Dual Diagnosis: The Importance of Treating Mental Health and Addiction Issues at the Same Time

Addiction Recovery Publishing Dual Diagnosis October 20, 2023

Dual Diagnosis: The Importance of Treating Mental Health and Addiction Issues at the Same Time

Here on Hawaii’s Big Island, there is an ancient proverb. It goes, “A’a i ka hula, waiho i ka maka’u i ka hale.” What this translates to is that we should always dare to dream, dare to dance, dare to do what is right, and never let shame or guilt get in the way of any of it. But, sometimes, forces out of our control do get in the way of how we wish to live our lives. These forces include issues of addiction and mental health. But, with a proper dual diagnosis, these issues can be addressed, and “A’a i ka hula, waiho i ka maka’u i ka hale” can continue to commence.

The Importance of Getting the Right Diagnosis Right Away.

When it comes to any issues of addiction or mental illness, it is critical to get the right diagnosis right away. Now, the only way to safely do this is to seek the help of medical professionals and addiction specialists.

While it is vitally important to be fully upfront and open with our primary care doctors, and they are incredibly capable of helping us with many medical issues, they often don’t have the addiction and mental health background required for a proper diagnosis (or dual diagnosis). But they will almost always have the right connection to someone who does.

For recovery, it is critical to be properly diagnosed because that is the only way that we are ultimately going to be properly treated. This is especially true for those of us who have co-occurring issues of addiction and mental health. If one issue is treated and not the other, then chances are they both will be present again at some point down the line. This is because mental illness and addiction are often so enmeshed that the untreated issues will almost always trigger the other.

How Common Are Co-Occurring Issues of Addiction and Mental Health?

Many people may be unaware of how common mental health and addiction comorbidities actually are. Here are the facts, according to the National Institute on Drug Abuse (NIDA): “7.7 million adults have co-occurring mental and substance use disorders. This doesn’t mean that one caused the other and it can be difficult to determine which came first.” Also, “Of the 20.3 million adults with substance use disorders, 37.9% also had mental illnesses,” and “among the 42.1 million adults with mental illness, 18.2% also had substance use disorders.” These are not insignificant numbers.

Also, there is a good chance that these statistics are not fully representative of the population of people with co-occurring disorders out there. This is because comorbidities of addiction and mental illness can often be missed during the diagnosis process, and there are many reasons for this.

Reasons Why Comorbidities Are Often Missed

Comorbidities can often be missed during diagnosis because so many mental health and addiction issues have symptoms that overlap each other. For example, people struggling with addiction and an anxiety disorder will often be diagnosed with substance use disorder (SUD) or anxiety, but not both. 

This can happen in two ways. One is that the person is not fully upfront about their substance use, so they only get diagnosed with an anxiety disorder. Two is that they are diagnosed with SUD, but the diagnosing doctor only sees the anxiety as but a symptom of the addiction. So, one can see how this can be quite difficult, which is also why it is so critical to see a reputable professional who is versed in both addiction and mental health disorders.

A Better Understanding of Dual Diagnosis

The Substance Abuse and Mental Health Services Administration (SAMHSA) breaks co-occurring disorders and dual diagnoses down into three different parts. They explain that co-occurring disorders happen because “Certain substances can cause people with an addiction to experience one or more symptoms of a mental health problem. Mental health problems can sometimes lead to alcohol or drug use, as some people with a mental health problem may misuse these substances as a form of self-medication,” and “Mental health and substance use disorders share some underlying causes, including changes in brain composition, genetic vulnerabilities, and early exposure to stress or trauma.”

Now, these three factors must be taken into account if there is going to be a proper diagnosis or dual diagnosis. Also, having this information will help after the diagnosis because it will help determine the composition of the recovery plan. This recovery plan must also focus on treating all of the issues present at the same time. If issues of addiction and mental health aren’t treated in tandem, then it becomes very difficult to heal at the cellular level.

Dual Diagnosis: The Importance of Treating Mental Health and Addiction Issues at the Same Time

Now, dual diagnosis doesn’t just happen with addiction and mental illness. It can happen with two types of addiction or two types of mental illness as well. For example, schizophrenia is sometimes diagnosed alongside major depression (this is also a diagnosis known as schizoaffective disorder: depressive type). When this diagnosis happens, it is important that both disorders are treated separately but at the same time as well. 

