Addiction to mind altering chemicals such as alcohol or narcotics, known clinically as Substance Use Disorder (SUD), describes a behavioral condition that many struggle to understand. Individuals who suffer with alcoholism and/or drug addiction often act in ways that are not in line with their personalities and morals, particularly when it involves access to their drug of choice. To complicate matters further, underlying psychiatric disorders can exponentially exacerbate addiction and maladaptive behaviors. Depression, for example, can drive individuals to seek refuge in alcohol. A depressive alcoholic will often drink to the point of stupor or blackout, which makes the depression worse. The same can be said for any psychiatric disorder paired with addiction. When an individual suffers from both mental illness and addiction, it is known as dual diagnosis.
The Difficulty of Dual Diagnosis
Two co-occurring behavioral disorders present complications beyond just the individual and surrounding loved ones. Teasing out what behaviors are caused by what is also difficult for the mental health professionals responsible for directing the affected individual’s treatment. This process is crucial for moving toward recovery and a better overall state of mind. Creating a treatment plan requires counselors, psychologists, and psychiatrists to ask these questions:
- What role, if any, is alcohol playing in the patient’s behaviors and complaints?
- Is the patient experiencing clinical depression to the degree that pharmacological treatment would be necessary? Other disorders that often require psychiatric medication include bipolar disorder, anxiety, and schizophrenia.
- What psychiatric disorder is the patient presenting, if any?
- How does one determine whether problematic drinking/use is the cause or the result of psychiatric symptoms?
Heavy substance abuse clouds the ability to distinguish the root cause of behavioral problems. Psychiatric disorders are identified by a pattern of signs of symptoms, which over the course of time can present as a syndrome. So outlining minor signs and symptoms of mental illness may simply point to substance abuse alone, but there is a point where those mental illness symptoms are compounded into a real psychiatric disorder. That’s where addiction becomes a case of dual diagnosis.
Mental Health: Symptoms Versus Syndrome
Mental health professionals use the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) to assist in diagnosing mental health disorders. Unfortunately, dual diagnosis does not have its own entry, although there have been calls in the psychiatric community to do so. So psychiatrists, psychologists, therapists, and addiction counselors must rely on the separate definitions of addiction and various behavioral disorders.
Substance use disorders span a wide variety of problems, and these are the criteria outlined by the DSM-V:
- Taking the substance in larger amounts or for longer than you’re meant to.
- Wanting to cut down or stop using the substance but not managing to.
- Spending a lot of time getting, using, or recovering from use of the substance.
- Cravings and urges to use the substance.
- Not managing to do what you should at work, home, or school because of substance use.
- Continuing to use, even when it causes problems in relationships.
- Giving up important social, occupational, or recreational activities because of substance use.
- Using substances again and again, even when it puts you in danger.
- Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance.
- Needing more of the substance to get the effect you want (tolerance).
- Development of withdrawal symptoms, which can be relieved by taking more of the substance.
Each of these criteria on their own are considered a symptom. Together, they constitute a syndrome. Behavioral disorders such as depression and anxiety have their own list of symptoms that addiction professionals use to identify cases of dual diagnosis.