Dual diagnosis, a condition in a patient wherein both mental and substance abuse disorders coexist, is often challenging to treat due to the complex relationship between the co-occurring disorders. To understand this relationship, one needs to consider the following issues:
- Most schizophrenics, in fact, 70 percent of them, are smokers. Besides the feeling of calmness or well-being, smoking helps a person in thinking more clearly, conduct a conversation more easily or reduce agonizing side effects of medications more comfortably.
- One is likely to witness anxiety, panic attacks, mania and sleep disorders due to stimulants like cocaine.
- As depression has an underactive reward pathway that receives little pleasure from common rewards, people with depression may abuse drugs to regain the normal levels of their reward pathways.
- Methamphetamine abusers often hear voices and experience hallucinations, which are the symptoms of some specific mental disorders.
In the instances mentioned above, the link between mental illness and substance abuse has been quite vividly reflected. However, many researchers continue to find no interconnectedness between both the conditions due to the lack of clarity about which is the egg and which is the chicken between mental illness and substance abuse.
To understand the reason behind comorbidity, there is a need to first recognize substance use disorder as a brain disease. As both substance use disorder and mental illnesses are considered a brain disorder, they affect some of the same areas of the brain. For example, the increased neurotransmitter dopamine activity in the brain is due to the addictive substances like cocaine and is one of the features of for depression, schizophrenia, and other psychiatric disorders.
Genetic makeup determines dual diagnosis
A National Institutes of Health (NIH) report suggests that some of the major mental health disorders thought to be entirely separate may share certain genetic “glitches.” These glitches may also be responsible for the disorders associated with dual diagnosis. Therefore, the effect of genetic predisposition cannot be overruled in the case of dual diagnosis.
Additionally, one’s genetic makeup also causes variance in the way a person reacts to substance abuse, such as people with a particular variant of the catechol-o-methyltransferase (catechol-o-methyltransferase) gene have increased the chances of developing schizophrenia due to the abuse of marijuana.
Childhood experiences increase chances of disorders
The environment in which a person has been raised also plays an important role in the onset of both mental illnesses and substance use disorders. By experimenting with addictive substances in childhood due to peer pressure and the presence of an abuser at home, one is more likely to suffer from substance use disorders, which further leads to mental disorders.
The above-stated early risk factors and traumatic experiences, such as sexual abuse, poverty, etc., are responsible for triggering both substance abuse disorders and mental disorders.
Quadrant model: Effective way to choose the right treatment
From the patients’ points of view, finding a solution for both the problems is more important than determining which condition triggers another. An effective framework for selecting the right approach to treatment and care in the case of dual diagnosis is the quadrant model, which has been designed based on the level of severity of both the conditions.
After determining the leading condition, the quadrant model, which mainly evolved in the U.K., determines the lead service coordinates care, as well as seeks suggestions and support for the other service (substance abuse or mental health).
Though this somehow resolves the issue of where the main responsibility lies, it leaves other issues pertaining to the relationship between mental health and substance abuse in dual diagnosis unanswered.
While it is a difficult task to determine the chicken and the egg between two co-occurring disorders, the treatment of both the conditions is necessary to ensure early recovery. If you or someone you know has co-occurring disorders, contact the California Dual Diagnosis Helpline. Call us at our 24/7 helpline number (855) 980-1736or chat online to access information related to the dual diagnosis rehab centers in California.