It is estimated that over 40% of people checking into rehab suffer from a dual diagnosis or comorbid condition. In a nutshell, this means that almost half of the people through the doors of addiction treatment centre are also suffering from another mental health issue. Furthermore, this demands that rehabs need to have a comprehensive and well-equipped dual diagnosis team who can identify and treat both the substance abuse issue any potential mental health condition.
Substance abuse is a mental health disorder
It may seem surprising to some but addiction to drugs and alcohol is actually recognised as a mental health disorder. This is not something that happens because people are bad people and neurologically the origins of the problem are based on the pleasure and reward centres of the brain.
In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition or DMV 5, the gold standard for diagnosing every recognised mental health disorder the following are laid out as criteria for substance abuse.
- Taking the substance in larger amounts and/or for longer than you’re meant to
- Wanting to cut down or stop but not managing to
- Spending a lot of time getting, using, or recovering from use of drugs or alcohol
- Cravings and urges
- Not managing to fulfil your daily responsibilities with family or at work/school
- Continuing to use, even when it causes problems in relationships
- Giving up important social, occupational, or recreational activities because of substance use
- Using substances again and again despite the fact it is putting you in danger.
- Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance.
- Needing more of the substance to get the effect you want (tolerance).
- Developing withdrawal symptoms, which can be relieved by taking more of the substance.
The DSM V recognises that substance use disorders span a wide variety of difficulties and comes in many different forms.
What do we mean by other mental health conditions?
Other conditions that commonly present alongside addiction include both mood disorders and mental health conditions. Addicts and alcoholics commonly also suffer from depression, anxiety, bipolar, schizophrenia and borderline personality disorders. What makes this a very confusing aspect of addiction science is many of the symptoms of other mental health conditions and addiction present as very similar
For example, an addict who has never had to take responsibility for their money may display real problems in rehab having to stick to a budget. They are used to spending every penny that they have on drugs and this behaviour may continue after the drugs have been removed with the client spending money on food or other items.
However, sometimes this can be an indicator that the person may be suffering from bipolar disorder (they are experiencing a manic state) or a personality disorder. The untrained eye may just presume this is another wilful addict acting out, however, if they continue to act this way despite the consequences it is possible that something else may need to be considered. The duration, intensity and patterns of behaviours usually indicate whether there is something else which needs to be addressed.
Moreover, it takes a little time before other symptoms can be identified. Anyone detoxing from drugs and alcohol will have rapidly changing moods and anxiety. The length of the detox period depends on the substance and in the case of some drugs it takes a lot of time before user’s brain returns to normal
It can take Ice addicts up to 2 years for their brains to return to normal and there is a recognised stage of recovery from 4 weeks to 6 months that is characterized by depression and boredom. This is part of the reason why staying in a residential rehab is a good idea because it gives the staff time to get to know you and determine whether your problems just relate to the stage of your addiction recovery or to some other outside issue.
Commonly Co-occurring Conditions
Mental health conditions that commonly occur alongside substance abuse issues include problems from all these categories.
- Mood Disorders
Mood disorders are a broad category of mental disorders that includes all types of depression and bipolar disorders.
- Anxiety Disorders
Anxiety and fear are normal feelings, but prolonged periods of feelings of anxiety that worsen over time may be indicative of an anxiety disorder.
- Psychotic Disorders
Psychotic disorders usually cause two serious symptoms: delusions and hallucinations. People with psychosis are disconnected with reality and may become a danger to themselves or others.
- Eating Disorders
Like substance use disorders, eating disorders are misunderstood. People with eating disorders do not choose to eat unhealthy diets they suffer from a serious mental illness.
- Personality Disorders
Personality disorders are mental illnesses associated with unhealthy thoughts, beliefs and actions. They can be triggered by everyday stresses or problems and can disrupt work and relationships.
- Behavioural Disorders
Behavioural disorders are associated with inattention, defiance and hyperactivity and usually occur in children.
Alcohol and drugs are often used to self-medicate the symptoms of mental health problems. People often abuse alcohol or drugs to salve the symptoms of an undiagnosed disorder, to cope with challenging emotions or to change their mood. Unfortunately, in the long term self-medicating can exacerbate the symptoms they initially helped to relieve and cause other issues.
Addiction can cause other mental health issues
Excessive use of alcohol and drugs can increase the risk of developing other mental health issues. Substance use causes structural changes in the brain and can prompt the development of other conditions especially if you are genetically predisposed. There is some evidence, for example, that certain people who use marijuana have an increased risk of psychosis and some people who abuse opioids have a greater risk of depression.
Substances can worsen an existing problem
Alcohol and drug abuse can make symptoms of a mental health problem worse. Substance abuse may sharply increase symptoms of mental illness or even trigger new symptoms. Abuse of alcohol or drugs can also interact with medications such as antidepressants, anti-anxiety pills, and mood stabilizers, making them less effective at managing symptoms.
Recovery from dual diagnosis
Recovery from addiction and most co-occurring conditions are entirely possible when addressed with a comprehensive, personalised treatment plan. If, however, a co-occurring disorder is present and not diagnosed in rehab, this can leave the door open for relapse. As well as relevant pharmaceutical intervention there are a great many excellent forms of therapy which are recognised to help with different mental health conditions.
The Hader Clinic, Melbourne provides integrated treatment plans which are designed to fit each individual’s specific needs. If you or a member of your family is suffering from addiction and another mental health problem call our team today to see how we can help.