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Dual Diagnosis Withdrawal Treatment

Drug withdrawal for people who struggle with both addiction and mental health issues can be complicated, since withdrawal can worsen existing mental health symptoms or cause new symptoms to emerge. In 2014, nearly 8 million people met criteria for a dual diagnosis disorder.1,2

Fortunately, a variety of treatments are available, including medications, therapies, and support groups, making recovery from both conditions possible.

What Is a Dual Diagnosis?

Dual diagnosis, or co-occurring disorders, occur when a person has both a substance use disorder and one or more mental health conditions.1 People with mental health disorders are at higher risk of developing addictions to drugs and alcohol compared to people who don't suffer from one of these conditions.1

In some cases, substance use begins a way to self-medicate, e.g., to cope with or alleviate symptoms of depression or anxiety.3 However, while it may feel like drugs or alcohol help the problem in the short-term, "medicating" symptoms with substances may actually worsen the mental health condition over time.

Another explanation for the high rate of mental illness among drug users is that substance use disorders and mental health conditions are often influenced by the same factors, including genetics, stress, and history of early trauma. Because drug abuse and mental illness have overlapping contributory factors, people who have genetic vulnerabilities and/or are exposed to trauma or stress early in life may be at higher risk for developing both conditions.3

Research on genetics and the brain have also revealed that substance use and mental illness impact several of the same brain areas and neurotransmitter systems. Additionally, the brain changes associated with one condition may impact the course of the other.3 People who abuse drugs may experience changes in the brain that can put them at risk of developing certain mental health conditions in the future. Similarly, people suffering from mental health conditions may experience changes in the structure and functioning of the brain that enhance the positive effects of drugs and lessen the perception of their negative effects. They may also find that the drugs lessen the severity of their mental health symptoms and begin turning to drugs regularly for relief.3

What Are the Signs?

In 2014, 7.9 million people suffered from both an addiction and a mental health disorder.4 If you suspect you or someone you care about may have a dual diagnosis, read more about the signs of substance use disorders and mental health disorders below.

Signs that you may have a substance use disorder, the diagnostic term for addiction, include:5

  • Consuming more of a substance or using a substance for longer than intended.
  • Difficulty quitting, decreasing, or controlling substance use.
  • Spending excessive amounts of time getting, using, or recuperating from a substance.
  • Cravings.
  • Difficulty completing responsibilities at home, work, or school because of substance use.
  • Continuing to use a substance despite it causing problems in relationships.
  • Discontinuing important social, recreational, or work-related activities because of substance use.
  • Using a substance in dangerous situations.
  • Continuing to use a substance in spite of it causing or worsening physical or emotional issues.
  • Requiring more of a substance to feel the desired effects or experiencing less of an effect over time when taking the same amount.
  • Developing withdrawal symptoms when attempting to quit or cut back.

Mental health disorders can impact your mood, thinking, behavior, and relationships. Several different types of mental health conditions exist:

  • Anxiety disorders include generalized anxiety, social anxiety, and panic disorders. They tend to involve excessive worry and intrusive thoughts and can impact a person’s sleep, energy level, and ability to focus.5 Anxiety disorders are the most common among all mental health disorders.4
  • Mood disorders, such as depression and bipolar disorder, can affect a person’s emotional state, appetite, sleep, energy, and motivation. Depression can cause persistent feelings of sadness, while type 1 bipolar disorder can cause significant highs (manic states) and lows (depressive states).5
  • Post-traumatic stress disorder (PTSD) can develop after a person is exposed to a traumatic event. It may involve flashbacks, intrusive memories, increased arousal and reactivity, avoidance of reminders of the trauma, and sleeping problems.5
  • Attention-deficit/hyperactivity disorder (ADHD) involves difficulty concentrating and controlling impulses.5 Treatment for ADHD typically involves the use of stimulant medications. While some parents and professionals have been reluctant to treat ADHD with medications because of concern about the risk of addiction, research studies have not found any evidence that children treated for ADHD with stimulants have an increased risk of developing substance abuse problems.3
  • Schizophrenia is a serious mental health condition that can include psychotic symptoms like hallucinations and delusions, disorganized thinking, and flat affect.3

Signs that you or someone you know may have a dual diagnosis disorder include:2

  • Changes in mood and behavior.
  • Isolation from family and friends.
  • Using drugs or alcohol in dangerous situations.
  • Feeling unable to function without drugs or alcohol.
  • Loss of control over substance use.

Military Personnel and Co-Occurring Disorders

Military personnel, especially combat veterans, may be at an increased risk of developing co-occurring disorders. The Substance Abuse and Mental Health Services Administration states that 18.5% of service members returning from Iraq and Afghanistan meet criteria for PTSD.6 Approximately 20% of veterans with PTSD also have a substance use disorder.7 Service members and veterans with PTSD are at a higher risk of developing substance use disorders because they may turn to drugs and alcohol to cope with their symptoms and avoid dealing with their trauma.7

Can Both Disorders Be Treated at Once?

Yes, co-occurring disorders can be treated simultaneously, and, in fact, getting appropriate help for both/all conditions is very important for someone hoping to achieve lasting recovery.

Many people with co-occurring disorders only receive treatment for one condition, leaving either a mental health disorder or addiction untreated.1 Failing to treat both disorders may put people at increased risk for relapse and can lead to further problems down the road. People with untreated dual diagnoses are at higher risk of homelessness, legal problems and incarceration, physical health conditions, suicide, and early death.1 Dual diagnosis treatment centers offer patients a chance to get help for all conditions impacting them, reducing these risks and providing hope for the future.

