Co-occurring substance abuse and mental illness, or dual diagnosis, is defined as the presence of one or more psychological disorders along with an addiction disorder. The prevalence of these disorders is actually very common. Research done over the years has shown that about 50% of all individuals with any type of mental illness are also facing an addiction of some kind. The reverse is also true; about half of all people in the United States with a substance abuse issue also have a mental illness.
With a population of about 4.7 million, Louisiana is the 25th most populous state in the Unites States. Located in the Deep South, the area was created by silt flowing from the Mississippi River and is the birthplace of the unique Creole culture. Amid this rich cultural region, Louisianans face mental illness and addiction at about the same rate as the rest of the United States. In fact, the depression rate among high school aged teens is 32% for males and 22% for females. This was very slightly higher than the national average. At the same time, the Substance Abuse and Mental Health Services Administration (SAMHSA) reported that from 2104-2015, and annual average of 20,000 teens in Louisiana used marijuana in the past month. SAMHSA also reported that in the same period of time, 10.7% of all teens reported drinking alcohol in the past month.
Louisiana's adults age 18 and older reported having a serious mental illness at the rate of 4.5%, this works out to be about 156,000 people in 2014-2015. Only about 40% of adults ever received any treatment for these mental illnesses. According to Mental Health America, this level of access puts Louisiana 42nd out of 50 states ranked for their provision of access to care for those with a mental illness. This low access is mainly attributed to the lack of services available within the state, especially in rural areas.
There is a list of mental illness that is more commonly seen with addiction. These include anxiety disorders, panic disorders, depression, PTSD, bipolar disorders, ADHD and schizophrenia. The fact is that these types of disorders commonly occur simultaneously with an addiction within one individual. Researchers have not been able to pinpoint directional causation for this, meaning that they have not been able to determine if mental illness directly causes addiction and vice versa. One of the most commons reasons that these disorders may co-occur is due to self-medication. There are individuals with undiagnosed and untreated mental illness who suffer greatly from the symptoms of their illness. Often times, they seek relief from these painful experiences in the form of an outside substance. Using drugs or alcohol to self-medicate in this way leads to dependency and addiction very quickly. Soon, these individuals find themselves dealing with two disorders instead of one. They may be unaware of the development of the co-occurring disorders, or even the reason why they are seeking out the substance.
There are certain risk factors that have been identified as common between the two types of disorders. A person's genetic makeup affects whether or not they have the potential for an addiction or a mental illness. The genes that control the development of these disorders are shared, and therefore if the genes are affected by one of these disorders then it is very possible that the other is also affected. For example, it is known that the chemicals within in drugs have the ability to physically change genes and DNA. When a substance acts on the genes, a mental illness that has laid dormant can be triggered to develop. In reverse, when a mental illness develops within a person, that person is more susceptible to falling victim to addictive behaviors.
Because of the many combinations that exist with co-occurring disorders, it is tough to pick out the signs and symptoms of any one specific combination. Symptoms of mental illness can vary greatly from person to person, however there are ways to determine if a person may be facing co-occurring addiction.
It is not necessary for the pay person to determine the specific combination of mental illness and addiction that may be present within themselves or a loved one. The main thing is to flag any symptoms that might indicate that this is the case. It is very important that these people receive treatment and get the help they truly need. Undiagnosed mental illness is the cause of many interpersonal and societal issues, avoiding this is the best course of action for the greater good of all.
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Although a dual diagnosis poses a challenge for treatment, recovery is possible. The medical community has made great strides in the last 30 years when it comes to diagnosing and treating co-occurring mental illness and addiction disorders. Through their work, it has been determined that the best approach to treating these cases is using an integrated approach. This means that all disorders present within an individual will be treated at the same time. It has taken a lot of effort to combine the treatment of the two separate disorders, and there is more work yet to be done.
Using an integrated approach, a trained medical professional will create an individualized treatment plan for each patient. Most of these treatment plans follow the same pathway which includes detoxification, inpatient rehabilitation, transitional housing, and continuing care.
There are cases where the withdrawal symptoms of a drug or a drink will be so intense that they need to be taken off medically. Dedicated detox centers are able to provide around the clock care to people who are going through substance withdrawal. Detox staff are able to provide tapering doses of the substance so as to keep the patient's body as healthy as possible through the process. Patients are also monitored constantly to ensure that they remain physically and emotionally safe. Pain medications are administered for those whose withdrawal symptoms are painful.
Rehabilitation programs offer many forms of therapy in order to treat the addiction and mental health disorders that a patient has been diagnosed with. Residential rehabilitation is very effective in treating patients because the programs are so immersive. Once a person is checked in, they live at the treatment facility 24 hours a day and are under expert supervision and care. Qualified clinicians provide the prescribed treatments for each patient. Common modalities used include cognitive behavioral therapy (CBT), talk therapy, medication, acupuncture, biofeedback and art therapy. CBT has been found to be very effective in treating addiction because it addresses the underlying thought patterns that fuel addiction. Once patients are able to change the way they think, they are able to modify harmful behaviors. For those with unresolved trauma, talk therapy has been found to be extremely effective for healing. Trauma that has not been addressed can affect a person for years without them even realizing.
After completing a rehabilitation program, patients often opt to move into transitional housing as opposed to going directly back to their normal lives. Transitional housing communities provide a level of support not found in the outside world. Patients are able to gain a degree of autonomy while still enjoying the benefits of a supportive safety net. The services provided by transitional housing include psychotherapy, occupational therapy, case management, medication management, and transportation to doctor's appointments. Transitional housing also comes at a very affordable cost to the patients, which is essential for some patients who were facing homelessness while dealing with their addiction previously.
In order for individuals to have the best possible outcomes it is important for them to continue to work on their recovery when they are done with rehab and eventually leave transitional housing. Continuing care involves attending therapy, taking medication, going to doctor appointments, fulfilling state requirements, and seeking out self-help support groups. There are many groups available for those who are in recovery. In a lot of cases, patients are connected with these groups during their stay in transitional housing, making it convenient for them to keep attending and being involved in these groups. This type of peer support is truly valuable for someone who is trying to keep their sobriety and maintain their mental health.
References
https://www.hhs.gov/ash/oah/facts-and-stats/national-and-state-data-sheets/adolescent-mental-health-fact-sheets/louisiana/index.html
https://store.samhsa.gov/system/files/sma17-barous-16-la.pdf
https://www.drugabuse.gov/publications/research-reports/common-comorbidities-substance-use-disorders/part-1-connection-between-substance-use-disorders-mental-illness
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