Dual Diagnosis: Why Substance Abuse Worsens Your Mental Health

Drinking and drugs worsen anxiety, depression, other problems

Mental illness can overwhelm those who are affected and their loved ones. Substance abuse is similarly distressing for addicts, alcoholics and families.

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When the two problems merge, a bigger challenge arises: dual diagnosis, or co-occurrence. “We see a large overlap between substance use disorders and mental health issues,” says psychiatrist Mohsen Vazirian, MD.

“For example, substance use disorders are twice as common in those diagnosed with anxiety or depression than they are in the general population.”

Why dual diagnosis occurs

One theory is that people struggling with mental health disorders may try to manage symptoms by self-medicating with alcohol or drugs, says Dr. Vazirian. They then become addicted.

For example, untreated attention-deficit hyperactivity disorder (ADHD), post-traumatic stress disorder (PTSD) and schizophrenia may lead to higher rates of substance abuse.

“Another theory is that substance abuse may cause the mental health disorder,” he adds. “Chronic marijuana use is linked to schizophrenia, for example. Also, methamphetamine use increases the susceptibility to psychosis.”

Genetics and environment

Substance abuse is a brain disease, not the character flaw many people believe it to be, he stresses. “Around half of those who develop a substance abuse disorder may be genetically vulnerable,” says Dr. Vazirian. Genes may also increase the risk of mental illness.

But environment also plays a role. Stressful life circumstances that trigger depression or anxiety can lead to self-medicating with alcohol or drugs.

Researchers are striving to unravel the complex relationship between substance use and mental illness.

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Simultaneous treatment

It’s important to treat the co-occurring disorders at the same time.

“If you don’t treat the substance abuse, you jeopardize treatment for the mental health disorder,” says Dr. Vazirian. “And if you don’t treat the mental health disorder, you jeopardize treatment for the substance abuse.”

For example, you may need medication to correct the brain chemical imbalance involved in major depression. But “alcohol is a depressant, and can cause anxiety and depression. So even if you’re getting the right medication, if you keep drinking, your symptoms may not improve,” says Dr. Vazirian.

Also, those who are inebriated or impaired can’t give a therapist their full attention.

Reluctance to seek help

Facing the twin stigmas of mental illness and substance abuse can make it difficult to seek help.

“The most important thing families and friends can do is to offer encouragement and support,” says Dr. Vazirian. “Getting all family members to be one voice and say the same thing is critical.”

If a loved one threatens physical or emotional harm to themselves or others, you may need to call 911 and get first responders involved, he says.

What to look for in a facility

Treatment for dual diagnosis can be costly, so it’s important to have a good insurance plan, Medicare or Medicaid.

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The best inpatient facilities offer a range of services for co-occurring disorders: psychiatric care, substance abuse counseling, group therapy, marital or family therapy and case management.

“When these services are not available, it’s more difficult for patients to maintain their sobriety,” says Dr. Vazirian.

Unfortunately, many substance abuse treatment facilities lack mental health professionals who can assess patients for mental illness. And mental health facilities often fail to address substance abuse, he says.

Support at home

Twelve-step programs like Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) help alcoholics and addicts maintain sobriety after treatment.

Al-Anon and Families Anonymous are 12-step groups for families and friends. “Families are unknowingly affected by addiction,” explains Dr. Vazirian. “Enabling behaviors of family members and friends may perpetuate addiction by not making patients accountable for their actions.”

The National Alliance on Mental Illness (NAMI) offers education and support for patients and families affected by mental health disorders. “It helps to learn that you are not alone, that other families also have issues and to encourage loved ones to stay in treatment,” he says.

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