Understanding Dual Diagnosis

Dual Diagnosis, Dual Disorders and MoreThe term dual diagnosis is a common, broad term that indicates the presence of two independent medical disorders. Recently, within the fields of mental health, psychiatry, and addiction medicine, the term has been popularly used to describe the coexistence of a mental health disorder and drug addiction / alcohol addiction problems. The equivalent phrase dual disorders also denotes the coexistence of two independent (but invariably interactive) disorders, and is the preferred term used in this Treatment Improvement Protocol (TIP).

The acronym MICA, which represents the phrase mentally ill chemical abusers, is occasionally used to designate people who have an drug addiction / alcoholism disorder and a markedly severe and persistent mental disorder such as schizophrenia or bipolar disorder. A preferred definition is mentally ill chemically affected people, since the word affected better describes their condition and is not pejorative. Other acronyms are also used: MISA (mentally ill substance abusers), CAMI (chemical abuse and mental illness), and SAMI (substance abuse and mental illness). Dual Diagnosis ExamplesCommon examples of dual diagnosis include the combinations of major depression with cocaine addiction, alcohol addiction with panic disorder, alcoholism and heroin addiction with schizophrenia, and borderline personality disorder with episodic drug abuse.

Although the focus of this volume is on dual diagnosis, some patients have more than two disorders, such as cocaine addiction, personality disorder, and AIDS. The principles that apply to dual diagnosis generally apply also to multiple disorders. The combinations of drug addiction / alcohol addiction problems and psychiatric disorders vary along important dimensions, such as severity, chronicity, disability, and degree of impairment in functioning. For example, the two disorders may each be severe or mild, or one may be more severe than the other. Indeed, the severity of both disorders may change over time. Levels of disability and impairment in functioning may also vary.Thus, there is no single combination of dual diagnosis; in fact, there is great variability among them. However, patients with similar combinations of dual diagnosis are often encountered in certain treatment settings. For instance, some methadone treatment programs treat a high percentage of opiate-addicted patients with personality disorders. Patients with schizophrenia and alcohol addiction are frequently encountered in psychiatric units, mental health centers, and programs that provide treatment to homeless patients. Dual Diagnosis: Drug Addiction and Alcoholism

Patients with mental disorders have an increased risk for drug addiction / alcohol addiction disorders, and patients with AOD disorders have an increased risk for mental disorders. For example, about one-third of patients who have a psychiatric disorder also experience drug abuse at some point (Regier et al., 1990), which is about twice the rate among people without psychiatric disorders. Also, more than half of the people who suffer from drug abuse or alcohol abuse have experienced psychiatric symptoms significant enough to fulfill diagnostic criteria for a psychiatric disorder (Regier et al., 1990; Ross et al., 1988), although many of these symptoms may be AOD related and might not represent an independent condition. Compared with patients who have a mental health disorder or an drug abuse or alcohol abuse problem alone, patients with dual diagnosis often experience more severe and chronic medical, social, and emotional problems. Because they have two disorders, they are vulnerable to both AOD relapse and a worsening of the psychiatric disorder. Further, addiction relapse often leads to psychiatric decompensation often leads to addiction relapse. Thus, relapse prevention must be specially designed for patients with dual diagnosis. Compared with patients who have a single disorder, patients with dual diagnosis often require longer treatment, have more crises, and progress more gradually in treatment.

If you are looking for a dual diagnosis treatment program, drug rehab or alcohol rehab call 1-800-511-9225, a national dual diagnosis helpline or go to www.lakeviewhealth.com

Jonathan Huttner is a principal with Lakeview Health Systems a drug rehab and alcohol rehab specializing in the treatmetn of dual diagnosis.

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