More than 50 percent of people with mental illness also have a substance abuse problem. Among the severely mentally ill, the incidence may be as high as 85 percent. Similarities in symptoms mean families may be unaware of—and healthcare professionals may misdiagnose—either or both conditions.
When substance abuse occurs with psychiatric illness, the combination is known as dual diagnosis. Often, families and healthcare or clinical professionals may be in a state of “dual denial” regarding both the psychiatric disorder and the addiction.
Your Best Choice to Treat Substance Abuse & Psychiatric Illness
Assistance for combined substance abuse and psychiatric illness begins with the diagnosis you receive from the mental health professionals at Dominion Hospital. As one of only three free-standing psychiatric hospitals in Virginia, mental health care is all we do. Our extensive experience in the assessment and treatment of dual diagnosis disorders in adults and adolescents assures you or your loved one of the best care available in the Northern Virginia and metropolitan Washington, D.C., region.
Dominion Hospital’s Multispecialty Approach to Care
Our successful multispecialty team approach supports you and your family as you identify substance abuse issues in the context of psychiatric illness. Through careful evaluation of medical and psychological history, our experts can determine the most appropriate treatment resources at Dominion Hospital and in the community, including self-help recovery groups.
You benefit from our complete spectrum of care in a structured environment, including assessments, different levels of treatment intensity to meet your individual needs and education on how best to manage your disease. Participation in onsite relapse groups, such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), provides valuable structure and develops skills needed to manage mental illness and achieve sobriety.
How We Can Help
Your program of care begins with an individual assessment to determine the depth and type of substance abuse or addiction present in your life. Then, in addition to our standard program of care, you’ll participate several times a week in a series of physician-ordered group therapy sessions, including our onsite Alcoholics Anonymous and/or Narcotics Anonymous groups if you’re staying in one of our inpatient units. Our program helps:
- Stabilize your current situation
- Support your investment in treatment
- Encourage ongoing treatment through our comprehensive discharge planning process
What You Need to Know About Dual Diagnosis (DD)
Substance abuse with psychiatric illness—dual diagnosis (DD)—occurs when alcohol and/or other drugs are used to soothe symptoms of psychiatric disorder or to cope with symptoms such as anxiety. Over time, a deep-seated addiction can develop. Sometimes, as addiction progresses, depression, agitation and other psychiatric symptoms may appear. The combination compounds a person’s distress and disability.
Many researchers believe substance abuse may trigger an underlying, previously undiagnosed psychiatric disorder. Using alcohol or other drugs can seriously impair judgment, putting those with dual disorders at greater risk for suicide. Special challenges in treating dual diagnosis include:
- Denial of both conditions
- Resistance to treatment
- Higher risk for relapses
- Difficulty functioning and maintaining relationships at work and at home
- Greater risk for suicide
Because the symptoms and conditions are serious, it’s essential to seek help right away.
The complex relationship between addiction and psychiatric illness presents difficulties in treating these coexisting disorders. Similar symptoms may appear for both conditions, as when a person with an alcohol addiction displays symptoms seen in psychiatric disorders, such as depression, anxiety, mood swings or erratic behavior, among others.
Treatment of psychiatric disorders becomes more complicated when combined with substance abuse problems. Even minimal use of alcohol and/or drugs can result in recurrent symptoms for a person with depression. Or an undiagnosed psychiatric disorder can trigger a relapse from sobriety. Successful treatment requires recognizing and treating both conditions simultaneously and aggressively.
Compared to the general population, evaluating substance abuse in people with mental illness requires different criteria. Typically, a person with dual diagnosis may not be drinking and using drugs regularly. However, any use of alcohol or drugs can be detrimental to psychiatric well-being. In assessing addiction, consequences of drug or alcohol use can be more significant, such as in the case of a person who may only drink once or twice a year, but each occasion precipitates a suicide attempt.
The three levels of substance abuse are:
- Use – Any intake of alcohol and/or drugs; experimentation
- Abuse – Continuing to use alcohol and/or drugs despite negative consequences
- Dependence – Substance abuse with greater tolerance
As an example, consider an adolescent male who begins experimenting with alcohol (use). He continues to drink more frequently, despite an arrest for driving under the influence (abuse). Over time, he requires greater quantities of alcohol to achieve the desired effect (dependence). When he tries to limit his alcohol intake, withdrawal symptoms (physical and psychological reactions to decreased substance use) occur. Without recognition and treatment, alcohol dependence eventually affects all aspects of his life—health, family, spirit, home, work.
