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Dual Diagnosis as Co-Occurring Conditions
Co-occurring conditions are assessed together because they affect each other. For example, AUD may trigger anxiety or depression, which can increase a person's risk of drinking again or experiencing a relapse. Treatment providers need to assess the person's mental health issues and treat them along with their alcohol problem.
Dual diagnosis is when someone has both an addiction and a mental health issue. This means that they are living with two conditions at the same time.
If you're struggling with depression, drinking more may not seem like a big deal at first. But as alcohol affects your brain chemistry in new ways, it can actually make you feel worse than before.
When this happens, you might try to use even more alcohol to "self-medicate" - in an effort to ease those feelings of sadness or hopelessness. Or, you may drink less but feel compelled to return to that level of drinking when your depression returns.
It is important to treat both problems at the same time.
Integrated treatment - Both mental illness and addiction are treated together in this type of treatment.
A dual diagnosis labels addiction together with some sort of underlying mental health issue. However, this does not mean that alcoholism or addiction cause the co-occurring mental health disorder. Rather, they are both conditions that are separate but linked.
Alcohol problems can cause or worsen a preexisting mental health condition, such as depression or anxiety. For example, when someone is under a lot of stress or experiencing difficulties in their life, drinking alcohol may provide temporary relief. But over time, heavy drinking can actually make mood disorders and anxiety worse or trigger the onset of other mental health problems.
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Conditions That Often Appear With Alcohol Use Disorder
Depression is a mental health condition that causes feelings of sadness, hopelessness, irritability, anxiety, loss of interest in daily activities, and changes in appetite or sleep patterns.
Anxiety disorders are a group of disorders that cause excessive fear and worry. Symptoms include persistent nervousness, restlessness, increased heart rate, shortness of breath, sweating, and shaking.
Trauma- and stress-related disorders such as post-traumatic stress disorder (PTSD), which can result from experiencing or witnessing traumatic events such as physical abuse, sexual assault, war, or natural disasters. The symptoms of PTSD include flashbacks, nightmares, difficulty sleeping, feeling constantly on guard or easily startled, avoiding people or places associated with the trauma, and difficulty concentrating.
Common mental disorders that occur with alcohol use include depression, anxiety, and bipolar disorder. These conditions often go hand-in-hand because they share some symptoms or underlying factors. For example, people who have depression may drink more heavily than others in an attempt to ease their pain. This can lead to dependence on alcohol over time, which makes it harder for them to quit drinking even after they recognize how harmful it is.
Anxiety disorders also often co-occur with alcohol use disorder. People who suffer from anxiety may turn to alcohol as a way of coping with their symptoms. Unfortunately, while drinking may provide temporary relief from anxiety, it can make things worse over time by causing dependence and other negative side effects such as blackouts or liver damage.
Bipolar disorder is another condition that often occurs alongside alcohol use disorder. People with bipolar disorder experience mood swings between extreme highs (mania) and lows (depression). They may find themselves drinking heavily during manic phases because they feel invincible, but then find themselves unable to stop once their mood swings into depression again.
Depression - Feeling sad, hopeless, or empty most of the time for at least two weeks.
Anxiety disorders - Excessive worry, fear, or feeling on edge.
Post-traumatic stress disorder (PTSD) - Reliving a traumatic event through nightmares or flashbacks.
Bipolar disorder - Alternating between episodes of mania and depression.
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Why Integrated Care Matters
Fragmented treatment leaves one condition undertreated while the other gets addressed. This can lead to worsening symptoms of both problems, which can negatively affect outcomes for both disorders.
Separate tracks for alcohol and mental health treatment may make it difficult to provide integrated, coordinated services that address both issues simultaneously. A lack of coordination between providers can lead to fragmented care that does not adequately meet patient needs or leads to gaps in care. Many patients with comorbid AUD and a mental illness do not receive adequate attention or treatment for their alcohol problem.
The importance of treating both AUD and co-occurring mental health disorders at the same time cannot be overemphasized. Both problems affect one another and need to be treated simultaneously to improve outcomes. Treatment that is effective for the primary AUD needs to take into account the presence of a mental illness or vice versa. For example, someone with an anxiety disorder may use alcohol as a way to self-medicate, and if this person only receives treatment for his or her anxiety disorder, he or she could continue to have problems with drinking.
