Dual Diagnosis: When Addiction is Not the Only Problem

Dual diagnosis is the term psychiatrists use to describe patients who suffer from both a drug addiction and another psychiatric disorder. There is some controversy surrounding this term because it is relatively rare for someone to develop an addiction in the absence of any other mental health issues. Many addicts describe a feeling of being “uncomfortable in their own skin” that preceded their addiction by many years. For these individuals, the experience of using a drug, gambling, having sex, or other compulsive behavior not only produces a pleasurable experience, it provides a break from the continuous discomfort they experience living in their own skin. While no one knows why some people become addicts and others do not, many mental health professionals believe that pre-existing psychiatric conditions may be an important factor.

Depression and Anxiety

While there are many psychiatric diagnoses which are associated with addiction, depression and anxiety are very common. The official term used by psychiatrists for depression is Major Depressive Episode (MDE). Someone who is experiencing a Major Depressive Episode or has ever experienced one in the past is given a diagnosis of Major Depressive Disorder (MDD). There are several different anxiety disorders including Panic Disorder, Post Traumatic Stress Disorder (PTSD), Obsessive Compulsive Disorder (OCD), and Generalized Anxiety Disorder.

Let’s look at the symptoms associated with these conditions to see why they might be a factor in the development of an addiction.

Depression

The hallmark features of a Major Depressive episode are depressed mood and a loss of interest or pleasure, also known as “anhedonia”. Other features of depression include the following:

• A decrease or increase in appetite>
• Insomnia (particularly early morning awakenings) or excessive sleep
• Fatigue or loss of energy
• Feelings of worthlessness or excessive feelings of guilt
• Decreased concentration
• Thoughts of suicide

Someone who is in a Major Depressive Episode will experience some or all of these symptoms nearly everyday for at least two weeks and usually for several months.

Anxiety

Here some features of Generalized Anxiety Disorder.

• Excessive worry occurring more days than not for at least 6 months
• Inability to control the worrying
• Restlessness
• Easily becoming tired
• Difficulty concentrating
• Irritability
• Muscle tension
• Insomnia (particularly difficulty falling or staying asleep)

The Downward Spiral

As you can see, Depression and Anxiety share many similar symptoms and they often occur in the same individual. It is easy to see why a someone with either of these conditions might continue to use a drug or engage in behavior that provided a temporary relief even in the face of negative consequences. Once someone has progressed far enough in their addiction, the act of using the drug becomes more of an irresistible compulsion than an escape. Unfortunately, the drugs and behaviors people become addicted to inevitably end up worsening the underlying psychiatric issues that might have pushed them toward addiction in the first place. Furthermore, anxiety and depressed mood are frequent symptoms of withdrawal from most drugs. For these reasons, dual diagnosis individuals often end up in a downward spiral of anxiety, depression, and addiction which can be very difficult to break without the proper help.

Help

Fortunately, modern medicine has developed many effective treatments for depression and anxiety as well as other psychiatric disorders associated with addiction such as bipolar disorder and schizophrenia. Additionally, most in the field addiction field now recognize that many recovering addicts are dual diagnosis and require treatment for their psychiatric condition as well as their addiction in order to achieve full recovery.