Dual diagnosis between drug abuse and mental illness is very common. The two problems affect and interact with each other. The number of people diagnosed with a mental illness and substance went from 210,000 to 800,000 between the years of 1998-2003. (Druss MD, Bornemann, Fry-Johnson MD, McCombs PhD, Politzer, & Rust MD, 2006) Substance abuse is the most common and clinically important dual disorder among adults with severe mental illness. Studies show that fifty percent of people with mental illness also have a substance abuse problem. (Saisan, Smith, & Segal, 2010) And more than half the persons with a substance abuse diagnosis also have a diagnosable mental illness. (Saisan, Smith, & Segal, 2010)

Clinicians believe that mental illness and substance abuse are biologically and physiologically based. “Although substance abuse and mental health disorders like depression and anxiety are closely linked, one does not directly cause the other.” (Saisan, Smith, & Segal, 2010) Both conditions can mirror each.

PROBLEM STATEMENT:

More and more people are suffering from a combination of substance abuse and mental health problems. Alcohol and/or drugs are often used to relieve the symptoms of a mental illness, side effects from their medications or just to cure symptoms they are having at the time. Alcohol and drug abuse can increase original risk for mental disorders and can make symptoms of a mental health problem worse. Substance abuse and mental illness commonly co-occur due to genetic factors, environmental factors, a brain disorder and/or a development disorders. “Co-occurring disorders, two disorders or illnesses occur simultaneously in the same person, they are called dual diagnosis or co morbidity.” (Topics in Brief, 2007) Treatment for this dual diagnosis has not been well designed. Clients have to go a treatment facility for mental health treatment and a different facility for substance abuse treatment. This kind of treat is not successful because this leaves the client trying to cope/manger a disorder on their own. It is almost impossible for them to manger the other disorder because if they could quit on their own they would not need treatment.

It can be hard to diagnose a person with a dual diagnosis of mental illness and substance abuse. One of the things that makes diagnose hard is denial by the patient. “Substance abuse and mental disorders commonly co-occur because of overlapping genetic vulnerabilities, overlapping environmental triggers like stress, involvement of similar brain regions, and drug abuse and mental illness are developmental disorders.” (Topics in Brief, 2007) Having a dual diagnosis put a person at greater risk for relapse. Violence and suicide attempts are also more prevalent among the dually diagnosed population.

BACKGROUND:

The problem of dual diagnosis became clinically clear in the early 1980s. (Drake R. P., 2001) Substance abuse and mental illness hinders your ability to function, handle life and have a healthy social life.

Mental illnesses are mental conditions that disrupt a person’s thinking, feeling, mood, ability to relate to others and daily functioning. “The World Health Organization has reported that four of the 10 leading causes of disability in the US are mental disorders.” (National Alliance on Mental Illness, 2010) Some of the major and the most common mental illness that occur with substance abuse are manic depression, schizophrenia, bipolar disorder, attention deficit hyperactivity disorder, obsessive compulsive disorder, panic disorder, post traumatic stress disorder, generalize anxiety disorder and antisocial personality disorder. It is reported that about 57.7 million Americans experience a mental health disorder in a given year. (National Alliance on Mental Illness, 2010)

Substance abuse, also known as drug abuse, refers to a maladaptive pattern of use of a substance that is not need to sustain life or to make it better. “One in four US deaths can be attributed to alcohol, tobacco, or illicit drug use.” (Innovatory Combating Substance Abuse, 2010) The commonly abused drugs by people with a mental illness are alcohol, cocaine and/or marijuana. Substance abuse complicates some aspect of care for a person with a mental disorder. It provides challenges for the counselor to engage the individual in treatment.

About “50% of individuals with severe mental disorders are affected by substance abuse.” (Saisan, Smith, & Segal, 2010) “Thirty-seven percent of alcohol abusers and 53% of drug abusers also have at least on serious mental illness.” (Saisan, Smith, & Segal, 2010) See the chart below. The risk of developing a drug abuse problem while having a disorder goes as high as 15.5% for antisocial personality disorder and as low as 02.1% for phobias. “The mental health problems that most commonly co-occur with substance abuse are depression, anxiety disorders, and bipolar disorder.” (Saisan, Smith, & Segal, 2010) When a person has a dual diagnosis of substance abuse and mental illness the clinician has to determine what are the symptoms/signs of the substance abuse and what are the symptoms/signs are from the mental illness.

Disorders with Increased Risk of Drug Abuse

Disorder

Risk

Antisocial personality disorder

15.5%

Manic episode

14.5%

Schizophrenia

10.1%

Panic disorder

04. 3%

Major depressive episode

04.1%

Obsessive-compulsive disorder

03.4%

Phobias

02.1%

Source: National Institute of Mental Health.

