Vol.2 Issue: 3 - Dual Diagnosis: Coexisting Substance Use and Mental Illness

Nadine Pelling, Ph.D.
Manager
Eastern Health Dual Diagnosis Team

The Dually Diagnosed Can Now Receive Help That Targets Their Distinct Needs

In the Melbourne area, people who have a substance use disorder can receive various treatments designed to help their substance use. For instance, withdrawal services, counselling services, and residential services are available. Similarly, people who have a mental illness can receive various types of assistance. For example, psychiatric treatment, case management, and regular clinical services are available. But what happens when someone has coexisting substance use and mental illness problems?

In the not so distant past those with coexisting substance use and mental illness problems, the dually diagnosed, would often be referred by substance use services to mental health services. Similarly, mental health services would often refer the dually diagnosed to substance use services. As a consequence, many dually diagnosed clients received little if any adequate treatment for either their mental illness or substance use problem. In addition, some of the agencies that did treat the dually diagnosed did so without adequate training in either substance use or mental health interventions, as clinicians are generally trained in either problem area and rarely in both. This was an deficient system as the treatment needs of people who have a combination of alcohol and other drug and a mental illness differ significantly from the treatment needs of people who have either an alcohol and other drug problem or a mental illness by itself.

In order to more adequately tend to the needs of the dually diagnosed, a number of dual diagnosis teams have been created in Victoria. These teams provide education and consultation to substance use, mental health, and psychiatric disability support service clinicians working with the dually diagnosed. Moreover, some direct service (counselling/assessment) is provided to the dually diagnosed. Consequently, the skill level of clinicians is being increased in the area of dual diagnosis treatment, service linkages between mental health and substance use agencies are being improved, and the dually diagnosed more appropriately treated.

What Is The Link Between Mental Illness and Substance Use?

Various studies indicate that about one third of the mentally ill population will also abuse alcohol or other drugs. Similarly, about one half of the population that presents for substance use treatment will have significant mental health symptoms. Consequently, a large portion of both populations will be diagnosable as having both a mental health and a substance use diagnosis, a dual diagnosis. Common examples of dual diagnosis may include depression and alcohol dependence or heroin abuse and panic disorder. The severity, chronisity, and level of disability or impairment can vary significantly for each disorder. In general, if both disorders are not treated in an integrated manner mental illness symptoms can be seen as an inadequate .recovery. from alcohol and other drug use. Similarly, mental health symptoms can interfere with clients. ability to benefit from addiction treatment. In addition, dually diagnosed people will often experience more severe and chronic biopsychosocial problems than those with a single diagnosis, as they are more vulnerable to relapse and a worsening of symptoms. The result is a less stable recovery from alcohol or other drug use and continuing mental illness symptoms. This equates to a large amount of human suffering

As a consequence, those who work with the dually diagnosed need to have an understanding of how the two disorders interact, that longer treatment will be required, that more crises are likely, and the specific importance of relapse prevention. Those trained in mental health need to gain an understanding of substance use treatment approaches and techniques and similarly those working in substance use agencies need to gain mental health knowledge and skills. The dual diagnosis teams across Victoria are addressing these needs.

Despite the increases in awareness surrounding dual diagnosis issues, an ongoing conflict regarding the treatment of the dually diagnosed involves the identification of a primary, or causative, problem for the dual diagnosis. Some people are insistent that the mental health problems are caused by the substance use and if the substance use ended the mental health problems would disappear. Others are convinced that the mentally ill use various substances to treat their own symptoms and thus the mental illness is what needs primary treatment. The truth is a combination of the above positions and depends on the individual client involved. Those who work with the dually diagnosed are becoming aware of the fact that there are several possible relationships between alcohol and other drug use and mental illness. The following are some of the disorder relationships that need to be addressed as possibilities:

1. Alcohol and other drug use can cause mental health symptoms or mimic disorders.
2. Alcohol and other drug use can prompt the development or worsen mental health symptoms.
3. Alcohol and other drugs use can mask mental health symptoms.
4. Alcohol and other drug withdrawal can cause mental health symptoms or mimic disorders.
5. Mental health and alcohol and other drug disorders can simply coexist, they exist independently.
6. Mental health symptoms can mimic those associated with alcohol and other drug use.

Regardless of the relationship between the substance use and mental health symptoms, both problems need to be addressed if long-term progress is to be made with both difficulties. Moreover, how both problems need to be addressed will differ from usual approaches taken in both mental health and substance use treatment. For instance, the use of psychiatric medication in mental health and the use of confrontation in substance use treatment may differ from their usual form if they are to be more effectively used with the dually diagnosed. Indeed, simply engaging a person in treatment is made more difficult when a dual diagnosis exists and this may necessitate assertive outreach treatment models.

Addressing the needs of the dually diagnosed is not an easy task, as clinicians must learn new ideas and techniques for working with clients. However, there is help available from the various dual diagnosis teams created to service Victoria. Attending to the specific needs of the dually diagnosed is a small price to pay to help improve the lives of these individuals.

Mental health, substance use, and psychiatric disability support services and their clinicians located in the Central and Outer East can gain dual diagnosis support and education by contacting the Eastern Dual Diagnosis Team on 03 9895 3555. We look forward to helping you help your dual diagnosis clients.