+ Individual and societal impacts
People who are actively using drugs or alcohol are less likely to follow through with their treatment plans. They’re less likely to take their medications as directed and more likely to miss appointments, leading to more psychiatric hospitalizations and other adverse outcomes. Similarly, active substance abusers are less likely to receive adequate medical care and have greater chances of experiencing severe medical complications and early death.
Individuals with mental illness who abuse drugs and/or alcohol, and who are untreated are:
- More prone to impulsive and potentially violent acts.
- More likely to attempt suicide and to die from their suicide attempts.
- More likely to become physically dependent on their substance of choice.
- Less likely to achieve lasting sobriety.
Undiagnosed, untreated or undertreated co-occurring disorders also increase likelihood of incarceration and homelessness. While treatment is proven to be effective, many who need it don’t have access to care. This burdens individuals, their families and society at large.
+ How Common is Dual Diagnosis?
Recent scientific studies have suggested that nearly one-third of people with all mental illnesses and approximately one-half of people with severe mental illnesses (including bipolar disorder) and schizophrenia) also abuse substances. A report published in the Journal of the American Medical Association documented that 37 percent of alcohol abusers and 53 percent of drug abusers also have at least one serious mental illness. Approximately 8.9 million adults are diagnosed with both a mental and substance use disorder. However, only 7.4 percent of individuals receive treatment for both conditions and more than half – 55.8 percent – receive no treatment at all.
+ Diagnosis
Upon initial examination, it may be difficult for a physician to determine if a person’s primary problem is substance abuse or a psychiatric disorder. Many symptoms of severe substance abuse are common to other psychiatric conditions. Therefore, the individual may have to undergo withdrawal from alcohol and/or drugs before a doctor can accurately identify an underlying mental issue.
+ Treatment
Treatment that addresses psychiatric conditions and substance use at the same time – integrated treatment – is most productive. This approach offers lower costs and better outcomes such as:
- Reduced substance use
- Improved psychiatric symptoms and functioning
- Decreased hospitalization
- Increased housing stability
- Fewer arrests
- Improved quality of life
Many people choose to seek assistance in ending their drug and alcohol abuse through inpatient detoxification at a hospital or a detoxification facility. Supervised treatment with the appropriate medications can significantly ease symptoms and avoid serious complications of drug and/or alcohol withdrawal. It can take a few days to a week or more depending on the substances and amount of time abused.
Once detoxification is complete, the patient can undergo simultaneous rehabilitation for the alcohol or drug problem and treatment for the psychiatric disorder. While it is possible to treat people with mental illness while they are still using, treatment of mental illness is far more effective when the individual is sober and fully participating in treatment.
Multipronged rehabilitation
Rehabilitation for substance abuse typically incorporates individual and group psychotherapy, education about alcohol and drugs, exercise, proper nutrition, and participation in a 12-step recovery program such as Alcoholics Anonymous. The objective is not simply to refrain from drugs and alcohol, but to learn to live life without them.
Psychiatric treatment
The nature and severity of the psychiatric illness and the substance use disorder, associated risks or complications, and the individual’s treatment history will help determine the appropriate level of care – inpatient treatment, partial hospitalization or outpatient treatment.
Psychotherapy
Some people find therapy to be a helpful part of maintaining their sobriety. This can include individual therapy (e.g., cognitive behavioral therapy) as well as self-help groups such as Alcoholics Anonymous, Narcotics Anonymous or Smart Recovery.
Medications
Medications can be helpful in maintaining sobriety as well as in treating the psychiatric disorder. A physician may prescribe medications to treat people with alcoholism or other addictions. The complexity of choices makes it advisable for any individual with dual diagnosis and their loved ones to discuss medication management strategies with their doctors.
Family and social supports
Participation in education, counseling sessions and support groups for the patient’s family also fosters successful rehabilitation for substance abuse and treatment for a psychiatric problem.
