Symptoms & Signs of Dual Diagnosis & Co-Occurring Disorders
A dual diagnosis indicates the presence of substance abuse in tandem with a mental health disorder. It’s also known as “co-occurring disorders.” The National Alliance on Mental Illness reports that 7.9 million Americans experience co-occurring disorders. Dual diagnosis can involve any addictive substance and any form of mental disorder. A substance use disorder can be caused by a mental health disorder, or vice versa. Co-occurring disorders should always be treated at the same time.
What Is a Substance Use Disorder?
Those with substance use disorders engage in compulsive use of addictive substances. The long list of these substances includes:
- Illegal drugs (heroin, cocaine, methamphetamine, etc.)
- Prescribed medications (opioid painkillers, attention deficit disorder medications, benzodiazepines, etc.)
Additionally, addiction can cause chemical changes in the brain that result in chemical dependency. This usually means that going without the drug causes harsh withdrawal symptoms.
The symptoms of substance abuse depend on the type of substance you’re addicted to, but common problems include:
- Repeated use of a substance, even in high-risk situations
- Isolation from family, friends or other support networks
- Sudden changes in attitude or behavior
- Increased tolerance to the effects of drugs or alcohol
- Onset of withdrawal symptoms when substance use stops or decreases
- Strong cravings for a given substance
- Difficulty maintaining normal functioning in work, school or family life
- Spending a significant amount of time or effort obtaining a substance
You should also note what your friends and family say about your behavior. Sometimes loved ones can see signs a person struggling with addiction cannot. If your family and friends tell you they notice a problem with your drug or alcohol use, take them seriously.
Mental Illnesses Associated with Substance Abuse
Substance abuse can cause mental illness when effects of the substances, like depressed nervous system function, affect brain chemistry. Mental illness usually causes substance use when alcohol and drugs are used to cope.
Some combinations of disorders are more common than others, like:
- Bipolar disorder and alcoholism – People experiencing a manic episode may misuse alcohol as a result of poor judgment and lowered inhibitions. Alcohol also may be used to cope with the symptoms of a depressive episode.
- Anxiety disorders and benzodiazepine addiction – Benzos like Xanax® are often prescribed to treat anxiety disorders. Addiction occurs when the drug isn’t taken as prescribed. This is typically done to increase the drug’s effects or when seeking a “high.”
- Major depressive disorder and cocaine addiction – Stimulants like meth or cocaine may counteract the lethargy that depression produces. They may give you a rush of energy and “feel good” chemicals. This combination is particularly dangerous because the come-down can result in worse depression than before.
- Eating disorders and methamphetamine addiction – Eating disorders like anorexia or bulimia cause an unhealthy preoccupation with your weight and body image. People with eating disorders sometimes turn to meth because it suppresses their appetite. On meth, users may go several days without feeling hunger.
Each mental disorder produces its own unique set of symptoms. There are four mental health conditions most commonly associated with substance abuse:
- Anxiety disorders
- Major depression
- Personality disorders
Let’s examine a few signs and symptoms of each and explain their connection to addictions.
- Feeling restless and on-edge
- Sleep problems—typically trouble falling and staying asleep
- Excessive and uncontrollable worry
- Muscle tension
- Heart palpitations or racing heartbeat
People with anxiety are more likely to take “downers” to feel calm or relaxed. These could include:
They might use to get through social situations or to sleep. They may simply want a break from relentless worry.
Major Depressive Disorder
The most common symptom of major depression is a persistent feeling of sadness and numbness. Other major depression symptoms include:
- Daily fatigue or loss of energy
- Impaired concentration and indecisiveness
- Insomnia or hypersomnia (excessive sleeping) almost every day
- Less interest or pleasure in almost all activities
- Recurring thoughts of death or suicide
- Significant weight loss or gain
Those with depression may turn to alcohol and drugs to numb their emotional pain. They may wish to “feel something” again. They may also use to get to sleep or stay awake or in an attempt to control other symptoms of depression. They tend to use “uppers” like ADHD medication and cocaine.
Schizophrenia is a disorder characterized by hallucinations (sensing things that aren’t there) and delusions (beliefs not based on reality). Other symptoms include:
- Confused thinking
- Disorganized and nonsensical speech
- Jumpiness or movement disorders
- Trouble concentrating
- Withdrawing from family and friends
- Poor hygiene
Alcohol, nicotine, cocaine and marijuana are the most common form of substance abuse among those with schizophrenia. Substances may be used to escape the stress and fear associated with schizophrenia. Marijuana and stimulants have been shown to make schizophrenia symptoms worse.
Personality disorders are characterized by a pattern of viewing the world that’s different than what society expects. This results in unhealthy behaviors and attitudes that are inflexible and resistant to change. Each personality disorder is completely unique. Here are a few examples:
- Schizoid personality disorder – This disorder involves detachment from relationships and limited expression of emotion.
- Antisocial personality disorder – People with this disorder typically lack empathy. They have an extremely difficult time relating to others and may show a pattern of disregard or violation of others’ rights.
- Borderline personality disorder (BPD) – Clients with BPD have low levels of distress tolerance and self-esteem. This results in instability in relationships and impulsivity.
- Histrionic personality disorder – Excessive attention-seeking behavior and exaggerated emotional expression are associated with this personality disorder.
People with personality disorders tend to use marijuana, alcohol and opioids more than those in the general population. Many drugs negate or decrease the effectiveness of antidepressants. Still, antidepressants are commonly used to treat personality disorders.
What Are the Treatment Options for Dual Diagnosis?
Dual diagnoses are best addressed through an integrated treatment plan. This means receiving care for both disorders at the same time. Otherwise, the effects of one may quickly lead to a relapse of the other.
Highly effective treatments for dual diagnoses are:
- Cognitive behavioral therapy (CBT) – This type of talk therapy is done one-on-one or in groups with a therapist. It involves learning about how thoughts, feelings and actions influence each other. Clients learn skills to interrupt these patterns. This results in better management of their symptoms and better control over their behavior.
- Medications – Antidepressants can be very effective for anxiety, depression and personality disorders. Mood stabilizers and antipsychotics are effective for those with bipolar disorder or schizophrenia. Quality psychiatric care is needed to make sure medications don’t interact negatively with co-occurring disorders or drugs abused.
- Support groups – Many people learn and practice new skills in support groups. They can find hope through a community of peers who understand what they’re going through. Support groups may include 12-step groups like Alcoholics Anonymous® or Narcotics Anonymous®. The National Alliance on Mental Illness® (NAMI) is a great resource for locating support groups for specific diagnoses.
If you suspect you or a loved one suffers from co-occurring disorders, it’s important to start with an assessment. The most effective mental health and addiction treatment depends heavily on the outcomes of a thorough evaluation. Successful recovery can completely shift how you live your life and interact with people around you.
Promises addiction treatment center offers dual diagnosis treatment that encompasses therapy, medications and support groups. We’ll help you with detox, if needed, and assess your symptoms to match you with a program best suited to your needs. We pride ourselves on our integrated treatment approach. Call us today at 844-876-5568 for a free consultation.