Dual Diagnosis in Addiction Treatment

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The co-occurrence of substance misuse with other psychiatric disorders is increasingly recognised as a major public health problem and dual diagnosis is now a common occurrence among patients seeking help with alcohol or drug addiction. Dual diagnosis is best treated within a hospital environment in order to successfully diagnose and treat both disorders. Some common examples of co-occurring disorders with substances misuse:

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What is Dual Diagnosis?

Dual diagnosis — which may also be referred to as co-occurring disorders, COD, or dual pathology —is a common and highly complex phenomenon that describes the condition of having a mental illness and substance use disorder. Most people with dual diagnoses report their first mental disorder occurred at an earlier age than their first substance disorder.

The name of the condition can be used broadly to describe a combination of mental health concerns: depression and alcohol use disorder;  severe mental illness such as psychosis and marijuana misuse; or a milder mental illness like generalised anxiety disorder and a dependency on sedatives.

However, the use of this single category of mental illness is often misleading for those with complex needs and more than two mental health concerns, behavioural issues and/or drug abuse and other addictions. In addition to this, diagnosing psychiatric illness in those who use mind-altering substances is challenging as substance use can often induce psychiatric symptoms. It is, therefore, necessary to differentiate between substance-induced and pre-existing mental illness.

Great care must be taken with diagnosing dual diagnosis because the treatment that follows can have negative consequences if the diagnosis is wrong.

For example, clinical depression that is quite separate in origin from someone’s alcohol abuse may require specific medication and specifically focused psychotherapy. If misdiagnosed, those drugs and the therapy may be quite inappropriate and, as such, ineffectual, and perhaps have an adverse effect on the patient’s ability to recover.

Those with co-occurring disorders face complex challenges. They have increased rates of relapse, hospitalisation, homelessness, and HIV and hepatitis C infection compared to those with either mental or substance use disorders alone.

Dual diagnosis treatment is an increasingly common occurrence among patients seeking help with alcohol or drug addiction at Smarmore Castle.

Signs and Symptoms of Substance Abuse

Substance abuse is a serious condition that occurs when the rewarding effects of a drug alter the brain’s limbic system, causing intense cravings and impulses to use the drug again despite negative consequences.

If you have struggled with drug abuse or alcohol addiction for a significant period or in high doses, you might start to develop a tolerance. This is characterised by needing more and more of the drug or alcohol to achieve the same result.

When your brain has become used to a mood-altering substance, you may feel as if you need that drug to maintain normalcy or to avoid withdrawal.

At this point, substance abuse can have a profoundly negative effect on a person’s life and the lives of those closest to them. Substance abuse, addiction and addictive behaviours can cause distressing symptoms and consequences including the breakdown of relationships, reduced work performance, poor physical health, and uncontrolled personal finances.

If you are concerned about yourself or someone else, there are some visible signs of substance abuse to look out for. These include altered sleep patterns, intoxication, loss of coordination, hiding drugs, lying about substance use or frequency of use, and mixing one mood-altering substance with another, to name a few.

Do you recognise any of the following symptoms of substance abuse in yourself or a loved one?

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Psychological Symptoms:

  • Anxiety and depression
  • Low self-esteem and feelings of hopelessness
  • Poor memory
  • Increased or outbursts of anger
  • Exhaustion
  • Delusion and paranoia
  • Agitation
  • Lack of concentration
  • Impaired judgement

Behavioural Symptoms:

  • Being secretive or dishonest about substance use
  • Failing to reduce or stop drug use
  • Impaired performance
  • Poor attendance at work or school
  • Isolating
  • Losing interest in hobbies
  • Continuing to use substances despite negative consequences

Physical Symptoms:

  • Lacking concern over physical appearance
  • Lacking concern over personal hygiene
  • Losing weight
  • Self-harming
  • Disrupted sleep patterns

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Recognising a Dual Diagnosis

Many of the symptoms of addiction are also the same as mental illness, so it can be hard to identify whether you or a loved one is suffering from the effects of addiction alone, or if they have an additional mental illness.

The warning signs of dual diagnosis vary from person to person. This is because there are many types of drugs and mental disorders with varying side effects and symptoms respectively.

There are some common problems those with dual diagnoses share. You may have a dual diagnosis if: 

  • Prior to developing an addiction, you experienced anxiety, depression, or were diagnosed with a mental health issue such as bipolar, personality or a mood disorder.
  • You find it hard to stop substance abuse because your anxiety, depression, or symptoms of a mental health concern become worse without alcohol or drug use
  • You find yourself being alienated by friends or are estranged from your family
  • You sometimes experience periods of extreme emotional highs and lows
  • You feel out of control or have a sense of not being able to cope so you use alcohol or drugs to soothe yourself  
  • You have had to call crisis lines or been admitted to the hospital due to your mental health
  • There is a history of addiction or mental illness in your family

Routine, thorough, and integrated screening and diagnosis of dual disorders are needed to facilitate the implementation of appropriate treatment and avoid underdiagnosis or misdiagnosis.

The Link Between Substance Abuse and Mental Health 

There is a consensus among addictions researchers and clinicians that mental health concerns and substance use problems are often interrelated. There is also growing awareness of the serious social, psychological and physical complications of the combined use of substances and mental health problems.

But it can be hard to identify which came first as co-occurring disorders can mimic or cause the onset of one another, meaning the condition may go unnoticed or be misdiagnosed.

