According to the National Survey on Drug Use and Health, almost 45% of addiction patients have a co-occurring mental health issue. By definition, a dual diagnosis is the presence of any behavioural or mental health condition alongside substance abuse disorder (SUD). 

Integrated addiction-related treatment is essential for people who receive a dual diagnosis to address all the interconnected and underlying issues.

Common mental health issues and addiction

• Bipolar disorder. Almost half the patients diagnosed with bipolar disorder struggle with addiction. It’s made complicated by the temptation to self-medicate. Alcohol and drugs tend to offer temporary relief from the manic episodes, making it easy to abuse them.
• Attention-deficit hyperactivity disorder (ADHD). ADHD is a common behavioural issue often developed during childhood. Based on the medical data, people with attention deficit hyperactivity disorder are more likely to abuse substances. It’s their way to cope with the difficulties of myriad uncomfortable symptoms. The stimulants prescribed to ADHD patients are often habit-forming. Once hooked, they could cause a toxic pattern leading to substance abuse.
• Borderline personality disorder. A lot of studies tell us that substance use disorder and BPD (borderline personality disorder) generally occur together. Almost 2/3rd of BPD patients tend to abuse substances, or will abuse them at some point or another.
• Generalised anxiety disorder (GAD). GAD is easily the commonest mental condition affecting over 18% of the total adult population. Again, to manage the symptoms of anxiety, people may turn to alcohol or drugs. On top of that, medications like Benzodiazepines are highly habit-forming. It’s easy to get hooked on these prescription medications.

What makes dual diagnosis treatment different?

In comparison with the general population, people with mental health or behavioural conditions run twice the risk of suffering from SUD. In the same way, people who abuse alcohol and drugs are more likely to develop a mental health disorder aka co-occurring disorder; for example, bipolar disorder along with alcohol addiction.

It is accepted that while substance addiction can cause mental health issues – and vice versa – there are many other elements that control both conditions. They may cause both of them to occur simultaneously.

Here are some of the most common overlapping factors that may aggravate SUD or mental health issues:

• Brain responses. Drugs can cause symptoms similar to a mental health condition. For example, excessive marijuana usage can cause psychosis in some people which is a major mental health issue. A patient with psychosis experiences dissociation and loses touch with reality.
• Genetics. Sometimes a person is genetically predisposed to suffer from a mental disorder or develop an addiction. Research tells us that almost 60% of susceptibility to develop addiction depends on the genetic makeup.
• Environmental triggers. Traumatic events, persistent anxiety, and chronic stress can kickstart a mental disorder or even substance abuse.
• Early exposure to drugs and alcohol. People who get exposed to drugs and alcohol early in childhood carry a higher risk of developing mental disorders or substance dependence later in life, often requiring substance abuse treatment. That’s because the brains of young adults and adolescents are more susceptible to chemical changes and brain damage caused by substance abuse compared to older adults.

It’s important to take into account all these factors to come up with an effective treatment programme that addresses all key aspects of a patient’s life.

Dual diagnosis treatment options for mental health and addiction

• Detoxification. Detox is almost always the first phase of all addiction treatment programs. If this phase is not successful, the patient will have a hard time achieving a successful recovery. Once they are past this initial hurdle, the rest of the treatment will begin. Doctors can do it on both an inpatient and outpatient basis. However, the former is most effective. During drug or alcohol detox, trained medical experts monitor the patient all day every day until it’s over. They may use a tapering method or medication to wean a person off of drugs and manage the withdrawal symptoms.
• Inpatient rehabilitation. It’s best for a person with a co-occurring disorder to enrol in an inpatient rehab treatment programme. As part of the programme, they receive round-the-clock medical and mental health care while residing on the premises. Rehab centres provide necessary support, therapies, services, and medication to work on underlying causes that are worsening the SUD and behavioural issues.
• Psychotherapy. Psychotherapy can be of several kinds such as cognitive behavioural therapy, group therapy, individual therapy, etc. The basic idea is to teach the patient ways to cope with negative thinking patterns and replace them with healthy ones. Patients learn to manage cravings to avoid relapses. It is highly effective in boosting self-esteem and raising self-awareness.
• Medications. Medications are indispensable for treating substance abuse and mental illness. Many medications like Benzos can ease the process. They can manage an often painful withdrawal period caused by detoxification.
• Supportive housing. Often, you will need support housing after you have successfully finished the inpatient addiction treatment. They also go by sober houses. Think of it like the layover between rehab life to regular life. It helps with the transition. However, because they are not run by licensed professionals, the quality of care may vary significantly. Therefore, do plenty of research before picking one.
• Self-help and support groups. Battling addiction or mental health issues can be isolating. It’s not without a fair set of challenges. That’s why support groups are so effective. They bring people together who are going through the same stuff. It gives a platform for them to share their joys and frustrations, celebrate their successes, find a sense of community, necessary help and resources for a quick recovery.

It’s the perfect space to develop healthy friendships that encourage you to stay sober and healthy. 12-step meetings, Alcoholics Anonymous and NA are common examples of these support groups.

The cost of dual diagnosis treatment

While dual diagnosis treatment can be expensive, you may get some part covered through health insurance. Generally, you can expect to spend an out-of-pocket cost running between $200–$900 per day. It can, however, vary significantly based on the location, duration of the program, nature of the treatment, amenities offered, etc. Some of the most expensive addiction treatment programs can cost over $100,000 for the treatment duration.

Duration of dual diagnosis treatment

You can expect to spend anywhere between 30–90 days. You could even enrol in a six-month programme if you are truly committed. The actual duration depends on the person’s individual circumstances, the severity of addiction, family support, and personal commitment to achieving sobriety.

Ellen Diamond did her degree in psychology at the University of Edinburgh. She is interested in mental health and well-being.