Dual Diagnosis
Historically
• In the 1970s it was thought that a minority of
clients suffered from both a mental illness and
an addiction
• Today, we know this is not true....
• Today we acknowledge that a majority of our
clients suffer from both a mental illness and an
addiction
•
•
•
Theories of DualDiagnosis
Self-medication theory: Substances are selectively used in
service of alleviating symptoms of mental illness (i.e. stimulant
abuse employed to counter the sedative effects of antipsychotic medications)
Alleviation of dysphoria: mental illness creates dysphoria
(feeling bad) and this dysphoria leads to drug use to mitigate
the experience of these unpleasant feelings
Multiple risk: In addition to the alleviation of bad-feelings, there
are additional risks such as: social isolation, poverty, lack of
daily structure, residing in areas with drug availability, history of
traumatic events
Theories Continued
•
•
•
Supersensitivity: individuals with severe mental illness
have biological/psychological vulnerabilities for substance
abuse caused by genetic and early environmental factors
that interact with life stressors
It is important to note that these theories might all be
present to varying degree’s in looking at the causal links
underlying a dual-diagnosis.
There are no definitive quantitative links correlating
mental illness/substance abuse apart from heavy
adolescent cannabis use and early onset schizophrenia
No Universal Agreed Upon
Definition
• Each disorder is intertwined with the other
• Each is able to influence the other (addiction magnifies)
• Chicken and Egg as far etiology
• Difficult to discern symptoms of one from psychiatric disorder
from the addictive disorder
• Many psychiatric symptoms omit once addiction is ceased or
after a period of abstinence
Stigma of the Dually
Diagnosed!
Likelihood that people with
mental illness will commit
violent acts
No greater than general
population!
Why worry about it?
• Have worse treatment outcomes
• Higher health care outcomes
• Increased risk of violence, trauma,
suicide, child abuse, neglect, involvement
with justice system
• More prone to helplessness, depression,
greater trouble coping
Table 22.1 The Overlap Between Substance Use
and Disorders and Various Psychiatric Disorders
_________________________________________
Lifetime psychiatric
Substance use disorder
diagnosis
Depression
Bipolar affective disorder
Anxiety disorder
Antisocial personality
Disorder
ADHD
Eating disorder
Schizophrenia
32%
64%
36%
84%
23%
28%
50%
In Canada
(Skinner et al. 2004: Concurrent substances use and mental health disorders, 2009, [CAMH]).
• 30% of people in Canada with a mental
illness will have a substance abuse problem
in their lifetime
• 37% of people who abuse alcohol in their
lifetime will have a mental illness
• Meanwhile, 53% who abuse drugs in their
lifetime will have a mental illness.
Problems in Working with
Dual Diagnosis Clients
• Fractured support systems
• Slow progress
• Off and on meds
• Significant level of denial
• Seeming inability to trust
• Collude and transference / idealization / or devalue
• Feelings on meds
• Field as a whole and turf wars