Depression deserves special focus in the discussion about dual diagnosis. Depression and addiction are so closely linked that even someone without a depressive disorder will likely experience feelings of depression during addiction withdrawal. Dual diagnosis is a term used often in addiction treatment to refer to the co-occurrence of a mental illness, such as a mood or personality disorder, with a substance use disorder.
Depression, though common in the general population, can be one of the most debilitating mood disorders. It is often characterized by a bleak outlook and intense feelings of hopelessness and helplessness. People with depression often lose interest in activities which used to bring them joy and pleasure, such as hobbies and social activities.
Though the likelihood of misuse of any substance is increased with a co-occurring mental illness, some substances accompany certain disorders more often than others. Depression, for example, is more commonly associated with alcoholism, while schizophrenia is often related to cannabis or hallucinogen use, and obsessive-compulsive disorder with the use of stimulants such as cocaine.
Neither the substance use disorder nor the mental illness directly leads to the other in all circumstances. Rather, they tend to have a cyclical effect wherein one aggravates and worsens the effects of the other. For example, people with mental illness are often more sensitive to the effects of drugs and alcohol, leading to greater rates of addiction, which in turn can make mental illness symptoms worse. A co-occurrence of depression and substance use disorders often presents a risk for poorer treatment outcomes for both disorders.
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People who are struggling with depression report using alcohol primarily to help them in social situations. Because depression can make it difficult to socialize, many people turn to alcohol in an effort to function more “normally” while interacting with others. Aside from social motives, people with depression use alcohol to help themselves cope with a variety of other daily situations. Alcohol is often sought as a way to temporarily alleviate low mood, help deal with boredom, induce feelings of pleasure, and mask other symptoms of mental illness. Alcohol dependence can build quickly when alcohol is used as a coping mechanism.
The most important component of treatment for a patient with a dual diagnosis is that it integrates treatment for both the mental illness and the substance abuse. Treatment will typically involve a case management team which uses motivational techniques to help a client understand how their depression and their addiction affect one another, and to understand that recovery is possible.
Motivational therapy lends itself nicely to the introduction of cognitive behavioral therapy (CBT) for addiction treatment. During CBT sessions, patients are taught how to effectively address cravings and cope in situations which typically drove them to use alcohol before.
In dual diagnosis patients struggling with alcohol abuse, one of the main goals of addiction treatment should be to address the importance that individuals have placed on alcohol as a coping mechanism and a social tool. Discussing how to interact in a social setting without drinking can be particularly beneficial.
Prescription drugs are also commonly used when treating dual diagnosis patients because they provide an effective way to deal with the effects of mental illness and allow a client to focus on addiction recovery. In the case of depression, antidepressants are commonly prescribed. Research has also shown that when antidepressants are combined with medication for alcohol dependence, symptoms of both disorders are reduced.
Dual diagnosis patients have a better chance of sustained recovery by taking part in aftercare programs. Continuing to receive counseling and the necessary medications can help prevent relapse. Attending 12-Step meetings such as Alcoholics Anonymous can continue to provide tools for consistent behavioral change.
Although co-occurring depression and addiction complicates treatment strategies for both disorders, today many healthcare professionals and addiction treatment facilities recognize the need for integrative treatment which addresses both problems at once. For more information, do not hesitate to explore your options for help and focus on a brighter future.
- Lydecker, K. P., Tate, S. R., Cummins, K. M., McQuaid, J., Granholm, E., & Brown, S. A. (2010, September). Clinical Outcomes of an Integrated Treatment for Depression and Substance Use Disorders. Retrieved August 30, 2016, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3609717/
- Padwa, H., Larkins, S., Crevecoeur-MacPhail, D. A., & Grella, C. E. (2013). Dual Diagnosis Capability in Mental Health and Substance Use Disorder Treatment Programs. Retrieved August 30, 2016, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3655772/
- McGovern, M. P., Lambert-Harris, C., Gotham, H. J., Claus, R. E., & Xie, H. (2014, March). Dual diagnosis capability in mental health and addiction treatment services: An assessment of programs across multiple state systems. Retrieved August 30, 2016, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3594447/
- Pettinati, H. M., Ph.D., O’Brien, C. P., Ph.D., & Dundon, W. D., Ph.D. (2013, January). Current Status of Co-Occurring Mood and Substance Use Disorders: A New Therapeutic Target [PDF]. Am J Psychiatry.
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Last updated on April 6th, 2017 at 07:08 pm