Dual diagnosis

Originally Published: August 13, 2010
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Dear Alice,

What is the meaning of "dual diagnosis" in regards to a drug addict?

Dear Reader,

Mental illness and drug addiction are a little like Thelma and Louise: they are two separate beings but together they become a dynamic, potentially risky pair. "Dual diagnosis" is the clinical term used to classify individuals suffering from this dynamic duo, or substance abusers (those with chemical dependence on narcotics, prescription drugs, and/or alcohol) who have one or more diagnosed mental health disorders. For instance, a schizophrenic addicted to cocaine is someone who would qualify as a dual diagnosis drug addict.

Unlike a simple cold, mental illness and substance abuse are complex diseases and an unfortunate reality is that one often leads to the other. This phenomenon, known as "downward drift" occurs when people with mental illnesses "self-medicate" with alcohol and other drugs, or find themselves in environments that promote substance use as a result of their mental illness. In fact, it is estimated that up to 50 percent of people with severe mental illness also have substance abuse issues. Oftentimes, those suffering from co-occurring disorders are underserved by mental health and substance abuse treatment systems.

The generally inadequate care that dual diagnosis patients receive occurs in part because of the complexity of their conditions (they don't fit perfectly into the mental health or substance abuse treatment systems), a paucity of research on effective treatments and interventions, and a lack of training for health care providers on these issues. Usually one condition (mental illness or substance abuse) is overlooked and studies have shown that unless both are addressed simultaneously, neither will be fully treated. As a result, people with co-occurring disorders often receive poorer treatment. Furthermore, dual diagnosis patients tend to be more violent and non-compliant with treatment regimens.

If you are concerned that you or someone you know has a mental health disorder and/or substance abuse issues, treatment is paramount. Integrated care for dual diagnosis patients includes a combination of medical treatment, counseling, and support services that encourage behavioral and cognitive skill development to manage each condition. Family and friends play an important role in this process, and students at Columbia who want to help themselves or another may access treatment by contacting Counseling and Psychological Services at x4-2878.

Even though mental illness and substance abuse often come as a dynamic pair, no one should have to suffer from their risky potential. Available services may help continue your adventures without downward results.

Alice