Integrated care treats both conditions in one place by providers who work together to coordinate patient care. It can be delivered as an ongoing treatment for a chronic condition, or as a more acute intervention that lasts weeks or months.
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Therapies Used When Both Conditions Are Present
Skills for drinking urges and mood symptoms might be addressed in alternating sessions or within a single session. For example, you may learn skills for managing both anger and alcohol cravings during a given CBT session. The goal is to help you develop coping skills that are relevant to both disorders.
Integrated treatment is the combination of mental health and substance use disorder services into a seamless approach that addresses both disorders simultaneously. Integrated care recognizes the biological and behavioral links between mental illness and substance use and offers treatment strategies that address the connections between them.
Motivational enhancement and cognitive behavioral therapy help with both mental illness and alcohol abuse disorder.
CBT can be used by itself or combined with other types of psychotherapy, including motivational interviewing. The goals of CBT are to teach you skills that will help you recognize the situations where you are most likely to drink, cope with difficult emotions without turning to alcohol, and develop a relapse prevention plan. For example, your therapist may work with you on how to handle triggers in your life, such as being bored or having an argument with someone.
Motivational enhancement therapy (MET) is often used along with CBT. It can help you identify the pros and cons of changing your drinking behavior. It can also increase your confidence in your ability to change that behavior.
Group and individual counseling both appear in many programs for adults with co-occurring substance use disorder and other mental illnesses. There are a variety of approaches available including psychoanalytic, insight-oriented, psychodynamic, cognitive behavioral therapy, dialectical behavior therapy, motivational enhancement therapy, and trauma-informed cognitive behavioral therapy.
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Medicines When Mental Health and Alcohol Overlap
Antidepressants may be started while drinking is still ongoing and should not be withheld until the patient is completely abstinent. However, if there is concern about alcohol-drug interactions, then antidepressant therapy can be initiated in conjunction with a medication that helps reduce craving for alcohol, such as naltrexone (oral or long-acting injectable), acamprosate, and disulfiram.
The combination of a medication that helps reduce craving for alcohol (naltrexone or acamprosate) with an antidepressant that treats the patient's mental illness is effective in treating both conditions. These medications may be combined with mutual-support groups such as Alcoholics Anonymous.
If the patient has both an alcohol problem and depression, anxiety disorders, or PTSD, an antidepressant can help with both conditions simultaneously.
The medications naltrexone (oral or injectable), acamprosate, and disulfiram are used to support alcohol abstinence or limit drinking.
Naltrexone is available as an oral or injectable formulation. It reduces drinking by decreasing cravings and the reinforcing effects of alcohol on the brain.
Acamprosate is a nonopiate medication that reduces the negative effects of abstinence from alcohol, thereby increasing motivation to stay abstinent.
Medicines for alcohol use can sit beside antidepressants or antianxiety medicines. Some drugs used to treat mental health issues are known to interact with alcohol, so it's important to talk about your medication before starting any type of therapy.
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Finding Integrated Care in Ohio
Ohio county boards plan mental health and addiction prevention and treatment services in their communities through contracts with service providers.
An individual with a dual diagnosis has both a mental illness and an addiction to drugs or alcohol. The combination of these illnesses is called a co-occurring disorder.
The ADAMHS Board and its service provider agencies offer a variety of recovery support services. These services include support groups, case management, peer recovery services, housing assistance, educational/vocational training, and life skills development. Support group services such as Alcoholics Anonymous, Narcotics Anonymous, and others are available throughout the county.
Asking a program about dual diagnosis capable or enhanced treatment services is one way to tell if a facility can help you with both disorders at once.
When seeking treatment for co-occurring disorders, it's important to look for programs or providers that are trained in treating both types of conditions. These providers will understand how addiction can affect your mental health and vice versa, which allows them to create an individualized plan of care that meets your specific needs.
Certified community providers contracted by ADAMH boards across the state work to provide integrated care (or dual diagnosis treatment) for substance use disorders as well as mental health issues.