Addiction recovery is a multidimensional process of peeling back layers of emotional, physical and genetic factors, over weeks and sometimes months, to discover the best path to healing. More than 9 million adults in the U.S. experience both mental illness and a substance use disorder, or “dual diagnosis,” according to the 2018 National Survey on Drug Use and Health.
“We can clearly identify addiction based on the patient’s behavior patterns, but mental health issues aren’t as clear-cut,” says Leanne Arbasetti, Clinical Director, Crestview Recovery in Portland, Oregon. “We rely on patient history of behavior and medication, and there’s often an initial diagnosis of depression and/or anxiety — both common companions to addiction. And then, more complex mental health conditions such as bipolar disorder and obsessive-compulsive disorder take more time to diagnose through therapy and medication trials.”
Regardless of how the initial mental health diagnosis evolves over time, treating the presenting symptoms of dual diagnosis to provide immediate relief for patients is the front line of recovery.
The intertwined nature of mental health and addiction
The National Alliance on Mental Health (NAMH) recognizes that the days of treating substance addiction before addressing mental health issues are over. Currently, accepted protocol is to treat both conditions simultaneously. At the same time, addiction patients and their families are often in denial about one piece of the dual diagnosis or the other.
“I see people who refuse to admit they have a drug problem and attribute their substance use to soothing post-traumatic stress disorder, for example,” Arbasetti says. “Or their story is that the depression, for example, is a byproduct of substance use. Breaking down that denial is a critical first step in providing an integrated treatment plan.”
There’s no easy answer to the question of which came first, the chicken or the egg. One thing that is clear: It’s a vicious cycle. Individuals may use drugs or alcohol as a way to numb painful mental illness symptoms. And ongoing abuse of substances inevitably leads to additional mental health problems. That’s why an integrated treatment approach is critical.
According to Arbasetti, anyone dealing with depression or anxiety will have a skewed view of reality. “The most important thing we do in treatment is breaking down denial and getting patients to stay in the moment and challenge their negative thinking: shame about the past and anxiety about the future.” This involves an individualized treatment program that should include:
- Assessment of mental health and addiction. Medication may be prescribed by a psychiatrist, and an integrated treatment plan will be designed.
- Treatment for the mind, body, and spirit. Holistic treatments including massage therapy, yoga, nutritional counseling, and meditation enable patients to establish a calm physical and emotional balance in their lives without substance use.
- Behavioral modification therapy. Individuals are taught new methods for coping with the constant loop of negative thoughts and worries that are typical of mental illness and shown how to avoid the triggers that can cause a relapse.
- Relapse prevention education. Aftercare programs provide ongoing support and accountability after leaving the rehab facility, greatly decreasing the chance of relapse.
According to Arbasetti, spirituality may be the most important piece of recovering, restoring the patient’s passion for life and connecting with others. “Addiction and mental illness both cut you off from what gives you meaning in life,” she says. “That could mean family, purpose, a God of your understanding, creative endeavors, a career. The guilt and shame are so intense that all of the joy in life disappears. Our goal is to reconnect individuals with whatever gives them meaning.”
Symptoms of dual diagnosis
According to The National Alliance on Mental Health (NAMI), symptoms of dual diagnosis vary widely due to the many possible combinations. Symptoms of substance use disorder may include:
- Withdrawal from friends and family
- Sudden changes in behavior
- Using substances under dangerous conditions
- Engaging in risky behaviors
- Loss of control over the use of substances
- Developing a high tolerance and withdrawal symptoms
- Feeling like you need a drug or alcohol to be able to function
Symptoms of a mental health condition may include:
- Extreme mood changes
- Confused thinking or problems concentrating
- Avoiding friends and social activities
- Thoughts of worthlessness and suicide
- Excessive, uncomfortable level of energy
Crestview Recovery in Portland, Oregon is a drug and alcohol rehabilitation center with the experience to help you recover. Our caring and understanding staff members are among the most experienced in the field.