Anxiety and Depression

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What is a dual diagnosis?

The term dual diagnosis is used when an individual is affected by the separate, but interrelated illnesses of chemical dependency and emotional or psychiatric illness.  The term dual diagnosis is often interchanged with the terms co-morbidity, co-occurring illnesses, concurrent disorders, comorbid disorders, co-occurring disorder, and dual disorder, among others.  Mental health illness and mood disorders include such issues as Bipolar Disorder, Borderline Personality Disorder, Depression, Anxiety, or PTS (Post-Traumatic Stress).

Depression, anxiety and drug or alcohol use.

Substance abuse, mood disorders, and mental health issues are commonly experienced together, and usually go hand-in-hand.  The relationship between mental health and substance abuse is cyclical.  Individuals who experience mental health issues such as depression or anxiety are more likely to turn to chemical substances to alleviate the acute symptoms of their mental health issue(s), especially if these issues are not medically managed, and the individual is not stabilized on any form of psychotropic medication therapy.  Similarly, an individual who abuses drugs and/or alcohol is more likely to develop mental health issues because of the depletion of neurotransmitter chemicals in the brain. Additionally, there are a variety of complicating problems surrounding dual diagnosis. One significant complication of dual diagnosis is that psychiatric symptoms may be covered up by the use of mind and mood altering substances.  Another complication is that detoxification from a mind and/or mood altering chemical can often impersonate symptoms of mental illness.  Yet another complicating issue to consider is that substance abuse that goes untreated can cause a resurgence of psychiatric symptoms, and unaddressed psychiatric illness can lead to substance abuse.

Dually-diagnosed individuals may be more susceptible to relapse. Dually-diagnosed individuals may be more susceptible to relapse, as co-occurring disorders often exacerbate and even mask the symptoms of each other.  This makes diagnosis and treatment of each disorder more complicated.

The cycle of substance use and mental health disorders (Dual Recovery Anonymous) states:

“A person may sincerely try to recover from one illness and not acknowledge the other. As a person neglects his or her mental illness, that illness may recur. This recurrence may, in turn, lead a person to feel the need to “self-medicate” through drug use. Over time, the lack of progress toward recovery on both fronts may trigger feelings of failure and alienation.”

All mind and mood altering substances cause the release of neurotransmitter chemicals such as Serotonin, Dopamine, and Norepinephrine.  These control mood, appetite, behavior, sleep, and the sensations of pleasure and pain, among other physical, mental, and emotional experiences. Serotonin is responsible for happiness, pleasure, contentment, and joy.  Drug and alcohol abusers flood their brains with these chemical neurotransmitters when they are under the influence.  This leaves the brain “starved” for these chemicals, and it is very difficult for the substance abuser to experience positive feelings when not in the active stage of using his or her preferred substance.  Unnatural surges of chemical neurotransmitters deplete the reserve of these chemicals stored in the brain, causing confusion, depression, insomnia, and anxiety for days, weeks, months, and even years after substance use.  As a result, drugs and/or alcohol are needed to replace the depleted neurotransmitter chemicals, and addiction occurs.

The depleted store of neurotransmitter chemicals in the brain of a substance abuser is the key to understanding the cycle of substance abuse and mental illness.  Drug and alcohol abusers tend to have additional problems associated with their substance abuse, such as major depression and/or anxiety.  Indeed, mental illness is exacerbated and intensified through the depletion of neurotransmitter chemicals because of substance abuse. This, in turn, makes it more difficult for the substance abuser to abstain from using because the only time they experience positive emotion, or even feel ‘normal,” is when they are under the influence.

Individuals who are born with a mental health or mood disorder issue are significantly more likely to develop substance abuse issues.  There are a few reasons why this is so.  First, many mental health disorders go undiagnosed, and suffering individuals often turn to mind and mood altering substances to gain a measure of relief, or to try to control the adverse mental symptoms they experience.  This too leads to a cycle that is negatively intensified as the individual progresses deeper into the cycle of substance abuse and dependence.