Mental Health Awareness Month in South Africa

Dual Diagnosis: Addiction and Other Mental Illnesses

During mental health awareness month, we educate professionals and the public alike with a specific focus on addiction as a brain disease and how it often occurs alongside other mental health problems like major depression, ADHD and bipolar mood disorder. This phenomenon is termed dual diagnosis.

About 40% of addicts and alcoholics have a co-occurring mental illness while an estimated 20% of all people diagnosed with a mental illness suffer from a substance abuse problem, according to the National Institute on Drug Abuse.

“Dual diagnosis refers to the formal diagnosis of simultaneous mental health and substance use disorders,” explained psychologist Kate Saxton who is the practice manager at Changes Addiction Rehab in Northcliff, Johannesburg. “Either illness can develop first, but drug and alcohol use can exacerbate symptoms of mental health issues. Treating both disorders is crucial for lasting recovery,” she said.

Diagnosis and treatment for co-occurrence or dual diagnosis can be complicated because it is difficult to assess the overlapping symptoms of addiction and mental illness.

“Nevertheless, it is essential, as failure to treat both conditions places a person at a greater risk of relapse,” added Saxton.

Addiction rehab centres that offer dual-diagnosis treatment give their patients a much better chance of sustained recovery or sobriety, yet many of these facilities are not equipped to handle dual-diagnosis cases.
Apart from relapse, untreated dual diagnosis can leave a person vulnerable to other serious consequences including:

• Aggression
• Increase risky sexual activity
• Low quality of self-care
• Physical health problems
• Suicide

Chicken and the Egg: Which Comes First?

In many instances, people resort to alcohol and/or drug use and abuse to cope with symptoms of mental illness.

“For instance, someone struggling with depression turns to illicit drug use to suppress their emotional turmoil. Another person with anxiety may try an opiate as a sedative, and they may quickly develop a dependence on the drug,” explained Saxton. But the opposite of this is also true. “An individual may develop mental health problems as a result of substance use. Since drugs alter brain chemistry and function, a person could begin struggling with depression or other mental health illnesses, due to the use of substances,” she said.

Drug and alcohol abuse may also trigger an underlying mental health issue.

How to Treat Dual Diagnosis

Dual diagnosis can be difficult but there are a couple of clear indicators for treatment, according to Saxton.

1. Detox needs to ensure that the mind-altering substance is safely removed from the system as a priority.
2. Following detox, the individual will start the addiction rehab process.
3. But at the same time, they should be seen by a specialist psychiatrist and given the correct medication to ensure that the client is stabilised.
4. Should a client be psychotic, they would need to be stabilised before the addiction rehab process can truly be effective.
5. Hence, a specialist psychiatrist, who works within a multi-disciplinary team, is the best option for a dual-diagnosis patient.

“Training and services for mental health and substance misuse generally don’t overlap, so professionals in one field aren’t always knowledgeable about the issues in the other field. It can be hard to find professionals who are skilled in treating both substance misuse and mental illness,” explained Saxton.

Importantly, people who experience dual diagnosis issues (addiction and mental health problems) are affected in different ways and therefore have individual needs. In practice, what is effective for one person may not be effective for another. “A dual diagnosis comes with a whole set of unique issues, and understanding these issues is key to addiction rehab treatment and recovery.”

Mental Health Awareness Month in SA

Dual Diagnosis: Addiction and ADHD: What’s the link?

Up to 50% of people with ADHD have a substance abuse problem. ADHD is the most common psychiatric disorder in children and symptoms persist into adulthood in 30 – 80% of cases. ADHD is characterised by inattention, hyperactivity and impulsive behaviour.

People with ADHD have been found to start abusing substances at a younger age when compared to addicts and alcoholics without ADHD.

Addiction tends to make ADHD symptoms worse and vice versa. However, research shows that treating ADHD alongside addiction treatment improves outcomes and reduces the rates of relapse. Read more about the link between ADHD and addiction here.

Addiction and bipolar mood disorder: What’s the link?

Some research suggests that up to 60% of people with bipolar disorder have some kind of history of substance abuse. Studies have also estimated that people with bipolar 1 are three times more likely to abuse or be dependent on alcohol and seven times more likely to abuse or be dependent on drugs when compared to the general population.

Bipolar is a mood disorder characterised by manic and depressive episodes that significantly impact a person’s ability to function healthily. Substance use can make bipolar symptoms worse as well as trigger the onset of dormant bipolar. Untreated bipolar can significantly impact a person’s ability to stay clean and sober by increasing the chances of relapse. Both conditions need to be treated simultaneously.

Read more about the link between addiction and bipolar mood disorder here.

Addiction and anxiety: What’s the link?

Everyone experiences some level of anxiety but you may be diagnosed with an anxiety disorder if your symptoms are extreme and interfere with your daily functioning.

Some research suggests about 30% of people with an addiction have also had an anxiety disorder at some point in their lifetime. About 20% of people with an anxiety disorder have experienced a substance abuse problem in their lifetime.

Drugs and alcohol may offer people suffering from anxiety relief in the short term but substance abuse invariably leads to anxiety symptoms worsening in the long-term.

Untreated anxiety increases the likelihood of relapse as well as poor outcomes of addiction treatment. An experienced psychiatrist will be able to differentiate an anxiety disorder from withdrawal-related anxiety in the treatment environment as well as treat both conditions accordingly.

Read more about the link between addiction and anxiety here.

Addiction and PTSD: What’s the link?

Trauma and addiction have a strong link. Some research on adolescents in the United States estimates that up to 70% of people being treated for substance use disorders have a history of trauma.

PTSD (post-traumatic stress disorder) is an illness that develops in some people after they experience a particularly traumatic event. According to a 2010 study, almost 60% of young people with PTSD go on to develop substance abuse problems.

South Africa has comparatively high rates of trauma and PTSD which is a significant driver of the country’s addiction epidemic. A nationally representative survey found that 75% of South Africans had experienced a traumatic event and about half had experienced more than one trauma.

It is thought that people turn to substances to self-medicate symptoms of PTSD. Such individuals may need to use more and more of the substance to experience temporary relief: This cycle often leads to the development of an addiction. Although substance use helps people with PTSD in the short term, abusing substances usually ends up making PTSD symptoms worse in the long term. Both need to be treated simultaneously for the best chance at recovery.

Read more about the link between addiction and PTSD here.

What’s the Link Between PTSD and Addiction?