Alcohol And Dual Diagnosis

What Does Dual Diagnosis Mean?

Dual diagnosis is a term used when someone has a substance use disorder (addiction) and an additional mental health disorder diagnosis. Some treatment programs use the term to indicate that they focus on mental health conditions as well as addiction. Fortunately, most addiction treatment programs already attend to mental health disorders since integrated treatment lead to better outcomes.

The term ‘dual’ usually refers to two related things. However, for people with addiction, it is much more likely to have multiple additional mental health and medical conditions. Therefore, regarding alcohol addiction treatment, dual diagnosis is understood as an umbrella term covering all additional diagnosis.

What Is Comorbidity?

Comorbidity is a medical term used when someone has two or more conditions that interact with each other. Comorbidities related to addiction are medical or mental health conditions that have a direct link to substance use and recovery.

Understanding Dual Diagnosis

There are three main explanations for dual diagnosis with alcohol addiction.

Alcohol Problems Can Cause Comorbid Conditions

This pattern is seen when someone develops mental health disorders only after their alcohol addiction has disrupted their lives.

For example, this could be seen in someone with an alcohol addiction who later develops depression or anxiety due to the neurological and emotional effects of their alcohol use. In these instances, the secondary mental health problems are likely to resolve with sustained sobriety.

Comorbid Conditions Can Cause Alcohol Problems

This pattern is often called “self-medication” since alcohol use is presumed to be directly related to a person’s attempts to reduce distress related to their mental health conditions. In these cases, alcohol addiction is secondary to the mental health condition.

For example, someone who has struggled with anxiety since childhood may later in life become dependent on alcohol because it temporarily relieves their anxiety.

Both Alcohol Problems And Comorbid Conditions Are Caused By Other Factors

Alcohol addiction and mental health conditions share many of the same risk factors. So, another explanation for the high rates of comorbidity is that someone with these overlapping risk factors is highly vulnerable to developing addiction, mental health problems, or both.

Common Dual-Diagnosis With Alcohol Addiction

People with alcohol addiction are likely to have multiple medical and mental health conditions.

Medical Conditions

Medical conditions that result from alcohol addiction include:

• Chronic pain
• Liver disorders
• Heart conditions
• Pancreatitis
• Cancer
• Traumatic brain injuries

This is not a comprehensive list, however, and people with alcohol addiction may have other medical conditions that interact with their alcohol use and recovery.

Mood Disorders And Bipolar Disorders

Difficulties with mood instability or feelings of emotional intensity, guilt, and shame are common for people with alcohol addiction. Sometimes these changes in mood are directly caused by the effects of alcohol or alcohol withdrawal.

Other times, these mood disturbances are independent mental health disorders like major depressive disorder, persistent depressive disorder, bipolar disorder, cyclothymic disorder, disruptive mood dysregulation disorder, and premenstrual dysphoric disorder.

Anxiety Disorders, Compulsive Disorder, And Eating Disorders

People with alcohol addiction often struggle with feelings of anxiety, worry, panic, fear, obsessions, compulsions, or exaggerated self-judgment. These symptoms can be directly related to and caused by alcohol use, or they can extend beyond substance-related thoughts and feelings.

There are high rates of comorbidity of alcohol addiction and generalized anxiety disorder, panic disorder, social anxiety disorder, obsessive-compulsive disorder, anorexia nervosa, bulimia nervosa, and binge eating disorder.

Trauma And PTSD

People with a history of significant trauma have a higher risk of addiction, even when their symptoms do not meet the full diagnostic criteria for post-traumatic stress disorder (PTSD).

Even if the trauma occurs while the person is under the influence of alcohol, the impact of the trauma can lead to distinct problems that are not caused by the addiction. It is common for people with an alcohol addiction to have a dual diagnosis of PTSD, acute stress disorder, adjustment disorder, or prolonged grief disorder.

Personality And Conduct Disorders

People who struggle with alcohol addiction often exhibit periods of altered personality and temperament, such as:

Sometimes these patterns are isolated to periods of alcohol intoxication or withdrawal, in which case they probably are not related to an independent personality disorder or conduct disorder. However, if these personality traits were evident persistently before alcohol addiction or continue beyond periods of intoxication or withdrawal, they may indicate a personality disorder.

Clinical evidence indicates that the personality disorders frequently diagnosed with alcohol addiction include borderline personality disorder, antisocial personality disorder, narcissistic personality disorder, conduct disorder, and oppositional defiant disorder.

Serious Mental Illness And Developmental Disorders

Alcohol intoxication and withdrawal can lead to cognitive deficits and perceptual disturbances including:

• Memory loss
• Difficulty focusing
• Impaired judgment
• Paranoia
• Hallucinations
• Delusions

However, if someone experiences those symptoms when they are not impacted by alcohol or other drugs, they could have an independent mental health disorder. The risk for alcohol addiction is higher for people with attention-deficit hyperactivity disorder (ADHD), high functioning autism spectrum disorder, and schizophrenia spectrum disorders.

Dual Diagnosis Challenges

For people with alcohol addiction, it can be particularly challenging to tell whether mental health symptoms are substance-induced or independent of the substance use disorder.

For that reason, healthcare providers may postpone making a mental health diagnosis until the person has a sufficient period of sobriety in order to determine if the mental health symptoms continue to be problematic once the person is no longer experiencing alcohol intoxication or alcohol withdrawal. However, this delay may not be necessary if the healthcare provider has sufficient evidence that the mental health symptoms started before alcohol use or have persisted during periods of past long-term sobriety.

Dual Diagnosis Treatment

Treatment for duel diagnosis focuses on treating the multiple and varied symptoms and side-effects for all conditions.

Integrated Treatment For Dual Diagnosis

In the past, addiction and comorbid mental health conditions were treated sequentially, with the assumption that someone could not benefit from treating their mental health comorbidities until they sustained sobriety.

However, research has refuted that idea, and integrated treatment for dual diagnosis patients leads to better outcomes. Integrated treatment should focus on coping skills and targeted treatment for mental health disorders while also helping the person address their alcohol use disorder.

Medication Options

Psychiatric medications can be particularly important for people with dual diagnosis. Certain medications can reduce that risk of relapse by reducing physical and psychological symptoms while the person is recovering from the alcohol-related changes. Some medications are prescribed specifically for alcohol withdrawal, others reduce cravings, and others treat symptoms of comorbid disorders.

Support For Alcohol Addiction And Dual Diagnosis

The effects of dual diagnosis and alcohol addiction can be hard to deal with on your own. Thankfully, treatment is available to provide direction and support in your recovery journey.

Contact a treatment provider today to talk about the treatment options available to you.