(Drug Abuse and Mental Illness Fast Facts, 2006)

At least 60% of people fighting substance abuse or mental illness are fighting both at the same time. (Bouchex, 2007) Patients with mood, anxiety or drug disorders are about twice as likely to be diagnosed with the other as well. Figure 1 (Topics in Brief, 2007) The prevalence of these dual diagnoses does not mean that one condition caused the other, even if one appeared first. The high rates show the need for better treatment and treatment centers able to deal with both at the same time.

WORKING DIAGNOSIS:

Substance abuse can cause mental disorders due to the fact that,

“drug abuse can cause a mental illness,”

“mental illness can lead to drug abuse,”

“drug abuse and mental disorders are both caused by other common risk factors”

all three can contribute to the establishment of specific dual diagnosis of mental disorders and addiction. (Topics in Brief, 2007)

FRAMEWORK/METHOD OF ANALYSIS:

I began my search using Google and searched using the terms “Substance abuse and Mental Illness”. This resulted in nine articles that were relevant to my topic all of which I used as references.

I then went to the Pub Med Central database and searched using the term “substance abuse and mental illness” and found many articles. I used four of those articles as references. The other references were found on website such as National Institute on Drug Abuse and the National Drug Intelligence Center.

ADDITIONAL INFORMATION (LITERATURE REVIEW):

This review looks at progress made in understanding the relation between drug abuse and mental illness. Volkow found that the relationship between substance abuse and mental illness “is likely to reflect common contributing factors and brain substrates.” (Volkow, 2001) One of the main factors substance abuse and mental illness have in common is stress. A question that still remains is the role that drug abuse has on causing psychosis in individuals with no previous psychiatric histories. Stimulant drugs induce psychosis because they increase extracellular dopamine concentration in the brain. However it does not explain why psychosis can continue after the stimulant drug is no longer present in the brain.

Regier, et al, broke his study down into specific mental disorders. This review found that of people with schizophrenia forty-seven percent has some form of substance abuse problem. People diagnosed with schizophrenia have a 4 times as likely then people who do not have schizophrenia to have a substance abuse problem. (Regier, et al., 1990) The odds for people diagnosed with anxiety disorders to have a substance abuse proplem were more than fourteen percent.

It is believe that substance abuse may trigger mental illness in vulnerable individuals. Evidence show a “complex explanation in which well-known risk factors- such as poor cognitive function, anxiety, deficient interpersonal skills, social isolation, poverty, and lack of structured activities combined to render people with mental illnesses particularly vulnerable to alcohol and drug abuse.” (Drake, 2009) People that already have a mental disorder probably appear to be extremely sensitive to the effects of alcohol and other drugs, due to having a form of brain disorder.

Drake, et al, explains the term dual diagnosis as misleading because people with a dual diagnosis are diverse and tend to have multiple illnesses rather than just two illnesses. Drake discusses how researchers have established some identical finding. First, co-occurrence is common. “Second, dual diagnosis is associated with a variety of negative outcomes, including higher rates of relapse, hospitalization, violence, incarceration, homeless and serious infections such as HIV and hepatitis.” (Drake R. P., 2001) Third, the mental health and substance abuse treatment system delivers fragmented and ineffective care.

RESTATEMENT OF WORKING DIAGNOSIS (Hypothesis):

There is evidence that substance abuse can lead to a mental disorder but also a mental disorder can also lead to a substance abuse, it is not known which comes first. Like the saying which comes first the chicken or the egg. It is said that having one of the diagnosis makes you vulnerable to the other.

MANAGERIAL/POLICY RECOMMENDATIONS:

Why people who are having a mental disorder are so prone to drug abuse raises a lot of questions due to the limited research done on the topic. The research so far is inconsistent and has failed to address a number of issues. There is a need for more research as well as more treatment center that are equipped to deal with dual diagnosis. The patient has two brain diseases that influence one another, and which both need treatment, at the same time. This is when dual diagnosis treatment is need. It is an approach used by clinicians to treat individuals affected by two co-occurring or coexisting conditions simultaneously. Dual diagnosis affects a person physically, mentally, spiritually, emotionally and socially. There is a need for an all-inclusive approach that identifies both disorders, evaluates both disorders, and at the same time treats both disorders. Many treatment centers now only treat one or the other. Substance abuse treatment are not recommended or designed to handle a mental illness and vice versa. Awareness about the problem needs to be made public, so that people know the signs to look for and how to approach the person about their disorder correctly. Patients also need to be aware of the help that is available to them and support groups like Dual recovery Anonymous. There also needs to be better training for the counselors and physicians so that they will be able to better and accurately diagnosis patients. For recovery to be successful you must treats a client’s addiction and mental health problem.