6 Theories Behind a Dual Diagnosis

Study after study has suggested that mental illnesses and drug addictions go hand in hand. For example, the National Institute on Alcohol Abuse and Alcoholism’s National Longitudinal Alcohol Epidemiologic Survey found that those with a history of alcohol problems were more than four times more likely to have a depressive episode than people who had no such alcohol dependence syndrome in the past. Often, it seems as though these types of disorders are just destined to come bundled in one package.

But it’s harder to determine exactly why these Dual Diagnosis situations take place. In fact, the reasons for a diagnosis like this might vary dramatically from person to person.

But these are just six of the theories experts suggest might stand behind a Dual Diagnosis issue.

1. Biology

Mental illnesses can seem like random occurrences that hit some people while leaving others unscathed. After all, some families may see a mental illness spring up in only one child, while the others might not have any symptoms of distress at all. But there are some mental illnesses that do have a genetic component. These illnesses might involve a deficit of some specific brain chemicals needed for communication, or they might involve electrical activity inside specific portions of the brain. The genes are to blame for these types of difficulties, but therapies can sometimes make a huge difference in how people feel and how well they function.

But these same genes could also make people vulnerable to the effects of certain kinds of drugs. For example, people who have a deficit of dopamine within the cells

of the brain might be at risk for depression, as they just don’t have the chemicals required in order to experience joy on the same level as others. If these people take drugs that boost dopamine, they might experience a euphoria that they have never experienced in real life, and that sensation might be incredibly addictive. Again, the genes are to blame for this vulnerability.

Researchers are continuing to study this idea, and it’s quite possible that they might identify specific genes that are responsible for the development of many addictions and mental illnesses. But in the interim, it’s best for families to understand that genes might very well be responsible for a loved one’s Dual Diagnosis problem. This knowledge might help them to approach the person with understanding, not blame.

2. Damage of One Issue Causes the Other

While a Dual Diagnosis situation might develop in response to some kind of genetic issue, it might also develop when damage caused by addiction comes into contact with a genetic abnormality that could lead to mental illness. For example, the National Institute on Drug Abuse suggests that people with a genetic vulnerability to schizophrenia might see that disorder appear when they use marijuana. The drug seems to trigger the disorder that’s lying beneath the surface, and it might never appear if people didn’t use drugs.

Some drugs of abuse can also cause subtle forms of brain damage that might allow a mental illness to take hold. For example, people who take heroin may experience repeated boosts of dopamine production and uptake, and in time, the brain might produce less of that chemical and amend its uptake of the chemicals that are present. When these alterations are complete, people might be at risk for depression, due to the damage they have faced.

It can be difficult to definitively diagnose a problem like this, as scientists often can’t determine which syndrome came first and why the other might appear. But many drugs have been implicated in the development of mental illnesses, including:

  • Marijuana
  • Crystal methamphetamine
  • Alcohol
  • Heroin
  • Prescription painkillers
  • Benzodiazepines
  • Cocaine

People who use drugs might be causing psychological damage that could impair the rest of their lives, and they might not even be aware that the process is taking place.

3. Coping Mechanism Gone Awry

Addictions can sometimes develop in people who are attempting to deal with a very serious mental illness that leaves them feeling upset almost every day. For example, the University of Utah suggests that 70 percent of people who have schizophrenia smoke cigarettes, and many do so because the nicotine in each cigarette allows them to think just a little more clearly, so they can carry on a conversation. Tobacco might also help to diminish the side effects people experience due to schizophrenia medications.

People like this may simply be trying to keep their mental illnesses in check, but the methods they’re using could make their symptoms much worse.

This same progression could happen in people who are given prescription medications in the treatment of a mental illness. People with obsessive-compulsive disorders, for example, might be given stimulant medications like Ritalin to help soothe symptoms, but they might also use these drugs in order to get high by snorting them or chewing them. These people might think that bigger doses of meds could help them more than smaller doses, but they could end up with very serious addictions that complicate their mental illness recovery processes.

4. Improper Diagnosis

Sometimes, a Dual Diagnosis label is used in order to describe two conditions that some experts feel are symptoms of the same disease. For example, people who have bipolar disorder may experience episodes of mania in which they:

  • Spend money recklessly
  • Drive too quickly
  • Have sexual encounters with strangers
  • Stay up all night long

During these episodes, these people might also take massive doses of drugs and alcohol, without thinking about the consequences of their actions. It’s possible to diagnose people like this with a substance abuse disorder, as they’re clearly doing harmful things with the drugs they take, but it’s also possible that this behavior is just part of the symptoms of bipolar disorder. Sometimes, the Dual Diagnosis label seems like an unlikely fit.

5. Brain Abnormalities

While addictions might sometimes be considered part of the symptoms a person with a mental illness might face, some people experience symptoms of mental illness and addiction due to the same brain abnormality. For example, a study conducted by the National Institute on Drug Abuse found that people who had schizophrenia and drug abuse had two brain abnormalities. One caused increased sensitivity to dopamine in the part of the brain that deals with psychosis. The other caused a decrease in dopamine uptake in portions of the brain that dealt with reward. As a result, people like this might use drugs to self-medicate, but these drugs might cause more psychosis and less reward, which would lead to more drug use.

Abnormalities like this can be difficult to untangle, and often, both medications and therapy are part of the treatment profile. But it’s clear that some people have severe forms of brain dysfunction that leave them vulnerable to both addiction and mental illness.

6. Overlapping Environmental Triggers

While some forms of mental illness stem from chemical or structural abnormalities inside the brain, others tend to take hold due to some sort of external experience. For example, people who endure sexual abuse during childhood may be left with anxiety disorders or depression disorders, particularly if they internalize the guilt and the trauma and never deal with the facts of what happened to them when they were small. People like this might also develop symptoms of post-traumatic stress disorder, as the physical abuse leaves its mark on both the mind and the body. These people may not have any brain abnormalities at all, and they may have no family history of mental illnesses. But the episodes that they endured left

them with scars that allowed a mental illness to take hold.

People like this might also be much more vulnerable to addictions, as they might lean on substances in order to help them to forget and cope. They might find that the numbing quality of alcohol allows them to fall asleep without being jolted awake by memories, or they may find that the euphoria a prescription painkiller can bring allows them to forget the emotional pain the abuse left behind. People like this might also have mental illnesses, but again, it’s the environmental factors that make them vulnerable to substance abuse.

Making Sense of It

While it’s interesting to learn more about why a Dual Diagnosis label might apply to a person in need, it’s not a requirement for families to place their bets on one cause. These problems can develop for all sorts of reasons, and sometimes the reasons overlap to a large degree. But it is vital for people who have a Dual Diagnosis problem to get help in a structured treatment program designed for them. When two issues are in place, they tend to work together and strengthen one another, so treating just one problem could mean allowing the other to grow stronger. In time, that secondary problem could pull the person back into dysfunction, no matter how good the therapy might seem at the time. People just need help for both problems at once, and that’s what a Dual Diagnosis program can provide.

This is the kind of help we specialize in, and we’d like to tell you more about it. Please call and our admissions coordinators can explain how a program like this might work and why it might be vital for someone you love. We can even help you to find a program near you. Please call to find out more.

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