Among the indicators of substance abuse are:
- Inability to control or limit substance use
- Preoccupation with substance use
- Failure to fulfill obligations at home, school or work
- Continued use despite persistent social or medical problems
- Need for increased amounts of substance
- Recurrent use in physically hazardous situations, such as driving (DUI)
- Withdrawal symptoms
Evaluating all aspects of an individual’s health provides vital information for accurate diagnosis and treatment planning. A comprehensive biopsychosocial (physical, psychological, social) assessment is the critical first step in treating dual diagnosis.
The assessment involves a multispecialty team consisting of a psychiatrist, a medical physician, a clinical social worker, expressive therapists and nursing staff. Family members are interviewed, and additional assessments may be conducted to gather information on hobbies, exercise activities and recreational interests. Other healthcare professionals also may be consulted.
- A psychologist provides personality or intelligence testing for children and adolescents.
- A dietitian evaluates nutritional needs.
Throughout the assessment process, Dominion Hospital clinicians gain an understanding of the individual’s overall level of functioning, family history and living situation, which enables our treatment professionals to identify and build on individual strengths during the recovery process.
Increasingly, evidence points to disturbances in brain neurochemistry as the biological basis for addiction and for psychiatric disorders such as depression, anxiety and psychosis. This may explain why psychiatric and addictive illnesses often occur in the same individual and why symptoms overlap. Individuals with dual diagnoses may display some of these common psychiatric illnesses:
- Adjustment disorders
- Bipolar disorder
- Conduct disorder
- Eating disorders
- Learning disabilities
- Obsessive-compulsive disorder (OCD)
- Panic disorder
- Post-traumatic stress disorder (PTSD)
- Schizoaffective disorder
Many factors affect the treatment of individuals with coexisting substance abuse and mental illness, including:
- Type and severity of psychiatric illness
- Duration of illness—ongoing; occasional; reaction to specific events
- Drug or combination of drugs used
- Severity of addiction
- Motivation for recovery
- Family history
Because safety is paramount for dual-diagnosis individuals, absolute abstinence may not be the initial goal. Most important is a continued commitment to sobriety and a willingness to be an active participant in the recovery process.
We view relapse as part of recovery. Individuals and families must be realistic during treatment—progress is often slow, setbacks can occur and symptoms may return.
Many dual-diagnosis individuals benefit from the 12-step approach endorsed by Alcoholics Anonymous (AA) and Narcotics Anonymous (NA). A recent study found that 40 percent of AA attendees also display signs of clinical depression.
At Dominion Hospital, our treatment plan integrates medication evaluation and management. Most medications used to treat psychiatric disorders—proven safe and effective for long-term use—are not addictive. However, other medications are highly addictive and should be avoided by individuals with a history of substance abuse.
When appropriate, special medications—including those to help reduce feelings of craving or euphoria—may be prescribed to assist recovery. But the combination of alcohol or drugs with some psychiatric medications can be toxic—even life-threatening—so close monitoring is advised.
Family history of psychiatric and/or addiction disorders may complicate the situation. Always affected when loved ones display a dual disorder, families may feel frustrated, angry and hopeless. Because families may experience difficulty when treatment begins, we provide educational information and guidance on ways to best help loved ones recover.
Behaviors typically indicating alcohol or drug problems (being detached, rebellious or argumentative) may already exist in people with mental illness—meaning families are often unaware of a loved one’s substance abuse problem.
Family counseling is an essential part of the treatment process. In addition, self-help and support groups are available for friends and relatives of individuals with a dual diagnosis. By attending family support groups like Al-Anon, families can find support and obtain a greater understanding of how to help a loved one.
Adolescence—a period of biological, psychological and social change—is a time of transitions and firsts as teens experience new schools and peers, first love, first job, first drink. For adolescents with dual diagnosis, such changes must be considered and factored into the biopsychosocial assessment.
Peer pressure makes adolescents more resistant than adults to working on substance abuse issues, which means family involvement is even more critical in achieving successful treatment outcomes.
As with adults, more than half of adolescents with psychiatric disorders also have a substance abuse problem. Typically, they don’t have a “drug of choice” and are more likely to use whatever’s most easily available, which increases the potential for more serious symptoms, such as delirium, delusions, hallucinations and psychotic episodes.
Learn more about school refusal as a potential symptom of deeper mental health issues in adolescents.
- Partial Hospitalization Program
- Expressive therapies
- Self-injurious behavior
- Reflections Eating Disorder Treatment Center
Review a range of mental health topics and special information about teen health issues, alcoholism, drug addiction, anxiety disorders, depression, trauma and eating disorders in our online Health Library.