Dual Diagnosis as Co-Occurring Conditions
When alcohol problems and another mental health disorder coexist, it is called a dual diagnosis. Dual diagnoses are often found in drug addiction cases as well.
The co-occurrence of alcohol abuse with other mental health problems is common among people who receive treatment from outpatient facilities. When a dual diagnosis is identified and treated properly, the chances of success are improved. However, if one condition is overlooked, the chances for recovery decline. For example, if an addict is abusing drugs because he or she has anxiety, then treating the drug abuse without addressing the anxiety will make it more likely that the patient will start using drugs again.
The symptoms of co-occurring disorders can be similar to each other or to symptoms of alcoholism or addiction. To correctly diagnose a dual diagnosis, a physician must evaluate both conditions at the same time.
Patients with co-occurring disorders should be treated for both conditions.
People who have both an addiction and a mental illness may find it harder to quit drinking than people who don't have other mental illnesses. The withdrawal symptoms that come with quitting can trigger or worsen other mental health conditions, such as anxiety and insomnia.
Conditions That Often Appear With Alcohol Use Disorder
Depression and anxiety disorders often appear with alcohol use disorder (AUD). The overlap of symptoms makes them challenging to diagnose without proper screening.
Depression is a mental illness that causes feelings of sadness, loss of interest in activities you normally enjoy, and changes in appetite and sleep habits.
There is a significant overlap between trauma- and stress-related disorders and AUD. Common examples of such trauma include sexual abuse or assault, witnessing domestic violence, combat exposure, or natural disasters.
Trauma- and stress-related disorders can lead to maladaptive drinking patterns in an attempt to cope with the symptoms.
Sleep problems are common in people who have alcohol use disorders.
People who suffer from alcohol use disorder often have other mental health conditions at the same time, including drug addiction. Other common examples of co-occurring disorders include anxiety and depression.
Why Integrated Care Matters
Quitting drinking alone may ease some psychiatric symptoms, but treatment of a co-occurring psychiatric disorder on its own typically doesn't lead to significant reduction in alcohol use. However, treating both the substance abuse and co-occurring condition simultaneously is likely to produce better results for both disorders.
Treatment for dual diagnosis should include a plan for how to handle both alcohol use disorder and the other psychiatric condition at the same time.
Treating only the psychiatric side leaves alcohol use untreated and vice versa. The two can't be separated. The co-occurrence of AUD and mental health disorders is an important factor in predicting negative outcomes for individuals with both conditions.
Integrated care addresses both conditions in the same place at the same time and offers a variety of benefits over traditional, sequential models.
The two conditions often interact in ways that make each one harder to treat on its own. For example, if you suffer from depression, anxiety or another mental health problem, you may find yourself turning to alcohol or other drugs as a way of coping with your problems.
Research has shown that this approach leads to better outcomes for patients with dual diagnoses than fragmented care in which mental health and substance use treatment are provided separately by different providers or organizations.
Dual diagnosis can happen when someone struggles with both an addiction and another mental health issue at the same time. The two issues often overlap, making it difficult to determine which problem came first. For example, a person may develop depression before abusing alcohol or drugs. It is also possible for a person to become addicted to substances and then experience emotional problems.
People who struggle with dual diagnosis may find it challenging to treat one condition without treating the other simultaneously. Because of this overlap, both conditions need to be addressed at once for effective treatment to occur. This process is known as integrated care.
Therapies Used When Both Conditions Are Present
The presence of a comorbid condition can complicate treatment. It is important to take these factors into account when designing an appropriate intervention plan.
For example, a patient with a substance use disorder and schizophrenia may require adjustments to their medication management routine.
In cases in which a mental illness is present alongside AUD, behavioral therapy is often part of treatment. The goal of this kind of therapy is to help you recognize and avoid behaviors that may lead to drinking. You also learn new coping skills to deal with stress or other issues without alcohol.
In the case of depression, an integrated treatment plan might include medication for depression as well as for AUD.
Motivational enhancement therapy builds readiness while addressing ambivalence about quitting or reducing alcohol use.
Cognitive behavioral therapy (CBT) helps change behavior through identifying and altering the beliefs and thought processes that contribute to addiction. In CBT, a counselor will teach you skills to manage stress, reduce cravings, and avoid triggers to drink. This type of therapy can also help you address co-occurring mental health conditions.
Cognitive-behavioral therapy (CBT) helps you learn ways to manage both conditions by changing your thinking patterns. CBT focuses on changing unhealthy thinking that can lead to drug use and other problems, such as depression or anxiety.
Behavioral therapies used when both conditions are present include cognitive-behavioral therapy (CBT) and 12-step facilitation. CBT focuses on changing problematic behaviors by identifying the situations that lead to heavy drinking and developing behavioral alternatives to cope with these situations. 12-Step Facilitation Therapy involves introducing individuals to the concepts of Alcoholics Anonymous (AA) or other 12-step programs.
Cognitive-behavioral therapy is often used for treating depression, anxiety, PTSD, and sleep disorders when comorbid with AUD. CBT for co-occurring mental health conditions focuses on teaching skills that improve coping abilities and help individuals manage thoughts and feelings.
An integrated plan may use CBT for AUD and also for PTSD.
Cognitive-behavioral therapy (CBT) teaches you skills to help you identify and change your problem drinking behaviors. It can also teach you how to recognize situations that cause you to drink too much. CBT is often used in combination with other forms of behavioral therapy.
Medicines When Mental Health and Alcohol Overlap
Oral naltrexone is taken once daily while injectable naltrexone is given as a shot (injection) every four weeks by a healthcare professional.
Extended-release naltrexone is an injection every 4 weeks and acamprosate is a delayed-release tablet taken by mouth three times daily.
Acamprosate is taken three times a day.
Disulfiram does not reduce craving and is intended only for patients who can commit to total abstinence from alcohol. It causes flushing of the face, headache, nausea, and vomiting.
Disulfiram discourages drinking by causing unpleasant effects when alcohol is consumed.
Antidepressant medication is often recommended to treat the symptoms of an underlying mental illness.
Medication may also improve a person's mental health symptoms such as depression or anxiety, which are common co-occurring issues with alcohol use disorder.
Finding Integrated Care in Georgia
Community Service Boards in Georgia connect people with substance use disorders and co-occurring mental health conditions with local resources for integrated treatment.
The Georgia Crisis and Access Line (GCAL) provides crisis intervention 24/7/365.
GCAL is a nationally accredited 24/7 crisis center that partners with the 988 Suicide & Crisis Lifeline.
In a non-emergency GCAL can help access a state-funded provider in your area.
Integrated care focuses on the whole person. This means that integrated care providers consider each patient's physical and mental health as well as their social needs.