What is a Dual Disorder?
The National Alliance on Mental Illness (2013) states, “ Dual Diagnosis is a term used to describe people with mental illness who also have problems with drugs and or alcohol. The relationship between the two is complex and the treatment of people with co-occurring substance abuse (or dependence) and mental illness is more complicated than the treatment of either condition alone. This is unfortunately a common situation- many people with mental illness have ongoing substance abuse problems, and many people who abuse drugs and alcohol also experience mental illness.” This definition of dual diagnosis is clear, accurate and can be applied to many different populations of people struggling with a dual disorder. Later in this definition, with additional clarity, the term “self-medicating” appears. The concept of self-medicating can lead to the misconception that the treatment of the underlying mental health disorder will naturally dissolve, or reduce the substance abuse disorder/ dependency. This is not the case; dual disorders should be treated collaboratively, with both disorders being treated with equal importance. Treating an addiction is just as important as addressing a mental health disorder.
Signs of a Dual Disorder (all or most signs of drug abuse) and:
- Self harm (cutting, burning, scratching self)
- Suicidal ideation and threats
- Suicide attempts (intentional overdoses, hanging, suicide threats)
- Reactive / aggressive behavior/ intense anger
- Violent behavior (punching walls, assaulting others, fights)
- Oppositional behavior- demanding, defiant, impulsive
- Depression, (sadness, lethargy, isolation, dropping out of activities/ loss of work, poor hygiene, poor sleeping patterns- too much or too little)
- Anxiety (tension, panic attacks, trouble sleeping, biting nails, obsessive thinking)
- Psychosis (can be caused due to regular use of drugs, especially marijuana)
- Obsessive & rigid behavior- doing things a certain way and if interrupted highly reactive (video games, expectations, routines, organization)
- Has had previous mental health diagnosis
Features of Adolescent Dual Disorders
The signs of a dual disorder and substance abuse are very similar with adolescents and adults, however, there are a few key differences. First, the adolescent with a dual disorder will show heightened or more intense behaviors than adolescents with substance use disorders alone. Second, it really takes a professional to identify a dual disorder, however, the above noted mental health symptoms (depression, anxiety, and psychosis) are the parts of a dual disorder that stand out.
Key pieces of understanding an adolescent dual disorder
Key pieces of understanding an adolescent dual disorder
- The adolescent is going through major biological changes, they are going through the process of myelination and pruning (brain development), meaning that the most reinforced behaviors are the one’s that stick throughout the lifespan.
- Half of adolescents incarcerated have a mental health disorder and a substance use disorder.
- The presentation of the individual (parent, clinician) attempting to intervene on an adolescent in distress is one of the most important factors to helping. Keeping our cool allows them to use us for managing their stress. They will eventually mirror what we do in an intense situation.
- Most kids with a dual disorder are aware that they are suffering
- Some are missing some strong supports, help finding new supports is important.
- Hold them to reasonable and realistic standards. Allowing them to get what they always want is not helpful. Say “no” in a kind way.
- Require sobriety- this is what can make all the difference for their overall growth and change- if they are using, they will struggle to gain traction or maintain gains they have made.