Diagnosis

Dual diagnosis (also referred to as co-occurring disorders) is a term for when someone experiences a mental illness and a substance use disorder simultaneously. Either disorder, substance use, or mental illness- can develop first. People experiencing a mental health condition may turn to alcohol or other drugs as a form of self-medication to improve the mental health symptoms they experience. However, research shows that alcohol and other drugs worsen the symptoms of mental illnesses. The professional fields of mental health and substance use recovery have different cultures, so finding integrated care can be challenging.

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How Common Is Dual Diagnosis?

According to a 2014 National Survey on Drug Use and Health, 7.9 million people in the U.S. experience both a mental disorder and substance use disorder simultaneously. More than half of those people- 4.1 million to be exact- are men.

Symptoms

Because many combinations of dual diagnosis can occur, the symptoms vary widely. Mental health clinics are starting to use alcohol and drug screening to help identify people at risk for drug and alcohol abuse. 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 overuse of substances

    • Developing a high tolerance and withdrawal symptoms

    • Feeling like you need a drug to be able to function

    Symptoms of a mental health condition can also vary greatly. Warning signs, such as extreme mood changes, confused thinking or problems concentrating, avoiding friends, social activities, and thoughts of suicide may be a reason to seek help.

“You are not your illness. You have an individual story to tell. You have a name, a history, a personality. Staying yourself is part of the battle.”

— JULIAN SEIFTER

Bipolar Disorder

Bipolar disorder is a mental illness that causes dramatic shifts in a person’s mood, energy, and ability to think clearly. People with bipolar experience high and low moods- known as mania and depression- which differ from the typical ups-and-downs most people experience. The average age-of-onset is about 25, but it can occur in the teens, or more uncommonly, in childhood. The condition affects men and women equally, with about 2.6% of the U.S. population diagnosed with bipolar disorder and nearly 83% of cases classified as severe. If left untreated, bipolar disorder usually worsens. However, with a good treatment plan including psychotherapy, medications, a healthy lifestyle, a regular schedule, and early identification of symptoms, many people live well with the condition.

Symptoms

Symptoms and their severity can vary. A person with bipolar disorder may have distinct manic or depressed states but may also have extended periods-sometimes years—without symptoms. A person can also experience both extremes simultaneously or in rapid sequence. Severe bipolar episodes of mania or depression may include psychotic symptoms such as hallucinations or delusions. Usually, these psychotic symptoms mirror a person’s extreme mood. People with bipolar disorder who have psychotic symptoms can be wrongly diagnosed as having schizophrenia.

Mania

To be diagnosed with bipolar disorder, a person must have experienced at least one episode of mania or hypomania. Hypomania is a milder form of mania that doesn’t include psychotic episodes. People with hypomania can often function well in social situations or at work. Some people with bipolar disorder will have episodes of mania or hypomania many times throughout their life; others may experience them only rarely. Although someone with bipolar may find an elevated mood of mania appealing—especially if it occurs after depression—the “high” does not stop at a comfortable or controllable level.

Moods can rapidly become more irritable behavior, more unpredictable, and judgment more impaired. During periods of mania, people frequently behave impulsively, make reckless decisions and take unusual risks.

Most of the time, people in manic states are unaware of the negative consequences of their actions. With bipolar disorder, suicide is an ever-present danger because some people become suicidal even in manic states.

Learning from prior episodes what kinds of behavior signals “red flags” of manic behavior can help manage the symptoms of the illness. The depressive symptoms that obstruct a person’s ability to function must be present nearly every day for a period of at least two weeks for a diagnosis. Depression associated with bipolar disorder may be more difficult to treat and require a customized treatment plan.

“There are wounds that never show on the body that are deeper and more hurtful than anything that bleeds.”

— LAURELL K. HAMILTON

Depression

Depressive disorder, frequently referred to simply as depression, is more than just feeling sad or going through a rough patch. It is a serious mental health condition that requires understanding and medical care. Left untreated, depression can be devastating for those who have it and their families. Fortunately, with early detection, diagnosis, and a treatment plan consisting of medication, psychotherapy, and healthy lifestyle choices, many people can and do get better.

Some will only experience one depressive episode in a lifetime, but for most, depressive disorder recurs. Without treatment, episodes may last a few months to several years. An estimated 16 million American adults- almost 7% of the population- had at least one major depressive episode in the past year. People of all ages and all racial, ethnic, and socioeconomic backgrounds experience depression, but it does affect some groups more than others.

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  • Depression can present different symptoms, depending on the person. But for most people, depressive disorder changes how they function day-to-day, and typically for more than two weeks. Common symptoms include:

    • Changes in sleep

    • Changes in appetite

    • Lack of concentration

    • Loss of energy

    • Lack of interest in activities

    • Hopelessness or guilty thoughts

    • Changes in movement (less activity or agitation)

    • Physical aches and pains

    • Suicidal thoughts

  • Depression does not have a single cause. It can be triggered by a life crisis, physical illness, or something else—but it can also occur spontaneously. Scientists believe several factors can contribute to depression:

    • Trauma. When people experience trauma at an early age, it can cause long-term changes in how their brains respond to fear and stress. These changes may lead to depression.

    • Genetics. Mood disorders, such as depression, tend to run in families.

    • Life circumstances. Marital status, relationship changes, financial standing, and where a person lives influence whether a person develops depression.

    • Brain changes. Imaging studies have shown that the frontal lobe of the brain becomes less active when a person is depressed. Depression is also associated with changes in how the pituitary gland and hypothalamus respond to hormone stimulation.

    • Other medical conditions. People who have a history of sleep disturbances, medical illness, chronic pain, anxiety, and attention-deficit hyperactivity disorder (ADHD) are more likely to develop depression. Some medical syndromes (like hypothyroidism) can mimic depressive disorder. Some medications can also cause symptoms of depression.

    • Drug and alcohol abuse. Approximately 30% of people with substance abuse problems also have depression. This requires coordinated treatment for both conditions, as alcohol can worsen symptoms.

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Treatment