In 2015, SAMHSA, the Substance Abuse and Mental Health Services Administration, released their most recent findings on the prevalence concurrent mental health issues in people with substance abuse issues. The survey was comprehensive, covering substance abuse ranging from tobacco, alcohol and prescription drug abuse — more common, legal substances — to more illicit, often illegal substances: hallucinogens, inhalants and methamphetamine. Among the prescription drugs categorized were pain relievers, tranquilizers, stimulants and sedatives — all drugs that when dosages stray from doctor prescription guidelines can cause serious harm to human life.

As of 2015, SAMHSA found that 51.2% of Americans age 18 and over engaged in illicit drug use. They break down the percentages of the population by type of drug use as follows:

• 46.9% used marijuana
• 15.9% used cocaine – with 3.7% having used crack cocaine
• 2.1% used heroine
• 16.5% used hallucinogens – with 10.3% having used LSD, 2.6% having used PCP and 7.4% having used ecstasy
• 9.7% used inhalants
• 5.9% used methamphetamines.

Overall, illicit drug use other than marijuana reached 30.1% of the population.

Mental Illness and Substance Abuse

Drug use is widely known to have deleterious effects, both short- and long- term and on the individual and the community at large. From heart attacks, kidney and liver failure, hepatitis and AIDS, the health conditions that drug users risk are severe. Even if drug use does not result in physical ailment, it can lead to behavioral changes and impaired decision making that affects one’s own life course and the course of those around them: “Drug use can [affect] a person’s nutrition; sleep; decision-making and impulsivity; and risk for trauma, violence, injury, and communicable diseases. Drug use can also affect babies born to women who use drugs while pregnant. Broader negative outcomes may be seen in education level, employment, housing, relationships, and criminal justice involvement,” the National Institute on Drug Abuse explains.

With risks this dangerous, it begs the question: why are so many American adults using drugs?

The answer is not simple, of course. For decades scientists and researchers have studied the nature of addiction and the environmental landscapes that can put someone at risk for drug use. But only recently have studies taken into account the Biopsychosocial model, and started looking more inward at the individual risk that mental health issues carry for drug use.

Pre-existing and untreated mental health disorders can be a strong risk factor for drug use. According to the SAMHSA report, in 2015, 17.9% of the adult American population experienced a mental illness in the past year. NAMI, the National Alliance on Mental Health, reports from that over 7.9 million adult Americans experience both a mental disorder and substance abuse disorder simultaneously.

Integrated Treatment

The number of people suffering from undiagnosed mental illness is unknown. Given the historical stigma surrounding mental illness — with negative portrayals in media like television and film — in addition to the historical lack of funding, research and resources for the general public, it is no wonder that many people suffer in silence and unaware. It was only 77 years ago, in 1952, that the first Diagnostic and Statistical Manual of Mental Disorders, or DSM, was created.

Given these numbers, we can see why many people suffering from mental illness may self-medicate through illicit drug use. Symptoms of depression, anxiety, agitation, confusion and legitimate pain can lead many, unaware of other options, to turn to drugs for relief. Their drug use, unfortunately, leads to even worsening symptoms of mental health when the individual experiences withdrawal and, if the drug use continues, their lives become less directed and chosen and more controlled by their addiction.

The good news is that today, there are many resources for people with both a mental illness and drug addiction — known as dual-diagnosis. Detoxification programs, inpatient and outpatient rehabilitation, supportive housing, psychotherapy, medication management and self-help and support groups are widely researched, approved and culturally applicable forms of treatment to support and individual with a dual-diagnosis.

However accepted these treatments have become, many often still don’t receive the full treatment they deserve. According to DrugAbuse.com, an American Addiction Centers Resource, in 2016 only an estimated 6.9% of adults were treated for both their addiction and their mental illness — leaving many not entirely cared for and vulnerable to relapses.

But it is becoming increasingly evident that there is a dire need for these types of programs to serve the people who suffer from dual-diagnosis. The numbers prove it: according to the Foundations Recovery Network, a research-based non-profit, the percentage of patients in drug rehabilitation programs who were then diagnosed with mental illnesses increased from 12 to 16% in a span of 6 years. As patient-care programs become more aware of their patient’s needs, mental illness treatment as a component in care is becoming more and more recognized.

Dual Diagnosis Treatment

It is important that, when looking into substance abuse treatment options, mental health is considered as a component. Seeing the signs of addiction and/or mental illness can be difficult — not everyone functions at low levels while they are suffering. The Foundations Network notes the SAMHSA findings that 13.2% of men employed full-time suffer from drug addiction or abuse in the past year; 14.2% of women employed full-time have dealt with mental illness in the past year. Functioning levels can vary, but suffering from untreated addiction or mental illness should never be the standard for quality of life when there are options available. Psychotherapy, cognitive-behavioral therapy and medication management — some of the most effective forms of treatment for common mental illnesses like bipolar disorder and depression  — are available at select treatment centers for people will mental illness.

