Dual Diagnosis: Which is the Chicken and Which is the Egg?

Much like the name implies, dual diagnosis disorders involve two co-occurring conditions, namely a substance abuse problem and some form of mental illness. People struggling with dual diagnosis disorder face an especially hard road in recovery as these conditions, when combined, tend to aggravate one another.

According to Dartmouth College, the symptoms associated with dual diagnosis greatly impair a person’s ability to function effectively in daily life. This includes areas involving work, relationships as well as health and overall safety concerns.

In effect, someone living with mental illness has an even harder time in recovery when substance abuse enters the picture than someone with no substance abuse issues. The same goes for substance abusers when symptoms of mental illness start to develop.

While dual diagnosis does entail two co-occurring conditions, more often than not, one condition precedes the other. In most cases, it’s difficult to determine which condition developed first due to the strong similarities mental illness and substance abuse share. However, understanding how these two conditions co-exist can go a long way towards helping dual diagnosis sufferers find needed treatment help.

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Dual Diagnosis: Dual Brain Diseases

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The causality concerning dual diagnosis varies case by case.

Normal brain function operates according to a delicate balance of neurotransmitter chemicals at all times. Any developing imbalances within this chemical system can potentially turn the brain into a diseased environment.

Drug addiction and mental illness both result from chemical imbalances in the brain. This similarity accounts for why these two conditions tend to develop alongside one another.

People who have mood or anxiety disorders are twice as likely to develop substance abuse problems compared to the rest of the population. Likewise, substance abusers face the same level of risk when it comes to developing mental health issues.

Mechanisms of Action

Inside the brain, addiction and mental illness impact the same chemical pathways and brain regions. Shared mechanisms of action include:

  • Both conditions interfere with serotonin production, serotonin being a primary neurotransmitter that regulates mood states
  • Both conditions increase dopamine production, another primary neurotransmitter that plays a central role in maintaining a person’s sense of contentment and ability to experience happiness
  • Both conditions interfere with the brain’s reward center, a region that dictates a person’s motivations, priorities and belief systems

Overall, the presence of one condition automatically predisposes the brain to developing the other. In effect, the two conditions that make-up dual diagnosis disorders interact with one another on a chemical level.

The Relationship between Mental Illness and Substance Abuse

According to the Substance Abuse & Mental Health Services Administration, as much as 43.7 of Americans struggled with some form of mental illness in 2012. Within the same year, an estimated 20.7 million adults had substance abuse disorders. Out of these numbers, 8.4 million adults were affected by dual diagnosis disorder.

The underlying causes of mental illness and substance abuse paint a clear picture of the relationship that exists between these two conditions:

  • Stimulant drugs such as methamphetamine and cocaine cause episodes of mania, panic attacks and anxiety.
  • Among people affected by schizophrenia, 70 percent smoke cigarettes. As nicotine is known for its ability to produce feelings of calm and well-being, these effects likely tie into the high prevalence of smokers within this population group
  • Heavy methamphetamine use causes users to experience tactile, auditory and sometimes visual hallucinations. These same symptoms are characteristic of psychosis.
  • An underactive brain reward system plays a central role in the formation of depression-based disorders. As drugs naturally stimulate this area of the brain, people struggling with depression symptoms may turn to drugs as a way to “activate” the brain reward system.

Can Drug Use Cause Mental Illness?

According to the University of Utah Health Sciences, it’s still as of yet unknown whether drug use can cause mental illness to develop. However, in cases where a person has a genetic predisposition to mental illness, the risk increases considerably.

Certain types of drugs, such as hallucinogens, can bring on a condition known as hallucinogen persisting perception disorder when used frequently on a long-term basis. Symptoms of hallucinogen persisting perception disorder resemble those associated with schizophrenia and typically subside after the drug leaves the system. On the other hand, people with a predisposition to mental illness can actually develop a full-blown psychosis disorder.

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Reasons for Drug Use

Most people engage in recreational drug use to relax and have fun. People affected by mental illness turn to drugs for the same reasons.

Whereas someone who isn’t mentally ill may turn to drugs out of boredom, or to be part of a group, someone struggling with mental illness can easily turn to drugs as means for self-medicating distressing symptoms.

While a drug “high” may offer temporary relief from symptoms, the withdrawal effects that come with regular drug use worsen the severity of symptoms associated with mental illness. Users readily see the relationship between the drug’s effects and symptom relief, but may not associate worsening symptoms with the withdrawal effects that come with drug use.

Diagnostic Considerations

With dual diagnosis, solving the “chicken or the egg” dilemma is seldom a straightforward process. Most forms of mental illness must meet certain criteria before a definite diagnosis can be made. Oftentimes, criteria requirements call for a gestation period where symptoms persist for a certain length of time before an accurate diagnosis can be made.

During this time, a person may well turn to drugs as a means for warding off uncomfortable symptoms. By the time he or she seeks needed treatment help, it can be hard to pinpoint when symptoms of mental illness first developed versus when drug use began.

Treatment Considerations

The combined effects of mental illness and substance abuse leave dual diagnosis sufferers to contend with:

  • Severe and ever-worsening symptoms of mental illness
  • Stronger drug cravings
  • Severe withdrawal episodes

These effects, in turn, form a vicious cycle where one condition aggravates the other making treatment and recovery all the more difficult. For these reasons, it’s imperative for someone struggling with dual diagnosis to seek needed treatment help as this condition only becomes harder to treat the longer it persists.

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