Dual Diagnosis: Co-Occurring Disorders with Alcoholism

Alcoholism: Dual Diagnosis

Robert Gerchalk

Robert is our health care professional reviewer of this website. He worked for many years in mental health and substance abuse facilities in Florida, as well as in home health (medical and psychiatric), and took care of people with medical and addictions problems at The Johns Hopkins Hospital in Baltimore. He has a nursing and business/technology degrees from The Johns Hopkins University.

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How Alcoholism and Co-occurring Disorders Are Treated Together

Even though alcohol is legal, it’s possible to develop an alcohol use disorder (AUD) if you drink too much. When seeking treatment for AUD, you might receive a dual diagnosis, which means that you’re experiencing alcoholism and a co-occurring mental health disorder at the same time. If these disorders are left untreated, the symptoms associated with both can become more severe. However, you can receive dual-diagnosis treatment in healthcare facilities equipped to treat both conditions.

What Are Mental Health Disorders?

A mental health disorder refers to a substantial disturbance in a person’s behavior, cognition, or emotional regulation. These disorders often occur alongside distress and problems functioning in social, work, or family activities. Along with the fact that there are numerous types of mental health disorders that a person can be diagnosed with, these conditions can also vary in severity. 

In the U.S. alone, nearly 58 million people have been diagnosed with a mental illness. The most common ones include depression and anxiety, both of which saw an increase in cases following the COVID-19 pandemic. The many types of mental health disorders that a person can be diagnosed with include the following:

  • Anxiety disorder
  • Bipolar disorder
  • Eating disorder
  • Depression
  • Post-traumatic stress disorder
  • Schizophrenia
  • Neurodevelopmental disorders
  • Dissocial disorder

What Is Alcoholism?

Alcohol use disorder (AUD) is a type of mental health condition that occurs when individuals are unable to stop drinking alcohol or control how often they do so. Even when they start experiencing health, social, or occupational consequences, they’ll be unable to change their behaviors. This disorder affects the brain and can range from mild to severe. 

If AUD persists over a lengthy period, the changes in the brain might be difficult to reverse. Early treatment usually results in a better outcome. There are several treatments that healthcare professionals use to work with people who have AUD, which include support groups, medications, and behavioral therapies. 

Symptoms of Alcoholism

To diagnose AUD, your doctor will use information from the Diagnostic and Statistical Manual of Mental Disorders. The information present in this manual makes it easier to identify the presence of AUD and determine how severe it is. The severity of AUD depends on the total number of criteria a client meets. If they meet two to three criteria, the condition is mild. It becomes moderate with four to five criteria and severe with six or more criteria. 

There are many symptoms associated with AUD. For example, if you regularly drink more alcohol than you intended to, you may suffer from the condition. Some other indications that you may have an issue with alcohol are:

  • You have made genuine attempts to stop drinking alcohol and failed.
  • You have experienced negative consequences due to failing to fulfill obligations at work, school, or home because alcohol affected your performance.
  • You do less of the things you used to enjoy due to your alcohol use.
  • You have driven a vehicle while under the influence of alcohol.
  • You need to drink more alcohol to feel the same effects. 
  • Your alcohol use has resulted in an injury or health condition.

In addition, people who are diagnosed with AUD usually spend a considerable amount of time drinking and recovering from their bouts of consuming alcohol. They may also face legal and financial issues due to excessive drinking. 

If you are worried about yourself or someone you care about, you should also be aware of withdrawal symptoms that regularly occur among people with this disorder when not drinking. These symptoms include:

  • Difficulty with sleeping
  • Restlessness
  • Nausea
  • Shakiness
  • Sweating
  • Malaise
  • Dysphoria
  • Seizures
  • Feeling downbeat
  • A racing heart

Understanding Co-occurring Disorders

People who develop alcoholism or some other type of substance use disorder are at a higher risk of developing another condition or chronic disease. When someone is diagnosed with an alcohol use disorder and a mental illness, this is considered a co-occurring disorder. Many people who obtain treatment for AUD also have a co-occurring disorder. Around 9.2 million Americans above the age of 18 have been diagnosed with both AUD and another mental health illness. 

It’s not fully understood why mental illness and AUD occur at the same time. There are, however, three potential reasons, the first of which is that more generalized risk factors increase the possibility of developing both conditions. There’s also a chance that misusing alcohol will begin as a result of a mental illness. The third option is that misusing alcohol and other substances affects a person’s mental health. 

It’s not easy to determine which disorder comes first. While the symptoms of an AUD might occur before the symptoms of mental illness, it doesn’t automatically indicate that AUD came first. 

