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Dual Diagnosis: The Problem

Diagnosis Falls Through the Cracks

Dateline: 12/9/98

"Dual Diagnosis" refers to those who have been diagnosed with major mental health disorders and alcohol or substance addictions at the same time.

At least 50 percent of the 2 million Americans with severe mental illness abuse illicit drugs or alcohol, compared to 15 percent of the general population, according to the Alcohol, Drug Abuse, and Mental Health Administration.

The problem for professional counselors and mental health care providers in trying to help these patients is making an accurate diagnosis. According to Patrick Smith, M.A., of PacifiCare Behavioral Health, "A substance abuse problem can mimic, mask, or aggravate various mental health disorders.

Drug and alcohol problems and mental illnesses often go hand-in-hand. Among alcoholics, nearly half have an overlapping mental illness or other substance dependence problem. Substance dependence can cover up a serious psychiatric illness, while depression can disguise a substance-use disorder.

Compound Factors

The "double troubled" patient can be extremely difficult to recognize. Often only one of the two problems is identified. The patient diagnosed with a mental disorder may be in denial about the drinking or substance abuse, while the obvious substance abuse of others can disguise the mental disorder.

With teens the diagnosis can be extremely difficult. As one counselor says, "How can (we) separate the normal mood variations of a fifteen year old teenager from certain Bipolar disorders? When substance use or abuse is present, with resulting mood fluctuation, the variables become staggering."

"It is not uncommon," according to Harold E. Doweiko's Concepts of Chemical Dependency, "for dual diagnosed clients to use one disorder to shield for another disorder." One client may admit to mental health issues in order to avoid his substance abuse and, once the psychiatric issues are resolved, drop out of treatment.

Another client may deny her disorder because "it is less threatening to be a junkie" than to accept a diagnosis of paranoid schizophrenia, Doweiko says. Frustration and depression may hinder one client's ability to recognize and ask for help, while another client may become confused by a lack of knowledge of the processes and goals of treatment services.

Crises for Families

Families who have mentally ill relatives whose problems are compounded by substance abuse face problems of enormous proportions. Mental health services are not well prepared to deal with patients having both afflictions or supporting their families.

Violence is more prevalent among the dually diagnosed. Domestic violence and suicide attempts are more common, and of the mentally ill who wind up in jails and prisons, there is a high percentage of drug abusers.

It is also known that sexual abuse has been a problem for many who are dually diagnosed. One report says that an estimated 40 percent of those attending Dual Diagnosis meetings, have had experiences with sexual abuse also.

When the patient is correctly diagnosed there are serious gaps in services available for the dually diagnosed, and for their families. Next week, we will look at what is being done to address the needs of these patients and their families in Dual Diagnosis: The Solutions.

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