For example, what this may mean in this instance is that the schizophrenic symptoms must be treated medically so that the depressive symptoms can be treated therapeutically. They are both treated separately, but if they both aren’t treated at the same time, then neither of the treatments will work. The same concept applies to those dual-diagnosed with issues of mental health and addiction. 

For example, someone diagnosed with opioid use disorder (OUD) and generalized anxiety disorder (GAD) must be treated for both issues simultaneously. The OUD may be treated with some form of harm reduction medication, while the anxiety may be treated therapeutically. Without the medication, the therapy cannot function cohesively, and without the therapy, it will be significantly harder to get away from the medication and onto the next stages of opioid addiction recovery. So, as we can see, treatment for those dual-diagnosed is very symbiotic.

Treating Dual Diagnosis With “Traditional” Mental Health Therapies

One of the ways that many people with a dual diagnosis are treated is with “traditional” mental health therapies. These are evidence-based therapies that have enough research and study behind them to prove their efficacy. 

This does not mean that therapies that aren’t deemed “evidence-based” can’t be highly effective; it just means that they are not categorized as such. Now, some of the most common evidence-based mental health therapies are cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT), and psychodynamic therapy. All of these are relatively common for a reason. They have all been shown, and continue to be shown, to be highly effective in treating both issues of addiction and mental illness.

The Benefits of Cognitive-Behavioral Therapy

CBT is perhaps the most used psychotherapy in the U.S. today. According to the clinical write-up, Cognitive-Behavioral Therapy, by Doctors Chand, Kuckel, and Huecker, CBT was first introduced in the 1960s, and “Since then, it has been extensively researched and found to be effective in a large number of outcome studies for some psychiatric disorders, including depression, anxiety disorders, eating disorders, substance abuse, and personality disorders. It also has been demonstrated to be effective as an adjunctive treatment to medication for serious mental disorders such as bipolar disorder and schizophrenia.”

CBT works on the idea that the thoughts (cognitions) of people struggling with issues of addiction or mental illness are often distorted, and this distorted thinking is what can create such negative, risky, and toxic behaviors. Then, CBT works to help the individual recognize when these thoughts and/or beliefs are about to surface so they can then modify the behaviors that are associated with them. Basically, CBT addresses the root/core cognitive causes of our external issues. DBT works off of similar principles.

The Benefits of Dialectical Behavior Therapy

DBT is based on the principles of CBT but also has a foundation of “acceptance” when it comes to how we perceive ourselves. It was originally created to help suicidal women with borderline personality disorder (BPD) but has since moved into the larger realm of treating many mental health and addiction issues.

According to the article, Dialectical Behavior Therapy: Current Indications and Unique Elements, by Dr. A. L. Chapman, “The patient populations for which DBT has the most empirical support include parasuicidal women with borderline personality disorder (BPD), but there have been promising findings for patients with BPD and substance use disorders (SUDs), persons who meet criteria for binge-eating disorder, and depressed elderly patients.” DBT also has a greater focus on mindfulness and goal orientation. Goal focus is also a big component of psychodynamic therapy.

The Benefits of Psychodynamic Therapy

Psychodynamic therapy works a lot on the concept of the unconscious, which was first introduced by Dr. Sigmeund Freud. Though it looks nothing like the psychoanalysis that Freud promoted in his time

According to the SAMHSA published text, Brief Interventions and Brief Therapies for Substance Abuse, “Psychodynamic therapy focuses on unconscious processes as they are manifested in the client’s present behavior. The goals of psychodynamic therapy are client self-awareness and understanding of the influence of the past on present behavior.” Also, “In its brief form, a psychodynamic approach enables the client to examine unresolved conflicts and symptoms that arise from past dysfunctional relationships and manifest themselves in the need and desire to abuse substances.” Resolving these internal root/core conflicts is critical for healing at the cellular level.

Treating Dual Diagnosis With Experiential Therapies

Whether treating individuals with one diagnosis or multiple, it is important to treat them with comprehensive recovery plans. This means multiple modalities and should also mean multiple therapies. Now, this includes experiential therapies.