Common Co-occurring Disorders

There are no specific combinations of substance use and mental health disorders that you can be diagnosed with. If you develop alcoholism, you can be diagnosed with any mental health disorder. The mental disorders that are most frequently identified during treatment for AUD include:

  • Conduct disorders
  • Bipolar disorder
  • Mood and anxiety disorders
  • Schizophrenia
  • Major depressive disorder
  • Attention deficit hyperactivity disorder
  • Post-traumatic stress disorder

Along with alcohol, it’s common for clients who receive treatment for mental disorders to misuse everything from marijuana and opioids to stimulants and prescription drugs. 

Dual Diagnosis for Co-occurring Disorders and Alcoholism

Many modern facilities are equipped with the tools necessary to treat alcohol use disorders and mental health disorders at the same time. The treatment you receive should be capable of addressing the symptoms associated with both disorders. This approach to treatment usually leads to better results and outcomes. 

In order for dual-diagnosis treatment to be effective, clients work closely with their healthcare providers to create a more personalized treatment plan. Treatment can only go forward if the affected individual stops drinking alcohol. 

Treatment usually begins with medical detoxification in a hospital or a rehab facility because withdrawal symptoms can be severe and should include 24/7 care to ensure the safety of the client. During detox, medical professionals often administer medications to decrease the severity of withdrawal symptoms. The goal is to make the client as comfortable as possible during the process. By the end of detoxification, the most intense effects of withdrawal should be over. When clients feel a little better, a professional will work with them to develop a plan to stay sober. These forms of treatment include everything from therapy to medication. 

Behavioral Therapies

Two types of behavioral therapies are used to treat co-occurring disorders: cognitive behavioral therapy and dialectical behavioral therapy. Cognitive behavioral therapy teaches clients how to handle negative patterns of thinking. Over time, clients can learn how to change these patterns to more positive ones. 

Cognitive behavioral therapy can be administered by counselors, psychologists, and therapists. There are some basic principles that it’s based on. For example, this therapy states that psychological problems are somewhat based on unhelpful or problematic patterns of thinking. It’s also believed that these issues are based on troublesome core beliefs and ineffective behavior patterns. 

The purpose of administering cognitive behavioral therapy is to help people with mental health issues figure out how to relieve their symptoms. In turn, their emotional and mental health should improve significantly. 

When you undergo this form of therapy, a professional will work with you to examine your emotions and thoughts to identify better how your thought patterns impact your actions. Over time, you may be able to unlearn the negative behaviors and thoughts that lead you to develop an issue with alcohol. 

Most forms of cognitive behavioral therapy are provided in a question-and-answer format. If treatment is effective, you may learn how to effectively respond to pain, stress, and challenging scenarios that make your mental health symptoms more severe and increase your risk of drinking alcohol. 

Dialectical behavioral therapy aims to reduce self-harm behaviors, which can include drinking alcohol. This is a form of psychotherapy that takes the tenets of cognitive behavioral therapy and adapts them to individuals who feel emotions more intensely than others. 

The purpose of dialectical behavioral therapy is to help people suffering from alcoholism and a co-occurring mental disorder accept the state of their lives and the behaviors they display. In the latter stages of this therapy, people learn how to make lasting changes to their lives and reduce unhelpful behaviors. 

Support Groups

Support groups provide people with social and emotional support as they continue on the path of sobriety. If you become part of a support group, such as alcoholics anonymous, you’ll receive help from people who have been in similar situations with alcoholism or other substance use disorders. These people can answer questions and share their own experiences. It is also a safe space to share your challenges and successes.

Inpatient Treatment

If the symptoms associated with your co-occurring disorders are severe, you could enter an inpatient treatment center. This form of rehab is more intensive than outpatient treatment. When someone stays at an inpatient treatment center, they’ll receive 24/7 supervised care by medical professionals. Treatment programs are personalized to meet the needs of each client. 

While staying in this environment, you’ll receive mental health and medical care that includes medication, group therapy, individual counseling, and family therapy. The duration of treatment depends on many factors, the primary of which is the severity of the disorders you’re experiencing. Treatment can last anywhere from a month to a year. While the goal of inpatient rehab is the same as outpatient treatment, it might prove more effective for people who need a structured environment as they learn how to manage their disorders.

Medication

Healthcare providers often prescribe medications to treat disorders. These drugs can ease symptoms and make the recovery process more manageable. The FDA has approved many medications to help with the treatment of AUD and other mental health disorders. For example, bupropion is often prescribed when treating seasonal affective disorder or adult depression.

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