The problem of dual diagnosis & diseases of addiction have a comorbidity rate of 53% and climbing each year. One newer study suggests the rate of this comorbidity of both illnesses is actually closer to 2/3rds of people with depression who also have substance abuse/addiction problems. The connection between those who have addiction and are depressed is so strong and an unavoidable problem when it comes to treatment, that people are quick to believe and perceive that it is the addiction which is causing the depression. The newest evidence has shown that quite the opposite happens in many instances. It's like the old what came fist the chicken or the egg theory; And with addiction & depression/mental illness, it is not that simple a question to answer, but there are some answers that help doctors every day to diagnose and decide which is the primary illness and which is the secondary or if they co-exist.
There are 3 types of groups which are studied under the Mental Health & Drug Abuse Coalition. The 1st, is people who have depression or other mental illness, may seek help but find what they are given is not working, so they begin to experiment with other ways to alleviate their symptoms, such as alcohol and drugs, leading quickly to an addiction once the patient feels the substance has "cured" their symptoms. It is the very well-known phrase of "self-medicating" which was actually a term and theory first coined by a few doctors which included the author of many books on the subject of "self-medicating" with opiates, alcohol, cocaine & other drugs, Doctor Edward Khantzian, a psychiatrist from Haverhill Massachusetts, and a Clinical Professor of Psychiatry at Harvard University, who first published this hypothesis of self-medicating with heroin for depression in a 1985 paper, which expanded until it was accepted as a true theory and still used today to explain diagnosis & treatment. In this case it is shown that a person had an onset FIRST of mental illness, and then the drug addiction came next.
The 2nd group is those who are people who are chronic drug abusers, ie: addicts. They use their drug of choice daily and over time, they begin to develop mental illness symptoms, causing them to then increase their use and making it very difficult to stop. This group of people are difficult to convince to access treatment or professional help, because they are usually so afraid of trying to seek treatment for the depression, for the sole purpose of being scared that their addiction will be be discovered. Certain drugs, almost all of them, including ecstasy, alcohol, opiates, methamphetamine, cocaine & more, have been shown in advanced clinical research, including brain scans of addicts, with results showing that their drug use has directly caused malfunctions in major centers of the brain where a person's impulse control, emotion regularity, reasoning, cognitive ability and many more areas are damaged by the chronic drug use. So this group usually begins with trying different illicit or pharmaceutical drugs. finding one they like, and after chronic, daily use, their brains are actually being damaged on many levels, in many areas by the very drug they use. So first the drug addiction starts, and then sets in the mental illness symptoms, like depression & anxiety, bipolar and many others.
The 3rd group of people are those who have co-occurring conditions that are ongoing and increase in severity. The drugs do not alleviate the depression, anxiety, or other mental illness symptoms quite well enough to consider themselves in good mental health, but the substance abuse has already caused further damage to their brains in many areas, making it that they are the hardest group of patients to treat. They are however, the people who are most likely TO seek treatment for both illnesses, knowing very well they both exist at all times and are aware of it daily. The usually might begin by asserting or believing that their depression, low mood, anxiety, panic attacks, loneliness, bouts of crying for no apparent reason, mania, hypomania, isolation, etc are all directly the result of being forced to stop their drug of choice or attempt to stop on their own. They attribute these mental and mood changes to withdrawal, but they aren't; in fact it is that they DO now have a very clear diagnosable mental illness caused by the changes in their brains from the chronic drug use and since they have stopped using these drugs, the symptoms are now more present and bothersome than ever before. So this group already had mental illness but was made much worse by chronic long-term drug use.
When patients with dual-diagnosis are treated they have a fairly good rate of recovery IF they adhere to taking medications and make serious changes in their lifestyles. When you have such chronic drug abuse and depression it is hard for doctors to decipher which symptoms are causing the other so dual diagnosis treatment first is used to detoxify the patient from the drugs and stabilize them so they are not in pain. Once this is done they can begin to introduce therapeutic programs as well as medications for bipolar, depression, anxiety or any other mental illness, as is indicated. They are monitored closely throughout every 24 hour period, their vitals checked for stability, dosages changed daily if that needs to be done, and the patient upon release is given very specific and easy to follow directions for returning home. This typically includes an intake for an intensive outpatient program (IOP), meeting schedules, individual therapy set-up, follow up appointments with doctors and if needed, an appointment with a clinic for continued use of subutex or suboxone.