Dual diagnosis is the term used to describe the overlapping combination of diagnosable substance use disorder (substance abuse/addiction) and separately diagnosable mental illness. In the U.S., millions of people have some form of this condition, which can present tremendous challenges during treatment and recovery. In a study published in September 2014 in the Journal of Dual Diagnosis, a team of researchers from Dartmouth College looked at some of the personal strategies that increase the odds that an individual with dual diagnosis will avoid relapsing back into substance use for extended periods of time.
Over 50 percent of all people involved in diagnosable drug abuse have the symptoms of a separately diagnosable mental illness, the National Alliance on Mental Illness reports. In addition, more than one out of three people involved in diagnosable alcohol abuse have the symptoms of a separate mental illness. A similar picture emerges for people affected by non-substance-related mental illness. Over 50 percent of those individuals with a severe mental illness (e.g., schizophrenia, major depression or bipolar disorder) also have separately diagnosable problems with drugs and/or alcohol. When all forms of non-substance-related mental illness are taken into consideration, almost one out of three affected individuals has additional drug/alcohol problems. Substance abuse/addiction and non-substance-based mental illness are comorbid conditions. This means that a person affected by dual diagnosis will have more problems than a person only dealing with abuse/addiction or a person only dealing with non-substance-based mental illness. Specific examples of the comorbid impact of the condition include a smaller likelihood of finding appropriate treatment resources, a smaller likelihood of taking advantage of available resources, greater difficulty finding effective medications for mental illness symptoms, a higher chance of experiencing serious physical health issues during recovery and a higher chance of dying well before reaching the average lifespan found in the general population.
All people addicted to alcohol, drugs or medications have undergone persistent changes in their baseline brain function that make them physically dependent on continued substance use. When the decision is made to enter treatment, any affected individual must go through a detoxification period before establishing an initial state of substance abstinence. Unfortunately, detoxification does not alter the underlying brain changes that support ongoing addiction. This is why a person who goes through detox must enter an active phase of treatment that uses medication, counseling/therapy or a combination of medication and counseling/therapy to support the return to a substance-free lifestyle and the continuation of abstinence over time. A relapse occurs when the urge to use drugs or alcohol at least temporarily overrides the changes brought about by treatment and the individual returns to substance intake. As a rule, addiction specialists view relapses as survivable pitfalls on the path to long-term sobriety.
How Do They Avoid Relapse?
In the study published in the Journal of Dual Diagnosis, the Dartmouth College researchers used interviews with a group of 12 men to gain a better understanding of the steps that people with dual diagnosis take to successfully avoid experiencing a substance relapse after establishing a pattern of abstinence. All 12 of these men had substance use disorder combined with a psychosis-producing mental illness and remained abstinent from substance intake for at least a full year after entering treatment. Specific substances previously taken by the study participants included marijuana/cannabis and alcohol (both known for their ability to support or worsen a psychotic mental state). Specific mental illness diagnoses among the participants included bipolar disorder (which triggers psychosis in some forms) and a schizophrenia-related condition called schizoaffective disorder. After completing their interviews, the researchers identified several strategies that helped the study participants avoid relapsing back into substance intake for extended periods of time. These strategies included creating an effective support network during the recovery process, finding activities that contributed to a positive and productive frame of mind and establishing a habit of closely reviewing thoughts/attitudes on relevant subjects such as substance intake, emotional/psychological well-being and personal accountability for treatment outcomes. The study’s authors broadly refer to the steps taken by the study participants as “self-management.” They believe that the participants’ abstinence success came from combining a number of self-management approaches. They also believe that their findings may demonstrate a durable strategy of abstinence maintenance that applies more widely to the sizable population of people attempting to recover from the impact of dual diagnosis.