About Addictions: Dual Diagnosis defined

Dual Diagnosis

Diagnosis of a "Dual Diagnosis" is complicated. It is often essential that you go to a health care professional to determine if you have a dual diagnosis e.g. another psychiatric disorder in addition to your addiction.

Besides major depressive disorder and bipolar disorder there are many other disorders that are quite serious that require psychiatric care, and sometimes hospitalization. When ever someone is a danger to themselves or others, not functioning adequately, is hallucinating, or is out of touch with reality, they require immediate psychiatric care.

Many alcoholics and addicts, come to the point of requiring psychiatric care for the types of reasons cited above. In many cases, they turn out to have what is known as a "dual diagnosis." In dual diagnosis, people are considered to have a disorder like bipolar disorder and alcohol dependence simultaneously. This is a dual diagnosis because substance abuse disorders are also considered major psychiatric disorders. Treatment consists of treating both disorders. For example, someone with bipolar disorder may be detoxed, placed on lithium, and follow up with psychiatric appointments, and attend AA meetings.

Furthermore...

In recent years, the mental health profession has also come to learn that symptoms of alcohol dependence and other addictions can mimic almost any disorder in the DSM-IV. Thus disorders like Major Depression and Bipolar disorder have qualifiers that require that they are not due to the direct physiological effects of a substance. Mood disorders which are due to the direct effect of a substance are called substance induced mood disorders. They are due to either the use of, or the withdrawal from substances like alcohol or other substance of abuse. Because there can be a protracted withdrawal state from many substances, these disorders may first occur or persist several weeks into abstinence. Other common substance induced disorders include, substance induced psychotic disorder, substance induced anxiety disorder, and substance induced sleep disorder.

Treatment

If a Person Does Have Both an Alcohol/Drug Problem and an Emotional Problem, Which Should Be Treated First?

Ideally, both problems should be treated simultaneously. For any substance abuser, however, the first step in treatment must be detoxification - a period of time during which the body is allowed to cleanse itself of alcohol or drugs. Ideally, detoxification should take place under medical supervision. It can take a few days to a week or more, depending on what substances the person abused and for how long.

Until recently, alcoholics and drug addicts dreaded detoxification because it meant a painful and sometimes life-threatening “cold turkey” withdrawal. Now, doctors are able to give hospitalized substance abusers carefully chosen medications which can substantially ease withdrawal symptoms. Thus, when detoxification is done under medical supervision, it’s safer and less traumatic.

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When And Why

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.

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