What is Dual Diagnosis?

A health article about Dual Diagnosis from Mental Health Problemsdealing with Health Problems & nutritional Self Care Strategies

Dual diagnosis commonly refers to co-occurring mental illness, drug addiction and/or alcoholism in various combinations.

Two common examples are that of major depression with marijuana addiction, and alcohol addiction with panic disorder.

Often the two disorders are treated separately or people may only be referred to one specialist, either in the mental health service or the addiction recovery service.

Considering the large numbers of people affected by dual diagnosis it may be more effective to treat people using a more integrative approach i.e. whereby people can receive treatment for both disorders at the same time.

Signs & Symptoms of Dual Diagnosis

The symptoms that a person with dual diagnosis displays are identified in two parts which sometimes makes it common for one diagnosis to be missed.

First are the symptoms associated with any major psychiatric disorder, such as schizophrenia, bipolar mood disorder, or personality disorder (Mental Health Information Service has fact sheets on all of these).

Second are the issues associated with abuse of alcohol and other drugs. These are listed below:

• Significant impairment or distress resulting from use

• Failure to fulfil roles at work, home, or school

• Persistent use in physically hazardous situations

• Ongoing legal problems related to use

• Continued use despite relationship or financial problems

DA abuse may or may not involve physiological dependence or tolerance. The symptoms that do indicate dependency or addiction are as follows:

• Compulsion and preoccupation with obtaining a drug or drugs

• Loss of control over use (losing track of how much has been consumed)

• Continued use despite negative consequences

• Tendency for relapse after period of abstinence

• Drug induced behaviour eg aggression, irritability, changes in thinking or mood

The main symptom is increased tolerance and withdrawal. This means the same amount of the drug or alcohol has less effect, the person can tolerate greater amounts without feeling the effects. Withdrawal symptoms occur after physiological dependence has been established and the person cannot acquire the drug or alcohol, or stops taking it for some reason.

Types of Dual Diagnosis

Dual diagnosis commonly refers to co-occurring mental illness, drug addiction and/or alcoholism in various combinations.

Two common examples are that of major depression with marijuana addiction, and alcohol addiction with panic disorder.

Often the two disorders are treated separately or people may only be referred to one specialist, either in the mental health service or the addiction recovery service.

What is the impact of dual diagnosis?

The impact of having not one but two diagnoses means that a person often experiences more severe and chronic medical, social and emotional problems than if they were to just have one.

They are vulnerable of not only an Alcohol and other drugs relapse but also a relapse of their mental health problems. The occurrence of either of these is likely to affect the other in a negative way.

Treatment and relapse prevention must therefore be specifically catered towards the person, and will often take longer, come across more obstacles, and progress only gradually.

What Causes Dual Diagnosis?

What are the causes?

The causes of psychiatric illness and abuse of alcohol and other drugs are complex. The evidence that people with mental illness are more likely to abuse Alcohol and other drugs, or vice versa, that those people who abuse Alcohol and other drugs are more likely to develop some form of mental illness indicates that the causes are likely to be complex. This is outlined in the statements below:

• Drug use can cause psychiatric symptoms and mimic psychiatric syndromes

• Drug use can initiate or worsen a psychiatric disorder

• Drug use can mask psychiatric symptoms and syndromes

• Drug withdrawal can cause psychiatric symptoms and mimic psychiatric disorders

• Psychiatric behaviours can mimic drug use problems

• Drug and alcohol abuse can make side effects from medication worse, and more likely to occur.

Risk Factors:

Mental Illness and Intellectual Disability

‘Dual diagnosis' has also been associated with people with both a mental health problem and an intellectual disability. There are different types of intellectual disability. Some types of disability increase vulnerability to psychotic illness. But many people with an intellectual disability do not develop mental health problems.

Between 1.5 and 2.0 % of Australians have an intellectual disability and they have two to three times the prevalence of psychiatric problems as the rest of the community. Intellectual disability increases vulnerability to psychotic illness.

For people with this form of dual diagnosis there have also been difficulties in obtaining an accurate diagnosis, and finding effective treatment methods and care.

Treatment options include a range of medication and both cognitive and behavioural programmes.

When to seek Medical Advice:

What does the assessment include?

Before any treatment takes place it is necessary to obtain a detailed history of both the psychiatric and substance abuse symptoms.

Important information on psychiatric status includes: chief complaint/presenting symptoms; family history; personal history; medical history; psychiatric history; history of present illness; and assessment of current mental state.

The important information on substance abuse includes: types of drugs used; age of onset; amount now being used; maximum amount; frequency; route; last used; maximum clean time; number of detoxes; history of withdrawal symptoms.

This information will be necessary to construct an individual treatment programme.

