Dual Diagnosis
There are 21 million Americans that suffer from a substance use disorder. Of that 21 million, 8 million also have a mental health disorder. A dual diagnosis is a common occurrence among individuals and has a variety of treatment options. 1
What do you mean, “Dual Diagnosis”?
A dual diagnosis is a combination of diagnoses, meaning someone is experiencing both a mental illness and a substance use disorder at the same time.1 Approximately 38% of people in the United States that
have a substance use disorder also deal with a mental illness.1 Living with a mental illness increases the susceptibility of substance use, in fact, substance use is 2x more frequent in adults with mental illness. Individuals, in the United States, that have mental illnesses make up more than 30% of all alcohol use, more than 40% of all cocaine use and more than 50% of all opioid prescriptions.1 The direct correlation between substance use and mental illness leads to a rising public health concern because alcohol and/or drugs have the capability to worsen symptoms associated with mental illness while substance use dramatically increases the risk for mental illness.
In 2021, the Substance Abuse and Mental Health Services Administration (SAMHSA) published the national survey on drug use and health. This survey revealed that over 9 million adults in the United States identify with having a dual diagnosis.2 There is no distinct blend of substance use disorder and mental health illness that creates a dual diagnoses however, the most common mental health illnesses seen in conjunction with substance use disorder treatment include: anxiety and mood disorders, schizophrenia, bipolar disorder, major depressive disorder, conduct disorders, post-traumatic stress disorder (PTSD), and attention deficit hyperactivity disorder (ADHD).2 In addition, individuals treated for mental health illness most commonly suffer with the following substance use disorders: alcohol, tobacco, opioids, stimulants, marijuana, hallucinogens, and prescription drugs.2 This is especially concerning for women who are pregnant or breastfeeding.
How does Dual Diagnosis affect Pregnant Women?
Women who suffer with substance use disorder during pregnancy or breastfeeding are urged to speak to their preferred healthcare provider. Using substances during pregnancy can harm both mother and baby. When substance use is coupled with mental health disorders it directly impacts parenting.3 Typically, mothers who suffer from untreated substance use or mental health disorders record lower rates of parental competency and appear less inviting and sensitive toward their children than mothers without mental health disorders.3 When a dual diagnosis occurs within mothers, there have been instances of low social support for the children and a dramatic increase in the severity of substance use and depression.
An opioid use disorder (OUD) during pregnancy can cause major concerns for both mother and baby. In 2019, approximately 7% of women reported using prescription opioids during pregnancy.4 Using opioids, even your prescribed medication, during pregnancy has the potential to cause neonatal abstinence syndrome.4 Neonatal Abstinence Syndrome (NAS) is a group of problems for newborns exposed to addictive, illicit or prescription drugs while in the womb, causing them to go through withdrawal symptoms after birth. 4Taking drugs during pregnancy can pass through the placenta and then to the baby. The placenta provides food and oxygen for the baby through the umbilical cord. Everything that a mother partakes in during pregnancy has a high probability of being passed to the baby. When OUDs are present during pregnancy, there is anywhere from 25-33% of women who also have a psychiatric co-occuring disorder. The most common psychiatric dual diagnoses with OUD are anxiety and depression.
What are my Treatment Options?
There are various treatment options for a dual diagnosis. Each option is relative in nature and should be discussed with a trained healthcare provider. Regardless of which option is chosen, the ultimate goal for treatment is to give the individual the tools to create high self-efficacy or increase their confidence in their capabilities. Mothers who believe in their capacity to raise their children while overcoming a dual diagnosis are healthy mothers who raise healthy babies.
Psychotherapy
Psychotherapy is a form of treatment for mental health conditions that involves verbal communication with the goal of assisting in identifying coping mechanisms in place of the use of substances.1Another term for psychotherapy is talk therapy. Motivational interviewing is an aspect of psychotherapy that aims to help change behaviors through goal setting, defining values, and developing a personalized picture of healthy living.5 During a psychotherapy session, mothers can expect to see a mental health professional
(psychologist, psychiatrist, counselors, etc). The mental health professional uses various techniques,after getting to know the mother, to aid in pinpointing root causes and healthy coping mechanisms that can reduce stress or unpleasant emotions. Once those root causes and coping mechanisms have been identified and practiced, the likelihood of substance use reduces.
Inpatient Rehabilitation
Inpatient rehabilitation is a more traditional method of treatment. This option allows for recovery to occur within a treatment facility with various healthcare professionals. It is a more guided treatment that is often chosen if or when an individual could benefit from the consistent presence of a medical team directing the treatment and recovery process. The length of stay varies from short term rehab programs (averaging 7 days) to extended rehab programs (on average up to 2 years). The most common length of stay is 30 days or a month, often referred to as a 30-Day program. Inpatient programs are more likely to yield longer-term recovery due to their tailored nature.6 There are round-the-clock check-ins and almost immediate access to certified healthcare professionals. These centers typically offer both medical and mental health care through therapy, support, medication, and health services.1
Supportive Housing
Supportive housing is a less conventional method of treatment that has seen some great successes. In the supportive housing treatment option patients are referred to as residents. This treatment alternative is for those who are new to recovery and designed to help them avoid relapse. Although these centers are not typically managed by mental health professionals, there are often great opportunities to find support and begin the journey to recovery. 1
Many mental health services do not overlap with substance use services.7 This implies that the healthcare of an individual affected by dual diagnosis is divided between various systems making both diagnosis and treatment burdensome. Research encourages the notion that a system of integrated care is a viable and successful option for dual diagnosis patients. Until this comprehensive system is provided, be diligent in the pursuit of health. Seek psychotherapy as a first step. There are numerous, certified, professionals around the nation that will guide you on this journey. They can better assess the situation and help create a plan of care.
If you or someone you know are suffering from a dual diagnosis or believe you may have a dual diagnosis, know that you are not alone. Co-occurring disorders can be difficult to treat, but it is not impossible. Consult your healthcare provider to develop a personalized plan that will work for you.
Blog Writer: Taylor Neither, MPH
Blog Reviewer: Dr. Krista Mincey, MPH, Dr.PH, MCHES
References
SAMHSA. (2023). https://www.samhsa.gov/medications-substance-use-disorders/medications-counseling-related-co nditions/co-occurring-disorders
NIH. (2017). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5173330/
CDC. (2022). https://www.cdc.gov/pregnancy/opioids/basics.html
NIH. (2019). https://www.ncbi.nlm.nih.gov/books/NBK571068/
American Addiction Centers. (2023). https://americanaddictioncenters.org/rehab-guide/how-long-rehab-last
Better Health. (2021). https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/substance-abuse-and-mental-i llness-dual-diagnosis