MENTAL HEALTH
Mental Illness & Substance Use – (Dual Diagnosis)
What is Dual Diagnosis?
The term ‘dual diagnosis’ refers to when substance abuse or dependency is diagnosed alongside a mental illness. Two common examples are that of major depression with marijuana addiction, and alcohol addiction with panic disorder. Often the two disorders are treated separately or people may only be referred to one specialist, either in the mental health service or the addiction recovery service. Considering the large numbers of people affected by dual diagnosis it may be more effective to treat people using a more integrated approach i.e. whereby people receive treatment for both disorders at the same time.
What are the Symptoms?
The symptoms that a person with dual diagnosis displays are identified in two parts which sometimes makes it common for one diagnosis to be missed. First are the symptoms associated with any major psychiatric disorder, such as schizophrenia, bipolar mood disorder, or personality disorder (the Mental Health Information Service has fact sheets on all of these). Second are the issues associated with abuse of alcohol and other drugs. These are listed below:
significant impairment or distress resulting from use
failure to fulfil roles at work, home, or school
persistent use in physically hazardous situations
ongoing legal problems related to use
continued use despite relationship or financial problems.
Drug/alcohol abuse may or may not involve physiological dependence or tolerance. The symptoms that do indicate dependency or addiction are as follows:
compulsion and preoccupation with obtaining a drug or drugs
loss of control over use (losing track of how much has been consumed or feeling unable to stop using)
continued use despite negative consequences
tendency for relapse after period of abstinence
drug induced behaviour e.g. aggression, irritability, changes in thinking or mood.
The main symptom is increased tolerance and withdrawal. This means the same amount of the drug or alcohol has less effect, and the person can tolerate greater amounts without feeling the effects. Withdrawal symptoms occur after physiological dependence has been established and the person cannot acquire the drug or alcohol, or stops taking it for some reason.
What is the Impact of Dual Diagnosis?
The impact of having not one but two diagnoses means that a person often experiences more severe and chronic medical, social and emotional problems than if they were to have just one. They are vulnerable not only to an alcohol and/or drug relapse but also a relapse of their mental health problems. The occurrence of either of these is likely to affect the other in a negative way. Treatment and relapse prevention must therefore be specifically catered to the person, and will often take longer, come across more obstacles, and progress only gradually.
What are the Causes?
The causes of psychiatric illness and drug and alcohol abuse are complex. The evidence that people with mental illness are more likely to abuse alcohol and other drugs, or that those who abuse alcohol and other drugs are more likely to develop some form of mental illness, indicates that the causes are likely to be complex. This is outlined in the statements below:
. drug use can cause psychiatric symptoms and mimic psychiatric syndromes
. drug use can initiate or worsen a psychiatric disorder
. drug use can mask psychiatric symptoms and syndromes
. drug withdrawal can cause psychiatric symptoms and mimic psychiatric disorders
. psychiatric behaviours can mimic drug use problems
. drug and alcohol abuse can make side effects from medication worse, and more likely to occur.
Getting an Assessment
Before any treatment takes place it is necessary to obtain a detailed history of both the psychiatric and substance abuse symptoms. Important information on psychiatric status includes: chief complaint/presenting symptoms; family history; personal history; medical history; psychiatric history; history of present illness; and assessment of current mental state. Important information on substance abuse includes: types of drugs used; age of onset; amount now being used; maximum amount; frequency; route; last used; maximum clean time; number of detoxes; history of withdrawal symptoms.
This information will be necessary to construct an individual treatment programme.
What kind of treatment is available?
Our present mental health service has evolved to address single disorders. However many treatments for specific illnesses can be adapted to address other problems. Treatment for people with dual diagnosis may be more effective if the two diagnoses are dealt with at the same time as the two are often related (e.g. drug use to cope with symptoms of mental disorder).
It has been recommended that during treatment administration, both conditions need to be regarded as primary, without one being seen as the cause of the other. Some of the treatment options available (dependent on the severity of symptoms) are as follows:
drugs prescribed by a psychiatrist can be tailored to reduce side effects and control symptoms of mental illness. Honest discussion of prescribed and recreational drug use can be a good first step in controlling overall drug use
counselling and psychotherapy involves working with a therapist on developing inner strengths, capabilities, resources and potential. It looks at developing personal strategies to reduce drug use
cognitive-behaviour therapy uses a number of strategies to change behaviour. These might include changes in thinking about drug use, rewards for positive changes and strategies to help reduce drug use. This therapy doesn’t look at why the person is using
working towards the person wanting to stop abusing and helping people to recognise the greater benefits in changing behaviour. It focuses on increasing the use of internal resources
What can I do to help myself?