Do I Need Professional Detox?

Detox is an important step in treating a co-occurring disorder. When a person is under the influence of drugs or alcohol, it can be extraordinarily difficult to accurately determine whether the symptoms they are displaying are caused by drug use or an underlying mental health condition.3 Once a person is completely detoxed from a drug and abstinent for a period of at least 2-4 weeks, doctors and other professionals can develop a more accurate diagnosis and treatment plan.8

If you have a dual diagnosis, it may be safest to detox in an inpatient treatment facility.

If you have a dual diagnosis, it may be safest to detox in an inpatient treatment facility.2 Inpatient treatment programs offer 24-hour care for the duration of acute withdrawal, which often lasts up to 7 days.2 Many people undergoing withdrawal experience an increase in mental health symptoms like depression and anxiety. Dual diagnosis treatment program staff can carefully monitor and treat an individual's physical and psychological withdrawal symptoms.

Medical detox programs will have doctors who can prescribe appropriate medications to alleviate certain symptoms and to prevent complications. If prescription drug abuse is a factor, doctors may conduct a gradual taper to slowly wean the individual off the substance in question, rather than force them to face the rapid onset of symptoms that may come from abrupt substance discontinuation. During this time, medications may also be prescribed to help manage the symptoms of underlying mental health issues, such as anxiety or depression. The types of treatments offered are highly specific to the needs of each individual patient.

Medical detox is often necessary when withdrawing from alcohol, benzodiazepines, and barbiturates because of the risk of complications such as seizures and delirium tremens.8 If you are withdrawing from a different substance, you may be able to detox in a nonmedical facility, often referred to as "social" detox. These programs focus on helping people get through withdrawal in a substance-free, supportive environment. These programs do not provide medical care but may refer you to another facility if you require medical treatment

What Happens After Detox?

Once detox is complete, people with dual diagnoses can benefit from further addiction treatment.

Unlike traditional addiction treatment programs, dual diagnosis programs don't focus exclusively on the addiction; rather they work to treat all mental health issues that the person faces while they are in the program. Medical and mental health professionals work together to diagnose and address each condition and help the person to understand how their mental health symptoms and substance abuse trigger and impact each other. They also help participants develop tools to manage their mental health symptoms and cravings for drugs and alcohol. This integrated approach to treatment can increase the person's chances of making a full recovery.

Many mental health disorders respond well to medication, and psychiatrists and doctors on staff at dual diagnosis rehab centers will be able to determine which medications are best to treat the disorder and prescribe them. For someone who has a mental health disorder but has never before received the right treatment, the lure of drugs and alcohol to improve their mood can be overwhelming. With symptoms managed with the right medication, that person may be much more capable of managing their cravings and avoiding relapse.

If you have an underlying mental health condition and a treatment program is unable to provide appropriate medications, it might not be the right facility for you. Some people and even some treatment providers operate under the assumption that taking any medication at all negates your sobriety. This belief is dangerous, since leaving any mental health disorder untreated can lead to serious consequences.

Dual diagnosis programs may be found in the form of inpatient or outpatient treatment. Inpatient or residential programs represent the most intensive form of dual diagnosis treatment. They offer 24-hour care that includes medical services and mental health treatments to help with recovery. This may include individual and group therapy sessions so that the person can interact with others working through similar issues.

Outpatient programs are considered less intensive, since participants come and go from the facility once or more per week to participate in therapy sessions. Partial hospitalization programs (PHP) offer high-intensity counseling treatment during the day and allow the patient to return home in the evenings. Intensive outpatient programs (IOP) offer 6-9 hours of treatment 2-3 times per week.8 Other outpatient programs may provide one or more weekly group or individual therapy sessions.

Dual diagnosis treatment programs may offer different types of therapy to help people recover from their addictions and mental health issues and to understand the reasons behind their addictions to drugs or alcohol.3 Cognitive behavioral therapy (CBT), for example, works to change negative thoughts and beliefs and replace them with healthier ones.7

Rehab Graduates Prioritize Payment Policies and Amenities

In 2016, Recovery Brands conducted a survey that asked individuals leaving a treatment facility which program attributes they saw as most important to take into account when looking for treatment. At the top of the list was the facility's financial policies, for example insurance accepted, financial support, and payment options. They also prioritized the facility's offerings (amenities, recreational activities, room quality, etc.) a lot more upon leaving treatment. People considering programs will want to look at a center's payment and insurance policies as well as the program's offerings to help with their facility decision.

Pre- and Post-Treatment Preferences

People struggling with co-occurring disorders may also benefit from attending self-help groups during and after dual diagnosis treatment. Alcoholics Anonymous and Narcotics Anonymous are 12-step groups that help members find strength in getting support from and showing support to others who have the same goal of recovery.

SMART Recovery is an alternative group that builds motivation for sobriety and teaches tools for managing cravings. Double Trouble in Recovery is another 12-step group specifically designed for people with co-occurring disorders.

References

  1. Substance Abuse and Mental Health Services Administration. (2016). Co-occurring disorders.
  2. National Alliance on Mental Illness. (2017). Dual diagnosis.
  3. National Institute on Drug Abuse. (2010). Research report series: Comorbidity: Addiction and other mental illnesses.
  4. Substance Abuse and Mental Health Services Administration. (2017). Mental and substance use disorders.
  5. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  6. Substance Abuse and Mental Health Services Administration. (2017). Veterans and military families.
  7. U.S. Department of Veterans Affairs. (2015). PTSD and substance abuse in veterans.
  8. Substance Abuse and Mental Health Services Administration. (2013). Detoxification and substance abuse treatment.
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