The Dangerous Dance of a Dual Diagnosis

An estimated 46 percent of all people will have some form of mental health condition during their lifetime, and 46.3 million people aged 12 or older will struggle with substance misuse. With high numbers and statistics like these, what are we doing to combat these common struggles? Additionally, what happens when they coexist? Coexisting disorders, otherwise known as a dual diagnosis, refers to when both a mental health and substance use condition are present in a person. A dual diagnosis brings specific questions, such as how does the treatment of that individual change and how does their recovery plan change? Loved ones, society, and the person with the diagnosis themselves raise these questions. Here, we will attempt to answer them by discussing potential causes, similarities, and treatment plans, as well as how mental health and substance use can affect each other. It’s crucial to approach these discussions with empathy and understanding, as these are not just statistics, but real people facing real challenges.

It can be difficult for some to understand substance misuse disorder or how debilitating mental health disorders can be. The typical “scared straight” example we Vancouverites may have been given is the individuals living on East Hastings. Although this community may seem to be in another world, it is much easier to enter that world than you may think. Unfortunately, many people experience terrible, life-lasting trauma in their childhood and adulthood and have not been given the proper resources to cope and heal. While one family may have the means to provide therapy for a child affected by trauma, another family may not ever acknowledge the trauma because they were raised themselves that way. One of the most common ways substance misuse develops is from self-medication, a form of coping with this trauma. Self-medicating refers to an individual’s attempt to aid their mental or physical well-being with a substance of their choice without professional help. Treatment barriers and stigma often force these individuals to do what they can with whatever means they have, and sometimes, the only way to get through the day is by using substances. Mental health disorders can manifest in similar ways. When the brain has experienced a life-altering trauma, it tends to implement coping mechanisms to protect you; an example of this is dissociative identity disorder (DID). This disorder commonly starts as a self-protection coping mechanism implemented by your brain to help you deal with the trauma being presented. You could also be predisposed to these issues based on your family history. The likelihood of both mental health disorders and problematic substance use can be hereditary. This is where the phrases “breaking the cycle”, or “addictive personality” come from regarding addiction or familial trauma. It is estimated that about 40 to 60 percent of a person’s vulnerability to substance misuse is caused by genetics, and 17 to 28 percent of four central mental health disorders (attention deficit hyperactivity disorder [ADHD], bipolar disorder, major depression, and schizophrenia) are traceable to the same common inherited genetic variations.

Substance use and mental health both affect the brain and, because of this, can affect each other. Countless studies have demonstrated the effects of these struggles when working together. Previously, we discussed self-medicating, which is an example of mental health affecting substance use, but how does substance use affect mental health? One could assume that using substances may not be great for your brain health, especially if you have an underlying mental health condition. Your substance of choice may worsen the symptoms of your disorder or create new ones. Even without a previous disorder, substances can cause separate issues on their own. Certain substances can cause people with a substance misuse disorder to experience one or more symptoms of a mental health problem. A mental health-related symptom of substance misuse is called psychosis. Psychosis refers to a break in reality, lasting anywhere from 24 hours to multiple months or years and can be deeply troubling. It’s not considered a condition on its own but rather a collection of symptoms, usually delusions and hallucinations. This break in reality can have many contributing factors, such as substance use or deep trauma. Substance use has profound effects on your brain function and can change the genuine makeup of your brain, causing long-term changes and damage. Unfortunately, these changes can happen quickly – sometimes in less than a month of consistent substance use.

With two massive challenges uniquely working together, how do we tackle a diagnosis or treatment plan that best serves the individuals managing these things? Well, we have a few suggestions. With a dual diagnosis comes proper, integrated treatment; this is where a barrier lies. For the best outcome, it’s believed that those with both a substance misuse disorder and a mental health issue receive integrated treatment. We are aware of co-occurring conditions, but our treatment plans don’t necessarily match these needs. Receiving a dual diagnosis in whichever form is a unique challenge that can be difficult to identify. One reason is that the symptoms are often complex and vary in severity. Suppose an individual presents as having only substance misuse disorder but truly has a co-occurring disorder. In that case, the second part of their diagnosis may be missed. Oftentimes, behaviour that comes from mental health disorders and behaviour that comes from substance use can look highly similar. For a person with a co-occurring disorder, this could result in their not receiving the best healthcare and understanding of their condition that they deserve. Co-occurring disorders are also a way to understand why it could be difficult for someone to stop using substances. Putting aside how difficult the physical reliance and withdrawal are, if the underlying mental health condition in a dual diagnosis is not treated, the individual will most likely go back to using substances as a way to cope. Research suggests that co-occurring conditions need to be treated at the same time. Taking away someone’s coping mechanism without properly replacing it is like removing a leg of your dining table and expecting it to balance and function.

A second process that could be implemented for better treatment and understanding of mental health and substance use is crisis intervention and training. We believe this specialized training is vital and necessary for professions such as teachers, bus drivers, flight attendants, in-person customer service, and first responders. Crisis intervention is an aid for any immediate mental health emergency. If done effectively, it most commonly looks like connecting to the person in crisis, stabilizing them, and taking them through specific steps to ensure their immediate safety. As mentioned previously, it can be challenging to discern between the cause of a crisis or mental health emergency, whether it’s a pre-existing condition, unknown condition/conditions, or psychosis brought on by substance use. Although each of these examples can cause a mental health emergency, they should not all be treated the same. For example, someone exhibiting erratic behaviour while high on a substance needs a different kind of intervention than someone exhibiting erratic behaviour while experiencing a schizophrenic episode. This is why proper crisis intervention and mental health training are so necessary.

Although there may be links between the two, we cannot definitively say mental health struggles cause problematic substance use or vice versa. Nonetheless, it’s valuable to understand their connections, as the consequences of undiagnosed, untreated, or undertreated co-occurring disorders can lead to a higher likelihood of experiencing homelessness, jail time, medical illnesses, and even suicidal ideation. Education fosters understanding; by educating yourself on issues such as these, you can better comprehend others’ circumstances or your own. In turn, becoming more empathetic towards loved ones and strangers. Next time you find yourself quick to judge, remember to lead with empathy and love. Picture how you’d want someone to treat you if the shoe was on the other foot and act accordingly. Keep in mind that just because you may see someone’s circumstance does not mean you understand the factors that lead them there or the struggles they go through. The golden rule we learned in childhood still applies to adulthood: treat others how you want to be treated yourself.