Dual Diagnosis - Addictions

People with addictions often have other psychiatric problems. This was documented in a 1970s survey known as the Epidemiological Catchment Area (ECA) study, in which households were polled in several geographical areas. Complete diagnostic surveys were done, and the study generated an enormous amount of statistical data that has been useful in our understanding of many different mental health problems.

We know that addictions often start with a person’s desire to alter his or her mood with a substance. In uncomplicated situations, such an urge might indicate fairly minor problems, such as the shyness and awkwardness of adolescence. But often there is more serious trouble regarding emotions and mental functioning.

The ECA study showed that problems like major depression, anxiety disorders, or schizophrenia frequently coexist with addiction and that the chance of having one increases for those who have another. In other words, addiction increases the risk that other mental health problems will develop and the presence of other mental health problems increases the risk that addiction will develop.

The treatment of people with serious mental illness and addiction became a problem because of the way mental health delivery systems were set up. Starting at the federal level and going on down to state and local levels, the funding and regulation of alcohol and drug treatment programs and of mental health treatment programs have been controlled by separate agencies. As a result, professionals have clustered on one side or the other. Some people who specialize in treating addiction have little experience with other mental health problems, and the reverse is also true.

The result of this split is that people who have both types of problems sometimes fall through the cracks of the system.

In the not-too-distant past, it was common for someone to seek treatment at an alcohol and drug facility only to be sent away because of mental health problems. When the same person went to a mental health facility, treatment there was considered “inappropriate” because of the addiction problem.

Dual diagnosis programs in which both conditions are given equal emphasis have been developed over the past decade or so to address this problem. Both conditions must be treated vigorously, and specialized follow-up is sometimes included. Dual Recovery Anonymous consists of 12- step groups involved in recovery from both addiction and severe mental illness. And many facilities also offer long-term therapy groups that work with patients at any level of recovery, with the aim of keeping people engaged in the treatment process so that gradual progress can be made.

Virtually any psychiatric disorder can coexist with addiction. And addiction itself often leads to symptoms of depression and anxiety as a result of the effects of the substances and of the destructive consequences of the addiction.

We can classify these coexisting disorders into three categories: substance-induced disorders, psychiatrically complicated addiction, and serious persistent mental illness and addiction.

Those to whom the first two categories apply can usually be dealt with in traditional alcohol and drug treatment settings through psychiatric consultation and minor modifications in the treatment program. But the third category includes disorders that result in significant impairment in functioning and require a specialized approach if the treatment of both conditions is to be effective.

Elizabeth Connell Henderson, M.D.



Appendix A: Regulation of Addictive Substances

Appendix B: Sources of Additional Information

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