ENTRY: Dual Diagnosis

This past weekend while at work I helped out a patient and afterwards we engaged in a little bit of casual conversation. The conversation just happened to get more serious at one point, and he mentioned that he was adopted. Now, this patient has always struck me as a very intelligent, confident, and well-spoken person. He explained that when he was younger, like around the ages of 10 to 12, he naturally wondered about his birth family.

As he grew into his teenage years, he became somewhat bothered by never having any answers, and he would wonder things like where some of his physical traits came from. Never knowing anything about his organic origins actually sowed the seeds for a terrible depression. Eventually, he mustered up enough courage to actually ask his adoptive parents if he could actively seek out his birth father. They permitted, thankfully.

The reason I tell this little anecdote, other than it being basically positive, is that the patient was telling me that the main basic reason he started using drugs in the first place was that he never knew where he came from. When he was a teenager, he absolutely hated always wondering about his birth parents. He did not know anything about them, and having this innate urge to know plagued him for years. His depression symptoms were pacified temporarily only with drugs, like opioids, since he wasn’t obliged to think when he used, and he could just nod out.

Substance abuse and mental health disorders such as depression and anxiety are closely linked, although one doesn’t necessarily cause the other. Abusing substances such as marijuana or methamphetamine can cause prolonged psychotic reactions, while alcohol can make depression and anxiety symptoms worse. Moreover, alcohol and drugs are often used to self-medicate the symptoms of mental health problems. People often abuse alcohol or drugs to ease the symptoms of an undiagnosed mental disorder, to cope with difficult emotions, or to temporarily change their mood. There is never a positive outcome when engaging in this type of behavior.

It can be difficult to identify a dual diagnosis. It takes time to tease out what might be a mental health disorder and what might be a drug or alcohol problem. The signs and symptoms also vary depending upon both the mental health problem and the type of substance being abused, whether it’s alcohol, recreational drugs, or prescription medications. For example, the signs of depression and marijuana abuse could look very different from the signs of schizophrenia and alcohol abuse. However, there are some general warning signs that you may have a co-occurring disorder:

Do you use alcohol or drugs to cope with unpleasant memories or feelings, to control
pain or the intensity of your moods, to face situations that frighten you, or to stay
focused on tasks?


Have you noticed a relationship between your substance use and your mental health?
For example, do you get depressed when you drink? Or drink when you’re feeling
anxious or plagued by unpleasant memories?


Has someone in your family grappled with either a mental disorder or alcohol or drug
abuse?


Do you feel depressed, anxious, or otherwise out of balance even when you’re sober?


Have you previously been treated for either your addiction or your mental health
problem? Did the substance abuse treatment fail because of complications from your
mental health issue or vice versa?


More on this in the coming days.

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