Substance abuse disorder is a condition associated with individuals becoming addicted to certain substances such as alcohol and/or drugs. Addiction is defined as individuals partaking in these mentioned substances, because they have become dependent on them, and results in the affected person becoming socially withdrawn, experiencing breakdowns in relationships with friends and family, as well as committing actions that can get them into trouble with the law.
When a substance abuse disorder occurs together with any underlying mental health conditions then this is referred to as dual diagnosis (also called dual pathology or co-occurring disorders). Mental health illnesses may include:
- Major depression
- Bipolar mood disorder
- Post-traumatic stress disorder (PTSD)
- Generalized anxiety disorder
Confirming the diagnosis of dual pathology may be challenging since substance abuse disorders may initially induce signs and symptoms of psychiatric conditions. Affected patients may then be regarded as having a substance abuse issue until such time as a complete and adequate medical history is taken from them to determine if the condition presented on its own or together with an underlying psychiatric disorder.
Issues Faced by Patients with Dual Pathology
These patients, compared to those with mental or substance abuse disorders alone, are faced with complex challenges such as:
- An increased relapse rate.
- An increased risk of being hospitalized.
- Being exposed to illnesses such as hepatitis C and HIV.
Theoretical Causes of Dual Pathology
The following are theories that can help explain the relationship between mental health conditions and substance abuse disorders:
- Causality – it is suggested that certain types of substance abuse can lead to specific mental conditions. An example is the use of cannabis leading to mild psychotic experiences although it isn’t proven to cause psychotic disorders.
- Exposure to multiple risk factors – exposure to certain risk factors can lead to both mental health and substance abuse conditions and these may include poverty, social isolation, associating with drug abusers, living in areas with high drug availability, and traumatic experiences like sexual abuse.
- Self-medicating – abusing medications used to help alleviate symptoms of mental health conditions may lead to the development of a substance abuse problem. Also, certain medications may be used to counter the side effects of certain psychiatric drugs and this can also lead to substance abuse.
- Attention-deficit hyperactivity disorder (ADHD) – up to 25 percent of patients with a substance abuse disorder are known with ADHD. A reason for this is because ADHD is associated with an increased craving for drugs. Treating both these issues is difficult and unfortunately, these patients have poorer outcomes.
- Autism spectrum disorder (ASD) – as opposed to ADHD, ASD reduces the risk of an affected individual developing a substance abuse disorder. The reason for this is believed to be that ASD presents with a person lacking sensation-seeking personality traits and this helps to protect against abusing substances. It should be mentioned though that certain types of substance abuse, especially that of alcohol, can cause or worsen certain neuropsychological symptoms that are common in patients diagnosed with ASD.