. learn to recognise personal 'high-risk' situations and apply specific coping skills and strategies to avoid drinking or using
. avoid environments where substance abuse occurs, e.g. parties where people are likely to drink heavily, friends who are heavy drinkers
. join a self-help group where you can talk to others about their experiences and provide mutual support
enlist the support of family and friends
Where to go for further help
. Contact Watershed
. Mental Health Information Service: 1300 794 991
. Your local Community Health Centre or Mental Health Team (under ‘C’ in the White Pages)
. Your General Practitioner
WHAT IS A MENTAL ILLNESS?
About one in five Australians will experience a mental illness, and most of us will experience a mental health problem at some time in our lives.
Mental illness is a general term that refers to a group of illnesses, in the same way that heart disease refers to a group of illnesses and disorders affecting the heart.
A mental illness is a health problem that significantly affects how a person feels, thinks, behaves, and interacts with other people. It is diagnosed according to standardised criteria. The term mental disorder is also used to refer to these health problems.
A mental health problem also interferes with how a person thinks, feels, and behaves, but to a lesser extent than a mental illness.
Mental health problems are more common and include the mental ill health that can be experienced temporarily as a reaction to the stresses of life.
Mental health problems are less severe than mental illnesses, but may develop into a mental illness if they are not effectively dealt with.
Mental illnesses cause a great deal of suffering to those experiencing them, as well as their families and friends. Furthermore, these problems appear to be increasing. According to the World Health Organization, depression will be one of the biggest health problems worldwide by the year 2020.
Types of mental illness
Mental illnesses are of different types and degrees of severity. Some of the major types are depression, anxiety, schizophrenia, bipolar mood disorder, personality disorders, and eating disorders.
The most common mental illnesses are anxiety and depressive disorders. While everyone experiences strong feelings of tension, fear, or sadness at times, a mental illness is present when these feelings become so disturbing and overwhelming that people have great difficulty coping with day-to-day activities, such as work, enjoying leisure time, and maintaining relationships.
At their most extreme, people with a depressive disorder may not be able to get out of bed or care for themselves physically. People with certain types of anxiety disorder may not be able to leave the house, or may have compulsive rituals to help them alleviate their fears.
Less common are mental illnesses that may involve psychosis. These include schizophrenia and bipolar mood disorder. People experiencing an acute episode of psychosis lose touch with reality and perceive their world differently from normal. Their ability to make sense of thoughts, feelings, and the world around them is seriously affected.
A psychotic episode may involve delusions, such as false beliefs of persecution, guilt, or grandeur. It may involve hallucinations, where the person sees, hears, smells, or tastes things that are not there.
Psychotic episodes can be threatening and confusing to other people. Such behaviour is difficult to understand for people who are not familiar with it.
Treatment of mental illness
Most mental illnesses can be effectively treated. Recognising the early signs and symptoms of mental illness and accessing effective treatment early is important. The earlier treatment starts, the better the outcome.
Episodes of mental illness can come and go during different periods in people’s lives. Some people experience only one episode of illness and fully recover. For others, it recurs throughout their lives.
Effective treatments can include medication, cognitive and behavioural psychological therapies, psycho-social support, psychiatric disability rehabilitation, avoidance of risk factors such as harmful alcohol and other drug use, and learning self-management skills.
It is rarely possible for someone with a mental illness to make the symptoms go away just by strength of will. To suggest this is not helpful in any way.
People with a mental illness need the same understanding and support given to people with a physical illness. A mental illness is no different - it is not an illness for which anyone should be blamed.
People with mental illness may be at risk of harmful alcohol and other drug use. This makes treatment more complex, so that effectively managing alcohol and other drug use is important.
Risk of suicide is heightened for people with some mental illnesses, particularly soon after diagnosis or release from hospital.