Experiential therapies can be highly beneficial because it allows the individual to get out of the therapist’s office and interact with the outside world. For individuals struggling with issues of addiction and/or mental illness and isolating due to their symptoms, reconnecting with the external world can be crucial. An ideal way of doing this is through the experiential therapy of nature immersion.

The Benefits of Nature Immersion Therapy

Nature immersion therapy is a great way to reconnect with the world around us and, in doing so, reconnect with our core selves. It also has many physical, emotional, and mental benefits.

According to the International Journal of Environmental Research and Public Health, “Besides physical health improvements, nature exposure can bring about positive influence upon psychological constructs such as boredom, friendliness, well-being, and liveliness. However, across more than one hundred studies on nature/wildlife exposure, stress mitigation has been shown to be one of the most consistent and important psychological benefits.” But also, nature immersion therapy has been shown to have similar impacts on cognitive functioning as CBT and DBT.

The journal continues, “Besides improvements to physical and psychological well-being, exposure to natural environments has been shown to bring about positive impacts on cognitive functioning.” Now, while traditional and experiential therapies can work well together, they often work even better when they are utilized alongside each other and some holistic approaches like meditation, breathwork, acupuncture, and yoga.

Treating Dual Diagnosis Holistically

Holistic methods of treatment have been used for thousands of years to help people focus and connect with themselves at the cellular level. However, it wasn’t until recently that holistic modalities began being used in earnest to treat issues of mental illness and addiction.

Holistic treatments are also often referred to as “complementary and alternative medicine” (CAM). According to the clinical journal Frontiers in Psychiatry, “Some evidence shows the effect of CAM practices, such as mindfulness meditation (MM) and motivational enhancement, in decreasing SUD relapse and substance-related injuries. With some complementary and alternative therapies for SUDs, such as mind-body therapies, acupuncture, and meditation, proving to be effective, CAM is gaining momentum in addiction medicine.” This includes the momentum surrounding yoga for treating mental illness and addiction.

The Benefits of Yoga

While it began over 3,000 years ago as a religious practice, yoga is now used by hundreds of millions of people all over the world to attain well-being, inner peace, and mindfulness. Also, relatively recently, yoga has experienced a surge in its use for treating issues of addiction and mental health.

According to the International Journal of Yoga, “Viewed as a holistic stress management technique, yoga is a form of CAM that produces a physiological sequence of events in the body reducing the stress response.” Also, it has been shown that “Yogic practices enhance muscular strength and body flexibility, promote and improve respiratory and cardiovascular function, promote recovery from and treatment of addiction, reduce stress, anxiety, depression, and chronic pain, improve sleep patterns, and enhance overall well-being and quality of life.”

Yoga is also an ideal option for treating people with dual diagnosis because there is no potential for complications between other treatments for the disorders. Also, a yoga practice can be taken anywhere, which means that a recovery practice can be taken anywhere.

Making the Right Choices Right Away With Exclusive Hawaii Rehab

Here at Exclusive Hawaii Rehab, we understand the importance of a proper diagnosis and exceptional individualized addiction and mental health care. We also know that the right start to recovery makes for a much better success rate.

Here on the Big Island of Hawaii, we also say “Kahuna Nui Hale Kealohalani Makua.” This means that we should love all that surrounds us, but we must also love ourselves. Also, this is a big part of what we offer here at Exclusive Hawaii Rehab. 

Yes, we offer recovery. But we also offer our clients struggling with a dual diagnosis of addiction and mental illness the love they need and deserve until they learn to love themselves again.

Co-occurring disorders are much more common among people struggling with substance use disorder (SUD) than many people may think. While almost any disorder can be a morbidity alongside addiction, some of the more common comorbidities include PTSD and bipolar I and II disorder. However, dual diagnosis need not be a deterrent from fully recovering to the core. There are many highly effective evidence-based, experiential, and holistic treatment options for treating those with a dual diagnosis. The key is treating all issues at the same time for healing at the cellular level and having a long, healthy recovery. For more information on dual diagnosis and some effective ways to treat it, reach out to Exclusive Hawaii Rehab today at (808) 775-0200.