Treatment/Therapy:

Our present mental health service has evolved to address single disorders. However many treatments for specific illnesses can be adapted to address other problems. Treatment for people with dual diagnosis may be more effective if the two diagnoses are dealt with at the same time as the two are often related (e.g. drug use to cope with symptoms of mental disorder).

It has been recommended that during treatment administration, both conditions need to be regarded as primary, without one being seen as the cause of the other. Some of the treatment options available (dependent on the severity of symptoms and the leading needs) are as follows:

• Drugs prescribed by a psychiatrist can be tailored to reduce side effects and control symptoms of mental illness. Honest discussion of prescribed and recreational drug use can be a good first step in controlling overall drug use.

• Counselling and psychotherapy involves working with a therapist on developing inner strengths, capabilities, resources and potential. It looka at developing personal strategies to reduce drug use.

• Cognitive-behaviour therapy uses a number of strategies to change behaviour. These might include changes in thinking about drug use, rewards for positive changes and strategies to help reduce drug use. This therapy doesn’t look at why the person is using.

• Working towards the person wanting to stop abusing and helping people to recognise the greater benefits in changing behaviour. It focuses on increasing the use of internal resources.

Self Care strategies for Living with Dual Diagnosis

• Learning to recognise personal 'high-risk' situations and applying specific coping skills and strategies to avoid re-abusing.

• Avoiding environments where substance abuse occurs eg parties where people are likely to drink heavily, friends who are heavy drinkers

• Joining a self-help group. This enables individuals with dual diagnosis to talk to each other about their experiences and provide mutual support.

• Enlisting and using the support of family and friends

Diet change strategies:

Vitamin & Nutrient Associations

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You may find benefit from our information on detoxification as well as a bit about detoxing because of change of diet

It may be due to difficulties with your digestive system that is causing your body to be starved of key nutrients, vitamins or minerals. In this case you may find useful answers by reviewing our article on Nutrition For Your Cells. There is also more information here about why is nutrition such an issue nowadays?

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Further reading through our articles on Dual Diagnosis health issues will give you a body of information that will help you decide what options you have to deal with the underlying causes of your problem through giving your body the nutrition products that will assist you body to heal from the inside out.

We wish you well in your search for solutions to this Dual Diagnosis problem and your movement towards better health in all areas.

More Resources available about Dual Diagnosis :

Mental Health Problems
Various factors either contribute to or challenge our ability to look after our "whole person". These factors include our degree of self-discipline, how aware we are of our feelings and thoughts, how well we know ourselves. Factors outside ourselves include the nature of our home and work environment, our financial situation, the current state of our relationships with important people in our lives - friends, partners, families and work colleagues. The quality of our mental health varies depending on our experience and circumstances. Periods of emotional or financial stress can take their toll on mental health. Working your way, mindfully, through life's difficulties can help us to grow in our emotional life and self-esteem, so that we are even better prepared for future challenges.

If the tension gets too much for us to cope with, however, it can cause us to "break down" emotionally or mentally, that is, not be able to carry on our lives in health. At these times, we may need to ask for help or support while we adjust. Many people live with disability, including physical illness or mental illness, and cope in a healthy way. The challenge for all of us is to search out new ways to cope.
(To read the rest of this article click on the Title above here.)

Book list

www.dualdiagnosis.org website has a list of recommended books. Check out Dual Recovery Anonymous also www.draonline.org

For help

• Mental Health Association NSW Inc ph (02) 9816 5688 or 1800 674 200 (outside Sydney Metro) for services in your area

• www.mentalhealth.asn.au

• Contact your local Community Health Centre or Mental Health Team (see ’Emergency, Health and Help’ section of the White Pages)

• Make an appointment with your G.P

• Lifeline on 13 11 14 for counselling

• Contact a counsellor or psychologist either through the Australian Psychological Society or through the Yellow Pages

• Alcohol and Drug Information Service on 1800 422 599/ 02 9361 8000

• Al-anon (a twelve step programme with support groups and literature) on 02 9663 1206. Joynton Avenue, 1st floor, Main Building, Old South Sydney Hospital, Zetland NSW 2017

• Narcotics Anonymous on 02 9212 3444. 1st floor, 204 King Street, Newtown NSW 2042

• Private Hospitals

For more information

• Mental illness, drug addiction, and alcoholism – www.users.erols.com

• Dual diagnosis recovery network for advocacy, self-help, information and referral - www.dualdiagnosis.org/

• Alcoholism, addiction and mental health resources – www.soberrecovery.com

• An association for persons with developmental disabilities and mental health needs - www.thenadd.org

• Dual diagnosis email group - www.angelfire.com/journal/bipolaralcoholic/

• MIDAS- www.midas.com.au

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