Myths, misunderstandings and facts about mental illness
Myths, misunderstandings, and negative stereotypes and attitudes surround mental illness. These result in stigma, discrimination, and isolation of people with mental illness, as well as their families and carers.
Common questions about mental illness are:
Are mental illnesses a form of intellectual disability or brain damage?
No. They are illnesses just like any other, such as heart disease, diabetes, and asthma. Yet the traditions of sympathy, support, and flowers given to people with physical illnesses are often denied to those with a mental illness.
Are mental illnesses incurable and lifelong?
No. When treated appropriately and early, many people recover fully and have no further episodes of illness.
For others, mental illness may recur throughout their lives and require ongoing treatment. This is the same as many physical illnesses, such as diabetes and heart disease. Like these other long-term health conditions, mental illness can be managed so that individuals live life to the fullest.
Although some people become disabled as a result of ongoing mental illness, many who experience even very major episodes of illness live full and productive lives.
Are people born with a mental illness?
No. A vulnerability to some mental illnesses, such as bipolar mood disorder, can run in families. But other people develop mental illness with no family history.
Many factors contribute to the onset of a mental illness. These include stress, bereavement, relationship breakdown, physical and sexual abuse, unemployment, social isolation, and major physical illness or disability. Our understanding of the causes of mental illness is growing.
Can anyone develop a mental illness?
Yes. In fact, as many as one in five Australians may develop a mental illness at some stage in their lives. Everyone is vulnerable to mental health problems.
Many people feel more comfortable with the notion of having 'a nervous breakdown' rather than a mental illness. However, it is important to talk openly about mental illness, as this reduces the stigma and helps people to seek early treatment.
Are people with mental illness usually dangerous?
No. This false perception underlies some of the most damaging stereotypes. People with a mental illness are seldom dangerous. Even people with the most severe mental illness are rarely dangerous when receiving appropriate treatment and support.
Should people with a mental illness be isolated from the community?
No. Most people with a mental illness recover quickly and do not even need hospital care. Others have short admissions to hospital for treatment. Improvements in treatment over recent decades mean that most people live in their communities, and there is no need for the confinement and isolation that was commonly used in the past.
A very small number of people with mental illness need hospital care, sometimes against their will. Improvements in treatment are making this less and less common, and fewer than one in a 1000 people are treated this way.
Is stigma one of the biggest problems for people with mental illness?
Yes. One of the biggest obstacles for people recovering from mental illness is confronting the negative attitudes of other people. These often mean that people with mental illness face isolation and discrimination just for having an illness.
Positive and hopeful attitudes of family, friends, service providers, employers, and other members of the community toward people with mental illness are critical to ensuring quality of life for people with mental illness and supporting recovery the signs and symptoms of different types of mental illness
What can be done about the stigma of mental illness?
Think about mental illnesses like any other illness or health condition and bring them into the open.
Talk about mental illness openly with everyone you meet - it is surprising how many people are affected by mental illness, particularly the highly prevalent disorders of depression and anxiety.
Educate the community to overcome negative stereotypes based on misconceptions.
Promote mental health and healthy attitudes through childhood and adult life.
Support the development of resilience: learn ways to deal with stress in relationships, situations, and events.
Assist friends and family with a mental illness to obtain care and treatment as early as possible.
Ensure high quality support and treatment services are provided to people with mental illness to promote recovery.
Actively support the families and carers of people who have mental illness, who also experience the confusion, distress, and stigma that can accompany mental illness.
Address discrimination in every area of life, including employment, education, and the provision of goods, services, and facilities.
Encourage research into mental illness to assist understanding of how these illnesses affect people and can be prevented and/or effectively treated.
Your general practitioner.
Your community health centre.
Your community mental health centre.
For information on services, check the Community Help and Welfare Services and 24-hour emergency numbers in your local telephone directory.
For immediate counselling assistance, contact Lifeline on 13 11 14. Lifeline can also supply you with contacts, further information and help.
Other useful sources of information about mental illness are:
SANE Australia www.sane.org
Mental Illness Fellowship of Australia www.mifa.org.au
The public area of the Royal Australian and New Zealand College of Psychiatrists www.ranzcp.org
Auseinet www.auseinet.com
Australian Government's HealthInsite www.healthinsite.gov.au |
