Addiction is recognized as a disease according to the disease model, however, recent studies suggest a relationship between addiction and other mental health diagnoses. If this relationship exists, the question we need to ask is, did one disease cause the other? And if so, how do we treat them?
First, let’s take a look at the semantics: The term ‘co-occurring disorders’ accounts for two or more diagnoses occurring within one individual. The concept behind dual diagnosis aims to “treat people who suffer from both addiction and a psychiatric disorder” (Khaleghi et al., 2011). We have known about it for about 20 years, yet it is something that is still highly mistaken. Since the 1980’s, research has found a noticeable correlation between addiction and other mental disorders, to the point where it can be said that addicts are twice as likely to suffer from a mental illness. Likewise, people with mental illness are twice as likely to become substance dependent (O’Leary, 2011). The relationship between mental illness and addiction is now difficult to deny. Within our context, according to a SASH (South African Stress and Health) survey, “significant associations were found between substance use and mood and anxiety disorders, with a particularly strong relationship between cannabis use and mental disorders” (Saban et al., 2014). The high rates of long-term psychosis amongst cannabis users is just one example that aligns itself with dual diagnosis. A person suffering from bulimia can also be bipolar, someone addicted to cocaine can, likewise, suffer from depression, and an alcoholic can, perhaps, have PTSD (O’Leary, 2011).
The reason addiction itself is not categorized as a mental illness, is because of its highly physical nature. However, it does contain psychological aspects as well. Some of the symptoms seen in addiction that reflect similarities with other mental illnesses include acting on self-interests and being incapable of controlling impulses. Substance abuse interferes with the neurochemical which controls the mood. Similarly, with mood disorders, antidepressants are successfully used in establishing balance. “In short, addiction may cause mental illness, be caused by mental illness, or develop simultaneously due to overlapping risk factors” (O’Leary, 2011). Khaleghi et al. (2011) also suggest that this kind of overlapping and duality means many addicts remain undiagnosed (or perhaps only partly diagnosed), untreated, and therefore influencing the high relapse rate amongst those trying to find their recovery from addiction.
Although not the only route available, addiction often stems from an individuals’ own self-medicating for a deeper underlying mental health issue that they, perhaps, are not even aware of. For instance, there is a high incidence of self-medicating the symptoms of ADHD which results in a stimulant-based addiction such as kat, cocaine, crystal-meth or crack. If co-occurring disorders are present, full, sustainable recovery means treating both problems, since “focusing on one does not ensure the other will go away” (Drake, 2008). The prognosis for untreated co-occurring disorders is dangerous. These patients are more likely to relapse, continue to move in and out of treatment programs, have a higher risk for violence, non-compliance and psychosis all being potential results. However, research shows that once one issue, such as alcohol or drug abuse, is being overcome, the patient is far more receptive to engaging with treatment for the other(s) (Drake, 2008).
Treating cases of dual diagnosis requires an integrated approach that goes beyond the borders of more traditional therapies (Drake, 2008). Treatment for dual diagnosis typically takes longer, and happens in stages, eliminating red flags one by one. Naturally, counseling takes up a critical role in this treatment process and is relied on extensively to help develop healthy coping mechanisms which are more than likely lacking. The kinds of counseling can vary and may come in the form of individual, group or family set-ups. Treatment for co-occurring disorders may require psychiatric intervention. For instance, individuals presenting with bipolar disorder in addition to addiction will require the management of a mood stabilizer and possible anti-depressant. Treatment also spills out beyond counseling and beyond the rehab institution, in that dual diagnosis requires assistance in the outside world, during and after rehab. It must be comprehensive, addressing jobs, housing, stress management and social networks, for example. “Effective integrated treatment programs view recovery as a long-term, community-based process, that may take months or years” (Drake, 2008).
No longer is addiction considered a consequence for ‘bad people’. Today, we have a more thorough understanding of it as a disease, and how it operates in the lives of often broken or searching individuals, many of which have endured their own secret battles for years. Holistic, integrated and comprehensive treatment is what needs to be sought out. Freedom from addiction is possible, and so is freedom from broken hearts, past traumas, and mental illness.
Drake, R. (2008) “Dual Diagnosis and Integrated Treatment of Mental Illness and Substance Abuse Disorder.” National Alliance on Mental Health. http://www2.isu.edu/irh/projects/better_todays/B2T2VirtualPacket/MentalHealthMentalDisorders/NAMI%20-%20Dual%20Diagnosis.pdf
Khaleghi, K. & Khaleghi, M. (10/10/2011) “What is Dual Diagnosis?” Psychology Today https://www.psychologytoday.com/blog/the-anatomy-addiction/201110/what-is-dual-diagnosi
O’Leary, D. (2011) “Addiction & Mental Illness: Does One Cause the Other? http://www.dualdiagnosis.org/addiction-mental-illness-one-cause/
Saban, A., Flisher, A., Grimsrud, A., Morojele, N., London, L., Williams, D.R., & Stein, D. (18/01/2014) “The association between substance use and common mental disorders in young adults: results from the South African Stress and Health (SASH) Survey.” The Pan Africa Medical Journal. 17(1):11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3946226/