As we continue our look into dual diagnosis, we already have identified the many challenges involved, symptoms, and some at-risk populations. Today we discuss dual diagnosis treatment.

Once again, the National Alliance on Mental Illness (NAMI) says that dual diagnosis is “a term for when someone experiences a mental illness and a substance use disorder simultaneously.” The two diagnoses share a close relationship across a number of areas. NAMI states: “Either disorder—substance use or mental illness—can develop first. People experiencing a mental health condition may turn to alcohol or other drugs as a form of self-medication to improve the mental health symptoms they experience. However, research shows that alcohol and other drugs worsen the symptoms of mental illnesses.”

And, as we’ve note, NAMI further states: “According to a 2014 National Survey on Drug Use and Health, 7.9 million people in the U.S. experience both a mental disorder and substance use disorder simultaneously. More than half of those people—4.1 million to be exact—are men.”

Dual Diagnosis Treatment

How can dual diagnosis be treated?

As we noted previously, the Substance Abuse and Mental Health Services Administration (SAMHSA), “supports an integrated treatment approach to treating co-occurring mental and substance use disorders. Integrated treatment requires collaboration across disciplines. Integrated treatment planning addresses both mental health and substance abuse, each in the context of the other disorder. Treatment planning should be client-centered, addressing clients’ goals and using treatment strategies that are acceptable to them.”

NAMI notes that “the best treatment for dual diagnosis is integrated intervention, when a person receives care for both their diagnosed mental illness and substance abuse.” Importantly, “the idea that ‘I cannot treat your depression because you are also drinking’ is outdated—current thinking requires both issues be addressed.”

Common methods can include:

• Inpatient Rehabilitation. “A person experiencing a mental illness and dangerous/dependent patterns of substance use may benefit from an inpatient rehabilitation center where they can receive medical and mental health care 24/7. These treatment centers provide therapy, support, medication and health services to treat the substance use disorder and its underlying causes.”
• “Supportive Housing, like group homes or sober houses, are residential treatment centers that may help people who are newly sober or trying to avoid relapse. These centers provide some support and independence. Sober homes have been criticized for offering varying levels of quality care because licensed professionals do not typically run them. Do your research when selecting a treatment setting.”
• “Psychotherapy is usually a large part of an effective dual diagnosis treatment plan. In particular, cognitive behavioral therapy (CBT) helps people with dual diagnosis learn how to cope and change ineffective patterns of thinking, which may increase the risk of substance use.”

 

Among the many challenges associated with substance abuse is the propensity for “dual diagnosis.”

As the National Alliance on Mental Illness (NAMI) notes, dual diagnosis is “a term for when someone experiences a mental illness and a substance use disorder simultaneously.” The two diagnoses share a close relationship across a number of areas. NAMI states: “Either disorder—substance use or mental illness—can develop first. People experiencing a mental health condition may turn to alcohol or other drugs as a form of self-medication to improve the mental health symptoms they experience. However, research shows that alcohol and other drugs worsen the symptoms of mental illnesses.”

In fact, the interactions may be even more tightly intertwined. How common Is dual diagnosis?

The Substance Abuse and Mental Health Services Administration (SAMHSA), part of the U.S. Department of Health and Human Services, notes that “People with a mental disorder are more likely to experience a substance use disorder and people with a substance use disorder are more likely to have a mental disorder when compared with the general population. According to the National Survey of Substance Abuse Treatment Services (N-SSATS), about 45% of Americans seeking substance use disorder treatment have been diagnosed as having a co-occurring mental and substance use disorder.”

Or, as NAMI states: “According to a 2014 National Survey on Drug Use and Health, 7.9 million people in the U.S. experience both a mental disorder and substance use disorder simultaneously. More than half of those people—4.1 million to be exact—are men.”

Dual Diagnosis Integrated Treatments

As highlighted here, some co-occurring or dual diagnoses include:

• Anxiety: Symptoms, OCD, PTSD, Phobia
• Bipolar Disorder: Symptoms, Bipolar Depression, Treatment
• Depression: Symptoms, Stats, Demographics
• Eating Disorders: Symptoms, Medical Complications, Treatment

In fact, SAMHSA “supports an integrated treatment approach to treating co-occurring mental and substance use disorders. Integrated treatment requires collaboration across disciplines. Integrated treatment planning addresses both mental health and substance abuse, each in the context of the other disorder. Treatment planning should be client-centered, addressing clients’ goals and using treatment strategies that are acceptable to them.”

The site continues: “Integrated treatment or treatment that addresses mental and substance use conditions at the same time is associated with lower costs and better outcomes such as:”

• Reduced substance use
• Improved psychiatric symptoms and functioning
• Decreased hospitalization
• Increased housing stability
• Fewer arrests
• Improved quality of life

In our next post, we’ll go deeper into symptoms and certain populations at risk.