Kentucky Partnership for Families and Children

Co-Occurring Substance Abuse and Mental Illness, also know as Dual Diagnosis, refers to the co-occurrence of mental health disorders and drug abuse. Typically, those suffering from a mental illness that causes stress or sadness (e.g. Bipolar Disorder, Depression and Post-Traumatic Stress Disorder) use drugs such as alcohol, cocaine, marijuana and prescription pills to combat their symptoms.

Causes:
Each mental health disorder and substance abuse problem has its own underlying genetic and/or environmental cause. The condition of Co-Occurring Disorders, on the other hand, does not. A Co-Occurring Disorder begins when an individual uses drugs to "self-medicate" their symptoms of mental health illness or side effects of their prescribed medications. These people feel that they can reduce their level of anxiety or depression, at least temporarily. Social factors may also play a major role in contributing to the condition. As a consequence of their mental illness, they may end up living in neighborhoods where drug use is common. Furthermore, since their mental illness may make them outcast to many groups, they resort to joining groups whose social activity is based on drug use.

PREVELANCE:
Recent findings suggest that as much as 50% of the mentally ill population also has a substance abuse problem. Additionally, studies indicate that males and those in the age group of 18-44 are more likely to be dually diagnosed. The group on the rise, however, is the teen-age population. With such high standards of being quote on quote "normal," among young adults in high school and college, these teen-agers are looking to drugs and alcohol to make friends, hide feelings and/or forget about the past.

CHARACTERISTICS:
Although identifying a person who has a mental illness or a substance abuse problem is somewhat difficult, it is even more so to detect someone with a dual-diagnosis. Since behavioral changes that lead to suspicion of a drug abuse problem already exists in persons with a mental health illness, it is very difficult to determine if that person begins abusing drugs. Some characteristics, however, to look for include:

• Appearance of new friends
• Valuables disappearing from the home
• Drug paraphernalia
• Heavily dilated or pinpointed eyes
• Needle marks in arm or other hidden places (between toes, buttocks, etc.)
• Sexual activity
• Spending large amounts of time alone in discreet places such as the bathroom

In addition to the short-term, immediate effects of Co-Occurring Disorders, other long-term characteristics have been identified. Violence, for example, occurs frequently in the dually diagnosed population. This includes domestic violence and suicide. Also, these individuals are more likely to commit serious crimes that land them in prison.

Treatment:
Traditionally, treatment programs designed for those with brain disorders and mental illness do not accommodate those who have a substance abuse problem, and treatment programs designed for those with substance abuse disorders are not geared toward those who have a mental illness. Unfortunately, in the past, many dually diagnosed patients went back and forth between the two types of programs with no real help of dealing with the two illnesses together.

CHARACTERISTICS:
Although identifying a person who has a mental illness or a substance abuse problem is somewhat difficult, it is even more so to detect someone with a dual-diagnosis. Since behavioral changes that lead to suspicion of a drug abuse problem already exists in persons with a mental health illness, it is very difficult to determine if that person begins abusing drugs. Some characteristics, however, to look for include:

• Appearance of new friends
• Valuables disappearing from the home
• Drug paraphernalia
• Heavily dilated or pinpointed eyes
• Needle marks in arm or other hidden places (between toes, buttocks, etc.)
• Sexual activity
• Spending large amounts of time alone in discreet places such as the bathroom

In addition to the short-term, immediate effects of Co-Occurring Disorders, other long-term characteristics have been identified. Violence, for example, occurs frequently in the dually diagnosed population. This includes domestic violence and suicide. Also, these individuals are more likely to commit serious crimes that land them in prison.

Treatment:
Traditionally, treatment programs designed for those with brain disorders and mental illness do not accommodate those who have a substance abuse problem, and treatment programs designed for those with substance abuse disorders are not geared toward those who have a mental illness. Unfortunately, in the past, many dually diagnosed patients went back and forth between the two types of programs with no real help of dealing with the two illnesses together.

Treatment (continued):
A "hybrid," or mixture, of the two programs is what is necessary for a person who is suffering from a Co-Occurring Disorder. Some characteristics of such programs include:

• A gradual approach of addressing the problem, with abstinence not being a contingency of beginning treatment
• Expecting denial of the substance abuse at first
• Attention to social factors, including helping develop a reinforcing social network, providing access to recreational activities and education for involved family members
• Non-threatening and non-coercive direction to accommodate the client's fragile state caused by their mental illness

What Can the Family Do to Help?:
Coping with and helping a family member who has a mental illness or a substance abuse problem is very difficult. Obviously, the difficulty is multiplied when a loved one is dually diagnosed. The first step in helping is simply recognizing the problem, which is not easy since the characteristics of each separate illness mimic each other. Nonetheless, it is important to investigate all behaviors that may be signaling drug use. The next step is confronting the problem. Here again, this not an easy task. Many persons who have a mental illness coupled with a substance abuse problem often deny allegations of using drugs to "self-medicate." A careful, deliberate manner is recommended to avoid the person from immediately denying the problem and closing off the possibility to themselves. Once the problem has been brought into the open, proper treatment dealing with both issues should be recommended and supported. Lastly, support and education is needed for the primary care-giver and the rest of the family. The caregiver has almost as tough of a role to play in the treatment as the ill child or teen-ager. Caregivers must support the ill child, help the rest of the family deal with what is happening, as well as take care of themselves. Other family members may become angry with the mentally ill family member who seemingly confounded their problem by using drugs. Additionally, family members may feel guilty because they feel that in some way it was their fault or that they did not prevent it. In both situations it is important to educate the family members about mental illness and drug addiction being a "disease." They could not as much help it as someone else who suffers from cancer.

The good news for family members is that the substance abuse can be overcome. With the proper treatment, support of the family and friends and patience, recovery from an addiction is an attainable goal.

Co-Occurring Disorders Resources
DUAL DIAGNOSIS WEBSITE
http://users.erols.com/ksciacca

• Plenty of information and links
• Dual Diagnosis Chat Room!
• Educational & Training Videos
• Inter-active Bulletin Board

DUAL DIAGNOSIS RECOVERY NETWORK
www.dualdiagnosis.org
220 Venture Circle, Nashville, TN 37228
Toll Free: 888-869-9230

• Dual Diagnosis Chat Room!
• Bookstore: specializing in books that focus on the recovery needs of adolescents and family members
• Plenty of information