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Dual Diagnosis; The Chicken or the Egg?

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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. 

As far as which came first the chicken or the egg, the depression or the addiction, is completely irrelevant once it has occurred.  Because no matter the reason for "why?", once the drugs are introduced and used regularly for long periods, they themselves change the function and makeup of the brain itself which then lends to symptoms of mental illness. So the argument doesn't matter so much because the studies and research is there to show that both happen; that depressed patients tend to try drugs, first alleviating symptoms & then making the manifestation of the mental illness worse.  The patients who use drugs first and chronically, also cannot avoid these changes to the brain which allows mental illness to take form and set in. 

Seeing that we have the numbers known of over 50% of those with addiction also with a co-occurring severe mental illness needing treatment, it is CRUCIAL that patients seeking help for addiction are screened for a mental illness or dual diagnosis and then treated appropriately or are admitted into a private dual diagnosis facility specializing in treating both.

Detox is simply not enough. It removes the drug from the body but the damage to the brain from long term drug use is still present and will set the depression, bipolar and anxiety into overdrive if not treated immediately and followed through with. It is not a matter of willpower. It is a matter of structural & functional changes in the addict's brain which cannot be overcome simply by wishing it away.  The scary and traumatic issue of patient leaving detox then attributing their mental illness symptoms to simply stopping their drug of choice, lead them to seek out the drug again and has a VERY high rate of relapse, almost 90%, instead of thinking that these are real problems also needing addressing by a doctor immediately before relapse happens. 

But most do not.  They attribute these mental illness/depression onset of symptoms to simply the lack of drug and never seek treatment or diagnosis for a mental illness.  This kind of relapse could end up being the last relapse that person will have and can be fatal. Do not take the risk, do the searching and call to find a dual diagnosis facility in your area to treat someone you suspect of having mental illness and addiction.  The important of treating both illnesses is something never debated in the mental illness NOR the addiction community.  

As a loved one of an addict suffering with dual diagnosis it can be not just overwhelming, but devastating and possibly give you feelings of failing as a parent, but this could not be further from the truth. The best a parent can do is to try and get their child the best help they need when they need it, so being an active part, a nonjudgmental, a non-hostile, but calming, reassuring presence in their lives while accessing treatment is the best role you can play. But loved ones & caretakers need help too. Get into counseling, therapy, even with your spouse and make sure to make time for the things you enjoy too. Addiction and Depression affects the whole family, but it does not have to define the whole family.  To find an excellent Dual Diagnosis center nearest you, your best bet is to go to your State's website and find the tabs for mental health or addiction services/resources. They may have a treatment locator or you may hay get a number to call. MAKE THAT CALL. Detox is not enough if the person leaves and attributes all of their mental illness symptoms solely to stopping their drug of choice!!!   They will know best along with calling your insurance company, where in your exact area are facilities specializing in this treatment. I would recommend trying these 2 options first.

Other centers who can help find you treatment for dual diagnosis are listed below with their hotlines: 

The Mental Health & Drug Abuse Coalition's Hotline is: #1-800-943-0566

Recovery.org's hotline is #1-888-249-7292

Dual Diagnosis.org has a hotline #1-877-345-3357

 

 

 

 

 

 

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Erika Cormier, author of  the memoir, "As the Smoke Clears", understands first hand that addiction isn't always a "visible" disease.  She has dedicated her life to helping other women suffering from addiction and has drafted a bill to place caps on the high cost of outpatient addiction-related services.



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