Dual Diagnosis
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The Alcohol, Drug Abuse, and Mental Health Administration (ADAMA) states that at least 50 percent of the 1.5 to 2 million Americans who have severe mental illnesses also abuse alcohol or illicit drugs, compared to 15 percent of the general population. (Talbot, 1987) The National Institute on Alcohol Abuse and Alcoholism released results of a study done in 1993 where clinicians attempted to make psychiatric diagnoses on suicide victims. After interviewing family members of over 1400 suicide victims they reported a finding that most of the suicide victims had suffered from a mood disorder, and that nearly half, or 48 percent also suffered from alcoholism or drug abuse. Severe depression accompanied by substance abuse has been shown again and again to be one of the most frequent causes of suicide. Dual Diagnosis is defined as "the simultaneous occurrence of a psychiatric disorder and a substance abuse disorder in the same individual at the time of diagnosis." It is often difficult to determine if an individual turned to substance abuse (especially alcohol) as a means of ending his pain, or if there was an underlying vulnerability that precipitated both the mental illness and the substance abuse. In fact it makes little difference whether the "chicken or the egg" came first…once a person has a mental illness and an addiction he/she is in a very difficult position and in great danger of becoming a statistic. An individual with unmedicated Bipolar Disorder, or one who has never been diagnosed is at great risk. Even if the mental illness is recognized and is being treated with the appropriate medications and therapies it doesn't necessarily mean that the substance abuse problem will go away. Certainly, in a person whose symptoms of Bipolar Disorder are controlled substance abuse is easier to treat, but BOTH must be addressed. It is essential that anyone with Bipolar Disorder who also has an addiction problem advise his/her doctor or psychiatrist. An active substance abuse problem will make a diagnosis of mental illness more difficult, as well as the treatment of that disorder. One of the most difficult things the individual with dual diagnosis must do is to admit that the substance abuse is a problem. This happens mostly in terms of alcohol, as those using drugs generally know that they are addicted. An individual can often recognize alcohol addiction or dependence simply by asking himself a few questions. Do I drink more or for a longer period than I intended? Have I ever attempted to control my drinking? Have I spent a lot of time obtaining, drinking and recovering from alcohol? Have I ever been unable to work or fulfill responsibilities due to drinking? Do I continue to drink even though I know it causes worsening mental or physical problems? Do I drink in dangerous ways? (such as before driving) Do I continue to drink even though it causes problems with my spouse or family? Have I had alcohol related legal problems such as DUI's? Do I ever drink to avoid withdrawal symptoms? If addiction is present, an honest frank and open discussion with the doctor or psychiatrist is necessary. Without a doubt Bipolar Disorder in itself can cause great stress for family members. Add to that symptoms of addiction and there is a volatile situation. It is a known fact that many relationships with individuals with Bipolar Disorder fail because the symptoms are so difficult to live with. Unhealthy patterns of relating and communicating are common. Treatment for both disorders can lead to better relationships. A new October 2000 study outlined in PubMed at http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10994680&dopt=Abstract has this to say about treatment for dual diagnosis:
"Recovery from substance abuse and mental health disorders (dual-diagnosis) requires time, hard work and a broad array of coping skills. Empirical evidence has demonstrated the buffering role of social support in stressful situations. This paper investigates the associations among social support (including dual-recovery mutual aid), recovery status and personal well being in dually diagnosed individuals (N = 310) using cross-sectional self-report data. Persons with higher levels of support and greater participation in dual-recovery mutual aid reported less substance use and mental health distress and higher levels of well being. Participation in mutual aid was indirectly associated with recovery through perceived levels of support. The association between mutual aid and recovery held for dual-recovery groups but not for traditional, single-focus self-help groups."
In effect this is saying that support is extremely important in the recovery of anyone who has a dual diagnosis. Many programs address either the Bipolar Disorder or the Addiction, but there are still far too few programs that address both. Mental health professionals routinely refer a patient for evaluation and treatment of a chemical dependency to a treatment center, rehabilitation center or possibly inpatient or outpatient treatment if the patient is out of control. Everyone is familiar with the traditional support group for individuals with alcoholism. Alcoholics Anonymous was founded more than fifty years ago and is based on the belief that alcoholics who recognize they have a disease can become and remain sober through acceptance of their powerlessness over alcohol and the support of recovering alcoholics. Dual Recovery Anonymous is an independent, twelve step, self-help organization for people with a dual diagnosis. The goal of Dual Recovery Anonymous is to help men and women with chemical dependencies and emotional or psychiatric illnesses get, and remain well. Both illnesses affect those with Dual Diagnosis in every area of life; mentally, physically, socially and spiritually. For more information about Dual Diagnosis or for information about starting a chapter in your town or city, please see the Dual Recovery Website at http://draonline.org/index.html For more information about Dual Diagnosis see the links on Dr Ivan Goldberg's Substance Abuse and Mood Disorders (Dual Diagnosis) page at http://www.psycom.net/depression.central.substance.html The links on this page include topics such as "assessment and treatment of people with dual-diagnosis" and "management of depression in the context of the naltroxene therapy of alcoholism." If you have experience with dual diagnosis I'd like to hear from you.

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