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Dual Diagnosis: Substance Abuse + Mental Illness

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? 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.

If a Person Has 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. In most cases, detoxification should take place under medical supervision. Detox can take a few days to a week or more, depending on what substances the person abused and for how long. Opiate Detox may seem the most dangerous, but in reality detox from opiates, cocaine and crystal meth rarely result in any type of life-threatening effects. By far the most dangerous detox is from alcohol or alcohol plus pills such as painkillers, or CNS drugs such as ativan or valium.

Which Develops First - Substance Abuse or the Emotional Problem?

Quite often it is the psychiatric problem that develops first. While trying to feel energetic, calm or happy, people that have emotional symptoms "self-medicate" through the use of drugs or alcohol. Continued self-medication can lead to physical or psychological dependene on the substance of choice. Once physical dependence occurs, there becomes two issues that must be addressed instead of one.

In adolescents, drug or alcohol addiction and abuse that continues into adulthood may contribute to the onset of emotional or psychiatric disorders.

For others, alcohol or drug dependency is their primary condition. A person with a severe substance abuse problem can have symptoms that mirror a psychiatric disorder including:

• depression
• hallucinations
• mania
• fits of rage
• suicide attempts