DUAL DIAGNOSIS: DEFINITION AND CHALLENGES
January 2007
What's Ailing Joe?
Joe was a good natured nineteen year old sophomore at the state university. He was an above average student who dreamed of becoming a teacher. In Joe's social crowd the drug of choice was marijuana. At first Joe smoked it at parties, but his use slowly became a daily occurrence. He just didn't seem to be able to get through a day without marijuana. He began experiencing heightened anxiety that on occasion lead to panic. His grades began to fall and he felt both depressed at times and then hyperactive. He told of distorted perceptions and hallucinations. Joe had a second cousin who suffered with schizophrenia and had an onset of the brain disease at nineteen. Joe seeks treatment for his symptoms. What is his diagnosis?
Definition and Challenges
Chemical dependency and mental illness are two separate and independent disorders. Their interaction adds to the complexity of the diagnosis, treatment, and recovery of the consumer. The dual diagnosed patient has two brain diseases that affect one another and that both require treatment. The occurrence of both illnesses among the mentally ill is high. It is estimated that over fifty percent of people with critical mental illness abuse illegal drugs as compared with fifteen percent of the general population. Frequency rates for dual diagnosis range from twenty to eighty percent. The problems inherent in a dual diagnosis can negatively affect the patient physically, socially, financially, psychologically, and spiritually.
A major challenge for service providers and families of the dual diagnosed is unraveling the interacting effects of both disorders. Many times the symptoms overlap and mask each other. Another challenge is that mental health providers are not well prepared to deal with both illnesses and the patient may be bounced from one treatment mode to another. One of the major questions that arise with the dual diagnosis is whether drugs themselves cause the mental illness or instead mainly worsen the symptoms. Self medication for the relief of symptoms of mental illness, for example, anxiety, depression, and stress also entangle the cause and effect of the two diseases.
Although a dual diagnosis presents many difficult challenges, more recognition of the condition has lead to more integrated treatment systems. Service providers in the fields of medicine, social services, and judicial systems have taken advantage of new understanding to create more effective recovery models.