Dual Diagnosis

							What is a Dual Diagnosis?                                               Substance Abuse Basics
Definition of Dual Diagnosis                                   Which occurs first--substance abuse disorder or
A dual diagnosis is when an individual has a mood disorder     mood disorder?
(e.g., depression or anxiety) combined with a substance        It depends. In some cases, people suffering from serious
abuse disorder (e.g., alcohol or other drug abuse or           mood disorders (often undiagnosed ones) take drugs to
dependence). The individual must be treated for both           alleviate their symptoms--a practice known as self-
disorders.                                                     medicating. According to the American Psychiatric
                                                               Association, individuals with schizophrenia sometimes use
What are some serious mental disorders associated              substances such as marijuana to mitigate the disorder's
with substance abuse disorders?                                negative symptoms (depression, apathy, and social
Chronic drug abuse may occur in conjunction with any           withdrawal), to combat auditory hallucinations and paranoid
mental illness identified in the American Psychiatric          delusions, or to lessen the adverse effects of their
Association (DSM-IV). Some common serious mental               medication, which can include depression and restlessness.
disorders associated with chronic substance abuse include
schizophrenia, bipolar disorder, manic depression, attention   In other cases mood disorders are caused by drug abuse.
deficit hyperactivity disorder (ADHD), generalized anxiety     For example, Ecstasy produces long-term deficits in the
disorder, obsessive-compulsive disorder, post-traumatic        brain functioning, leading to mental disorders such as
stress disorder, panic disorder, and antisocial personality    depression and anxiety. Chronic substance abuse by
disorder.                                                      adolescents during formative years is a particular concern
                                                               because it can interfere with normal socialization and
                                                               cognitive development and thus frequently contributes to
Relationship between mood disorders and substance
                                                               the development of mental disorders.
abuse disorders
                                                               Finally, chronic substance abuse and serious mental
Patients with mood disorders have an increased risk for        disorders may exist completely independently of one
substance abuse disorders, and patients with substance         another.
abuse disorders have an increased risk for mood disorders.

        Substance abuse disorders can cause mood              Compared with individuals who have a mental
         disorder symptoms and mimic an actual mood            health disorder or a substance abuse problem
         disorder.                                             alone, individuals with dual disorders often
        Substance abuse disorders can initiate or             experience more severe and chronic medical,
         exacerbate a mood disorder.                           social, and emotional problems. Because they have
        Substance abuse disorders can hide mood               two disorders, they are vulnerable to both
         disorders and/or symptoms of mood disorders.          substance abuse relapse and a worsening of the
        Substance abuse withdrawal can cause mood
                                                               mood disorder.
         disorder symptoms and/or mimic an actual mood
         disorder
        Substance abuse disorders and mood disorders can      Treatment
         be present at the same time.
        Mood disorders can mimic substance abuse              To effectively treat a dual diagnosis both the substance
         symptoms.                                             abuse disorder and the mood disorder must be correctly
                                                               diagnosed. Individuals need to understand which disorder
The combinations of substance abuse problems and mood          is contributing to their symptoms and accept treatment for
disorders vary in regards to severity, chronicity, and         both disorders. Maintaining sobriety is essential as alcohol
degree of impairment in functioning. For example, the two      or other drugs may negatively interact with medications
disorders may each be severe or mild, or one may be more       prescribed for the mood disorder. Individuals will be
severe than the other. Indeed, the severity of both            encouraged to participate in treatment plans, which support
disorders may change over time.                                sobriety as well as addressing their mood disorder. A
                                                               typical treatment plan will involve self-help groups, talk
                                                               therapy, and medication management if needed.




Information from National Institute of Drug Addiction                                       Prepared by College Health IPA
www.nida.nih.gov                                                                                           December 2004