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Dual diagnosis can mean that a person concurrently suffers from two related conditions. For instance, a person who is schizophrenic and mentally retarded would have what is considered two related and concurrent conditions. More often though, the term dual diagnosis relates to people who suffer from mental illness (depression, bipolar disorder, schizophrenia, generalized anxiety disorder) and are also addicted to drugs or alcohol.
This term has become one frequently used in certain alcohol and drug recovery groups such as Alcoholics Anonymous (AA) because part of each condition can depend on the other. A person with depression may seek to self-medicate with a variety of drugs, and in so doing, tends to worsen his depression. Alternately, someone already taking prescribed medications for a condition might abuse them, or might concurrently take unprescribed medications, abuse alcohol or illegal drugs, which can significantly affect how well prescribed medications will work in allaying a mental health condition. The vicious circle of dual diagnosis is a very difficult one to escape, because at least in part, addiction may sometimes alleviate, and also sometimes contribute to any mental illnesses.
People with dual diagnosis may have a hard time functioning in certain AA groups or rehabilitation centers that focus on taming addiction. Some AA groups may still view the taking of any medications that chemically alter the brain as cheating, medicating or “not dealing” with addiction. This attitude is usually in place because well-meaning folk don’t understand the potentially devastating affects of a person with mental illness failing to comply with their medication regimen, and since AA groups are not normally led by mental health experts, a person with dual diagnosis may either try to give up their meds, or feel guilty or a failure.
Dual diagnosis is becoming better understood, and modern additions of AA’s Big Book do address the real concern about treatment of mental health issues and alcohol or drug cessation. Still this message hasn’t permeated through all AA communities, and a community may not be large enough to sustain meetings specifically for people with dual diagnosis. Fortunately in larger communities, there are some great AA or NA-centered meetings that can serve many people with addiction and mental health problems, and these may be moderated by registered nurses, therapists or psychiatrists.
One of the challenges with dual diagnosis is much like the challenge that awaits those who try to recover from food or shopping addiction. You normally can’t just stop taking drugs for your condition, just as you can’t stop eating or shopping for things you need. So a complicated part of dealing with dual diagnosis is how to properly follow a medication regimen, without abusing that regimen or using supplementary drugs and alcohol.
Moreover, continued abuse of other medications can make it extremely difficult to successfully treat mental health conditions, and contribute to behavior that is dangerous to one’s self or others, or that people will deeply regret later. It’s fair to state that most major mental health conditions and the medications for them tend not to pair well with use of alcohol or unprescribed medications, even mild to moderate and not addictive use. Yet a person may have spent the majority of their lives trying to treat their own illnesses through addiction instead of through medications, or attempted to compensate for ineffective medication through adding extra medications, alcohol or drugs.
Part of treatment is helping a patient recover from addiction, and hospitalization may be needed especially during the detox period. The second part is evolving a medication regimen that works for the patient, since the current meds may not be adequate. Lastly, continued support through groups, therapy or in patient hospitalization may be needed to help a person fight two difficult conditions at once, and to gain the strength needed to both take the medications they do need, while remaining firm in their conviction not to drink or use.