Someone may present as having a mental health issue such as anxiety but the substance use disorder is left unresolved which then increases the severity of the mental health issue’s symptoms.

In addition, it might be clear that someone has a substance use disorder but a co-occurring mental health condition may be missed.

This may mean the person finds it hard to recover from addiction, experiencing frequent relapses, which only compounds the negative experiences associated with a mental health condition.

Mental health disorders can also be confused with withdrawal syndromes. But mental health disorders at times occur as a result of going through withdrawal from substances such as alcohol, stimulants or sedatives, thereby creating confusion between mental health symptoms and substance use disorders.

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Treatment for Dual Diagnosis Patients

Treatment for dual diagnosis varies between treatment providers but will usually involve a mix of therapies, group work, trauma resolution, complementary therapies and 12-step meetings. Dual diagnosis is best treated within a residential environment where co-occurring disorders and treatment progress can be regularly monitored.

Recovery from dual diagnosis requires time, hard work and a broad array of coping skills. People with higher levels of support and greater participation in dual diagnosis recovery report less substance use and mental health distress and higher levels of wellbeing.

Treatment Facilities for Dual Diagnosis in Ireland

Ireland is not currently well-equipped to provide dual diagnosis treatment. According to Dual Diagnosis Ireland, “most mental health services and addiction treatment centres in Ireland are currently not organised to treat such people holistically.”

However, The Smarmore Castle treatment programme is a well-tried route to recovery for dual diagnosis patients because it allows uninterrupted medical and psychotherapeutic treatment that addresses both illnesses: addiction and any additional mental health disorders. We recognise the challenges of dual diagnosis and use special assessment tools to ensure that diagnoses are made correctly.

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Treatment for Dual Diagnosis at Smarmore Castle

Our intensive, personalised treatment programme follows the 12-step model, providing detox and medical treatment, psychotherapy, cognitive behavioural therapy (CBT), and other specialist therapies. Our complementary therapies, equine therapy, and even drumming help explore the hidden causes of addiction and related psychological issues.

Our highly trained and experienced team of medical staff is made up of a consultant psychiatrist, certified therapists, doctors and nurses. As part of treatment, the team reviews each patient’s progress on a daily basis and recommends any necessary adjustments to a patient’s personalised treatment plan as needed.

This allows those with more complex cases, like dual diagnosis, to receive the time and attention they require for a full recovery.

At Smarmore Castle, dual diagnosis patients will start the usual addiction treatment programme of individual and group therapy, written assignments and educational lectures and workshops. In addition to their treatment plan, clients will receive counselling from specialist staff on any extra issues that arise from the dual diagnosis, such as anger, depression or anxiety.

If you are diagnosed with post-traumatic stress disorder, complex post-traumatic stress disorder or developmental trauma, you may require trauma-resolution therapy such as EMDR (Eye Movement Desensitisation and Reprocessing). There are also specialist groups to address childhood trauma, grief and other similar issues.

We aim to educate patients about their illnesses while encouraging assertiveness and building self-esteem. We also teach healthy coping strategies, empowering clients to employ relapse prevention techniques once they have left treatment.

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Contact Us for Dual Diagnosis Treatment

If you or someone close to you is struggling with addiction alongside a mental health disorder, it’s important you seek help for both illnesses to find recovery. Contact us if you wish to access treatment, or for advice on the next steps.

  • How to Access Rehab With Health Insurance

    For those experiencing existing mental health conditions in Ireland, there are private medical insurers who can help you cover treatment. As addiction experts, we know that receiving the appropriate care and support when you have a mental health disorder is pivotal to attaining long-lasting recovery. Below, we will go through the various health insurance options to help you understand your options when it comes to seeking private residential care for substance abuse. Please note that there is no guarantee that you can be covered for all addiction problems as policies are always assessed on a case-by-case basis. Find Out More

  • My Loved One Doesn’t Want Help, What Do I Do?

    You can’t force someone to go to rehab. At the end of the day, it needs to be their decision because they are the ones that need to be open to turning their lives around. There are ways in which you can encourage someone to enter treatment, one of these ways is via an intervention with a trained interventionist, who facilitates an honest discussion between family members and the addict. This is something Smarmore Castle can arrange – contact us today.

  • Which Drugs Does Smarmore Castle Detox From?

    We can detox people from any drugs whether they are illegal drugs such as cocaine, heroin, ketamine; or prescription drugs such as benzodiazepines or zopiclone, oxycodone, zolpidem, klonopin, methadone, cannabis; and legal drugs such as alcohol.

  • How Long Is the Treatment Programme?

    Our treatment programme starts at 4 weeks and is flexible in length, giving you the opportunity to extend for a longer period if you need it.

  • Do You Treat Dual Diagnosis?

    All patients are reviewed by a consultant psychiatrist in the first week and we can diagnose and provide treatment for a number of co-occurring mental health conditions.

  • Do I Need to Be Abstinent Before Admission?

    Our medically managed detoxification with 24/7 medical cover means that we can perform complete and complex detoxes at Smarmore Castle. You don’t need to be abstinent before arrival.

  • How Do I Get To Rehab Safely?

    Smarmore Castle is one hour north of Dublin international airport and we can arrange a driver to collect you and bring you straight to us for free.

    We can also arrange a ‘sober transport’ service with a trusted driver, from anywhere in Ireland or Northern Ireland, at an additional cost.

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