What is Dual Diagnosis?
Dual diagnosis, or co-occurrence, is when an individual has both a substance use disorder (SUD) and a mental health disorder. According to the National Alliance on Mental Illness (NAMI), about half of all people with mental illness also have a SUD. At the same time, one-third of all people with a SUD also have a mental health diagnosis.
If You Have a Dual Diagnosis, You are Not Alone!
The SAMSHA 2021 National Survey on Drug Use and Health reports that in 2021, 44.1 million Americans over the age of 18 were grappling with a substance use disorder. Of those, 17.9 million were operating with a dual diagnosis. “Among the 17.9 million adults aged 18 or older in 2021 with co-occurring AMI [any mental illness] and an illicit drug or alcohol use disorder in the past year, 52.5% (or 9.0 million people) received either substance use treatment at a specialty facility or mental health services in the past year.” Further, 5.8 million people in the U.S. are struggling with a co-occurring SUD and severe mental illness (SMI). Of those, 66.9% (3.9 million people) had sought treatment in 2021.
What these numbers indicate is that there is a huge need right now for programs that can help people with a dual diagnosis treat both their mental illness and their substance abuse. They also indicate that the reasons individuals fall into substance abuse are often far more complex than they appear. Some of the mental health issues regularly associated with substance abuse include depression, anxiety, ADHD, schizophrenia, bipolar and personality disorders. Here at The Grounds Recovery, we have also worked with patients struggling with eating disorders and PTSD, among others.
Why Does Co-Occurrence Happen? The Self Medication Hypothesis
Studies suggest that co-occurrence happens when people with a mental health diagnosis attempt to alleviate their symptoms with substances. Some people report using drugs or alcohol to relieve symptoms of anxiety or depression, to help them sleep, and to give them an escape from the difficulties that come with their mental health diagnosis. People with bipolar disorder have reported using methamphetamine to induce a manic state or as a way to counteract side effects from prescribed medications. More generally speaking, people with mental health diagnoses often use substances to relieve dysphoria or a general unease or lack of satisfaction in life.
A Need for Better Diagnostic Standards for Dual Diagnosis Patients
The co-occurrence of SUDs and mental health issues was first identified as a potential diagnosis in the 1980s. Before and during this time period, mental health issues and substance use issues were treated separately, and the success rates were low. Within that decade and in the decades that followed, efforts were made to create integrated treatment plans that addressed both disorders concurrently. Still, according to A Call for Standardized Definition of Dual Diagnosis, published in the journal, Psychiatry in 2007, the results/efficacy of these attempts were difficult to quantify. The authors claim that one of the reasons for this was that during that entire time period, the inconsistent diagnostic criteria created methodological problems when trying to evaluate whether or not a program worked.
Eleven years later, in 2018, the Illinois Criminal Justice System published an evaluation of one of its dual-diagnosis programs operating in a women’s prison. The paper’s introduction laments the lack of “a standardized definition of COD [co-occurring disorders].” The authors go on to explain how this negatively impacts screening procedures within the criminal justice system and contributes to the continued bifurcation of treatment and compartmentalization of funding.
Now, in 2023, there is more support than ever for dual diagnosis patients, and the theory that co-occurring disorders should be treated simultaneously and together is widely accepted and implemented. Despite these strides, however, there is still no nationally standardized diagnostic protocol, and this continues to be an impediment to the development of clinically proven integrated care models. A 2020 study titled, Concurrent Disorder Management Guidelines. Systematic Review, published in the Journal of Clinical Medicine, conducted literature searches for “current concurrent disorders’ clinical recommendation management guidelines” and found that despite being a recognized diagnosis for going on five decades: “Overall, specific evidence for the management of concurrent disorders continues to be rare, making it necessary for guidelines to often rely on combining evidence for individual disorders.” Further, “…certain important aspects that are essential for treatment planning are not addressed by any guideline, including the specifics of a concurrent disorder framework, the “matching” of treatment needs, and the evaluation or ‘staging’ of the severity.”
What Does This Mean for Dual Diagnosis Patients?
There is ample evidence on the streets, in our prisons, and within many of our own families that the healthcare system needs to do better when it comes to treating patients with dual diagnoses. The national homelessness crisis is one glaring case in point. An article from Stanford University reports that, in California, homelessness rose 42% between the years 2014 and 2020, with 25% of all homeless adults having a severe mental illness and 27% having a long-term SUD. But the validity of these numbers is questionable because getting a truly accurate gauge on the problem goes back again to the lack of clear diagnostic criteria. The same article states:
In 2019, the Los Angeles Homeless Services Authority released a report showing that 25 percent of the unsheltered homeless had a severe mental illness, and 14 percent had a substance use disorder. Using the same survey data, the Los Angeles Times showed a much higher prevalence level: about 51 percent with mental illness and 46 percent with substance use disorder. The critical difference lies in the definition of mental health and drug addiction. The government’s estimates are lower because they only counted people with a permanent or long-term severe condition (LAHSA 2020).
Effectively, this means that because we don’t have standardized diagnostic tools, we can’t really understand the severity of the problem, and this has led to huge cracks in our support systems, and many, many people are falling through.
Despite These Issues, There Are Approaches that Work
Despite the work that still needs to be done in understanding and treating dual diagnosis, there are many organizations that strive to help individuals with co-occurring disorders manage their diagnoses and develop the skills and tools to help them lead healthy, productive lives.
Studies indicate that social support combined with intensive case management leads to positive outcomes for individuals with dual diagnoses. Having people to lean on and rely on for help goes a long way. Mental health patients and SUD patients benefit greatly from personalized interventions that help them develop life skills, personal empowerment, accountability and coping strategies, and individuals receiving this type of care often have better outcomes that are maintained over time.
The Grounds Recovery Can Help Dual Diagnosis Patients
At The Grounds Recovery, we take our role as doctors, mentors, counselors, instructors, and friends very seriously. We are here to help our residents who are living with co-occurring disorders understand their diagnosis and their triggers. The social support of living in a home with other people who are learning the same skills is supplemented by a case management system and personalized treatment plan that fosters accountability, personal responsibility, self-efficacy and practical skills needed for successful daily living.
We work with individuals struggling with anxiety, depression, eating disorders, PTSD and bi-polar disorders; however, we do not treat individuals with severe mental illness, individuals with an un-stabilized mental health condition, or individuals who may pose a threat to other patients and/or staff.
