Test Your Knowledge

It is important to recognize the risks and prevalence of a dual diagnosis with mental illness and substance abuse. Problems with substance abuse complicate nearly all areas of mental health care. Mental illness likewise complicates substance abuse treatment.

Those who abuse substances tend to have more relapses of their mental illness and require more hospitalizations. In addition, such substances can interfere with the effects of medications commonly used to help control symptoms of mental illnesses.

Because both mental illness and substance abuse may be accompanied by denial (refusal to admit truth or reality), some patients refuse to seek treatment. Others seek treatment only after friends, family members, coworkers or others have urged them to do so. Some patients enter treatment only after it is ordered by a judge or other means.

There are often problems with the medical treatment of dually diagnosed patients. Treatment therapies for one condition are not designed for the other. Because of this, treatment for dual diagnosis of mental illness and substance abuse often requires a patient to move back and forth between facilities. However, patients with mental illness may not be welcomed in residential and rehabilitation programs for substance abuse and patients with substance abuse problems may not be welcomed in therapies for mental illness. In addition, a person with a mental illness and a substance addiction requires treatment from professionals in both fields.

Because treatment for non-substance abuse mental illnesses are more likely to be covered by insurance plans than substance abuse treatment, it appears that the substance abuse issues may be downplayed by both patients and health care professionals when treatment is sought.

According to the National Alliance on Mental Illness (NAMI), traditional substance abuse programs are not typically recommended for mentally ill patients. NAMI emphasizes that the standard techniques of many substance abuse programs frequently result in high degrees of stress that can exacerbate psychiatric symptoms or cause relapse of a mental disorder. In addition, the confrontive and coercive techniques associated with these programs, as well as the common tendency to discourage the use of all medications, can be detrimental to the treatment of these patients. Substance abusers who are placed in treatment programs that do not focus on their abuse usually receive little benefit from them.

Effective programs for the treatment of the combination of mental illness and substance abuse must address both conditions together in an integrated fashion. This treatment needs to take a gradual approach. It must be viewed as long-term. In some cases, it may take years to treat the conditions and develop abstinence from substances of abuse and remission of mental illness. 

Both conditions must be recognized as illnesses, not character flaws. Instead of punishing patients for slips or mistakes, effective therapists acknowledge accomplishments. Social networks that can reinforce positive behavior are important. However, in substance abuse programs, treatment often begins with patients taking responsibility for their behavior.  This is in contrast to programs for the treatment of other mental illnesses.

Since mental illness and substance abuse drastically affect all aspects of the patient’s life, assistance will likely be comprehensive. It may need to include job and housing assistance, family counseling and money and relationship management.