What does dual diagnosis or co-occurring illness mean and how common is it in the United States?
The term co-occurring disorder (also referred to as dual-diagnosis) is the term used to indicate a person who has one or more disorders relating to the use of alcohol and/or other drugs of abuse as well as one or more mental disorders.
A diagnosis of co-occurring disorders is made when at least one disorder of each type can be established independent of the other and is not simply a cluster of symptoms resulting from one of the disorders. Either substance use or mental illness can begin first. Some individuals who have mental illness may use a substance as a means of reducing their symptoms. This is often referred to as “self-medicating”.
The term mental health disorder generally refers to mood disorders (depression or bipolar), anxiety disorders (generalized anxiety disorder, panic disorder or social anxiety disorder), trauma or stressor related disorders (PTSD, adjustment disorders), thought disorders (schizophrenia), and other disorders not substance-related or induced by substances. The Diagnostic and Statistical Manual 5 or DSM 5 is the national standard for the definition of mental disorders.
According to the National Survey on Drug Use and Health (NSDUH) approximately 9.2 million adults experienced both substance use disorder and mental illness in 2018.
The NSDUH data for 2018 provides a few general trends worth noting these include; increasing rates of serious mental illness, major depression, and suicidality in young adults and major gaps in treatment received by those affected.
The NSDUH data for 2018 also illustrated increased rates of substance use among those who have mental illness compared to those who have no mental illness. Suicidal thinking and attempts are also higher in those who have substance use disorders and those who have a co-occurring mental illness. Those with co-occurring illnesses have higher rates of relapse.
How can my doctor determine if I have a co-occurring disorder?
It is important to let your doctor know if you are using any substances including herbal or over-the-counter supplements. If a doctor or licensed counselor is unaware of substance use, they may provide an inaccurate diagnosis or treatment.
Your doctor will attempt to determine if the symptoms are caused by a substance, medication (given by a doctor, over the counter, or taken without a prescription), or a general medical condition. In addition to asking questions, your doctor may perform a physical examination and order other tests such as blood work or request to review your previous treatment records.
Your doctor will ask about your history of substance use and mental health symptoms. If a period of sobriety has occurred this can often help in clarifying the diagnosis. For example, If you noticed feeling depressed while using alcohol regularly the feelings of depression could be due to alcohol. If you then stop using alcohol and notice feelings of depression stop this suggests alcohol was the cause of the symptoms. On the other hand, if the cessation of substance use does not alleviate mental health symptoms an independent mental health diagnosis may be the cause.
For many a period of abstinence is not possible or waiting to clarify the diagnosis is not an available luxury and treatment of both is recommended. In these cases working closely with your doctor over time is critical.
What can I do if I think I have either a substance use disorder, mental health disorder, or both?
Speak with your doctor or a counselor. For many individuals, their primary care provider (PCP) or family physician is the first contact made. An individual can also seek an assessment with a psychiatrist or licensed mental health counselor.
Some offices/agencies require appointments made ahead of time while others offer walk-in assessment hours on specified days.
An excellent resource can be found on the Substance Abuse and Mental Health Services Administration or SAMHSA website (link below). This website provides a treatment locator for substance use disorder, mental disorders, or both.
You can also contact your insurance carrier and request a list of providers who accept your insurance. This can also be done online with many companies.
What are some of the treatment options for those with co-occurring illnesses?
The best treatment option for those with co-occurring illnesses is integrated treatment. Integrated treatment refers to a program that can provide treatment for substance use disorder and mental illness.
Treatment may include the use of medication, therapy, or a combination of medication/therapy and self-help groups. The treatment setting in which treatment is provided can vary and is based on the individual needs of the person seeking treatment. Some typical treatment settings include residential treatment, partial hospitalization, intensive outpatient, aftercare and outpatient. It is important to remember that treatment needs can vary over time and an individual may find benefit from transitioning to more intensive treatment during times of symptom worsening. During times of symptoms remission and stability, an individual may opt to reduce the intensity of their services. Always let your doctor or counselor know if you have unmet treatment needs so you can work collaboratively to address them.
Effective treatment realizes recovery does not occur in days but rather in months and years. Those with co-occurring disorders, substance use disorder, or mental illness do not achieve functional improvements or stability quickly but gradually through regular engagement with a consistent treatment program tailored to their individual needs.
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Substance Abuse and Mental Health Services Administration. Integrated Treatment for Co-Occurring Disorders: The Evidence. DHHS Pub. No. SMA-08-4366, Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services, 2009.