because the addiction can cause barriers with the mental health diagnosis and the individual can continue to use drugs to cope with their mental illness. Alcohol and drug abuse can heighten the mental health illness. And if the alcohol or drug abuse is predominate illness, it may cause a mental health diagnosis. When a substance use disorder individual is hospitalized, the focus is primarily to get the client clean and concentrate on the chemical abuse rather than determining if the core of the illness is attributed to their mental health diagnosis.
The individual being helped may not be forth coming in regards to the history of their drug usage or any type of mental illness. And sometimes they might not be aware that they have or are experiencing a mental health illness. Some recovery centers only focus with the alcohol or drug addictions and not mental health and psychiatric hospitals deal with the mental illness and not the addictions. So, the dual diagnosed individual may get caught in the proverbial revolving door between the two entities and this could potentially cause the person to give up hope for any type of recovery.
The dual diagnosis client can present themselves with a unique form of denial. The form of interchangeable denial involves the utilization of one problem to defend the other. For example, if the healthcare worker focuses on the mental health disorder, the client will shift to their substance abuse disorder and vice-versa (Doweiko, 2015). This interchangeable denial ping-pong can cause the client to be treated ineffectively because it hinders the ability of the healthcare worker in making accurate diagnoses.
Treatment
It is paramount that the dual-diagnosis client gets effectively assessed so that the treatment is tailored to the individual and their specific needs. The dual- diagnosed client composes a high percentage of potentially violent mental illness (Gilliand & James, 2013). If they are undiagnosed, untreated, or undertreated these individuals could experience levels of medical illness, incarceration and homelessness.
To have a successful treatment program for the dual-diagnosed individual, the program will need to have a foundation of understanding the relationship between mental illness and substance abuse. This understanding will need to encompass the knowledge that both sides of the client will need to be treated. This is known as integrated intervention and it involves treating both of the illnesses at the same time.
Treatment for the dual-diagnosis client usually begins with a detox phase due to wanting to address the chemical dependency first. Once this phase occurs the psychological assessment can be performed either through individual therapy and group therapy. The first goal in working with a dual-diagnosis client is the establishment of a good therapeutic relationship (Dowieko, 2015). There are several types of behavioral therapy that can be utilized such as, Cognitive Behavioral Therapy, Dialectical Behavior Therapy, integrated group therapy and individual psychotherapy. Certain medications can be used for both the substance abuse and the mental health diagnosis. Treating clients with a dual-diagnosis can be a very long and complicated process and therapists may have to endure extended periods of minimal progress on the part of the client and perhaps some regression (Dowieko, 2015). But through patience, commitment and time, recovery can produce hope, healing and empowerment.

References
Doweiko, H.E. (2015). Concepts of chemical dependency (9th ed.) Stamford, CT: Cengage Learning.

Gilliland, B., & James, R. (2013). Crisis intervention strategies. Pacific Grove, Calif.: Brooks/Cole Pub.

The dual disorders book: A twelve step program for those of us with addiction and an emotional or psychiatric illness. (1993). Center City, MN: Hazelden.