Dual Diagnosis

An anxiety disorder can cause intense feelings of panic and fear that seem to have no cause. The emotions, frequency, and intensity can vary and often impact your day to day living.

Generalized anxiety disorder is a condition where you experience chronic and unrealistic anxiety about at least two areas of your life, such as family, relationships, finances, etc. Some symptoms include:

• Feeling nervous
• Irritability or feeling on edge
• Trouble concentrating
• Difficulty sleeping

Social anxiety disorder causes intense anxiety and fear about social situations. If you struggle with speaking in public for fear of being judged or are visibly uncomfortable in social situations, you may be experiencing symptoms of a social anxiety disorder. Other symptoms include:

• Feeling afraid, especially around new people, even though you want to get to know them.
• Extreme fear of being judged by others
• Avoiding places where people will be

This form of depression is characterized by symptoms that include:

• Mild to severe sadness
• Little pleasure in activities you usually enjoy
• Weight loss or gain because your appetite increases or decreases
• Sleeping too little or sleeping too much
• Poor self-care
• Trouble concentrating
• Suicidal thinking

This disorder includes cycling between two states: mania and depression.

Depression symptoms of bipolar disorder include:

• Extreme sadness
• Trouble making decisions or concentrating
• Inconsistent sleep patterns

Mania-based symptoms of bipolar disorder include:

• Racing thoughts
• Inability to make decisions
• Impulsivity with no thought to consequences
• Overly confident, inflated sense of self
• Decreased sleep

This chronic depression is usually diagnosed if you’ve experienced early-onset depression (in your teens or young adulthood) and your depression has persisted for at least two years. While depressed, you may experience:

• Low energy and chronic fatigue
• Poor self-esteem
• Constant feelings of hopelessness
• Anhedonia, where you are unable to experience pleasure.

Personality disorders are characterized by very rigid and distorted ways of thinking, impacting your behavior and interpersonal relationships. In one study, 14.3% of people diagnosed with alcohol addiction also met the diagnostic criteria for Borderline Personality Disorder.

This condition usually begins in early adulthood, affecting how you think and feel about yourself and others. Symptoms include:

• Intense fear of abandonment
• Impulsivity, such as reckless spending, sexual behavior, and substance use, suddenly quitting a job you enjoy
• A pattern of pushing people away, while wanting them to stay around you
• Unstable and intense relationships
• Suicidality and/or self-harm
• Feeling empty
• Rapid mood swings occurring within hours or over several days. An example is waking up happy and suddenly feeling rageful with no apparent cause.

Trauma can happen when you see or experience a deeply disturbing event or events and your ability to cope effectively is overwhelmed. Some examples of traumatic events include:

• Childhood neglect or abuse
• War or other violent events
• Witnessing violence
• Experiencing violence against yourself
• Physical, emotional, sexual abuse
• Grief
• Natural disasters and other events or accidents.

While you may think of trauma related to veterans, the National Council for Behavioral Health reports that 70% of adults in the U.S. have experienced some kind of trauma.

Post-traumatic stress disorder (PTSD) can develop following a traumatic event, and it is a cluster of symptoms that interrupt your daily functioning that is grouped into four categories:

• Intrusion: Experiencing intrusive thoughts, memories, flashbacks of the event, or disturbing dreams. Flashbacks may be so intense you feel emotionally and physically as though you are reliving the event.
• Avoidance: You may avoid people, places, and events that remind you of the event to avoid triggering memories.
• Altered memory and moods: You may struggle to remember details of the traumatic event, and you may experience chronic shame and self-blame surrounding the situation.  You may be unable to feel any positive emotions.
• Arousal and Reactions: These symptoms may mean you behave dangerously, you are hypervigilant of your surroundings, and you have unpredictable bursts of anger. It may also be difficult to sleep or concentrate.

Complex Post Traumatic Stress Disorder (C-PTSD) is caused by prolonged exposure to a traumatic event. While sharing the above symptoms with PTSD, the following additional symptoms differentiate the two conditions. If you have C-PTSD you may also experience:

• Difficulty maintaining relationships
• Avoidance of other people
• Lack of connection

In all of the above cases, substance use disorders feed into mental health conditions, with each problem compounding the other and making it vital to treat both simultaneously. As with any mental health diagnosis, you should speak to a qualified professional who will accurately diagnose and guide treatment for you.

Research shows your genetic makeup can be an essential factor influencing developing a specific mental health diagnosis. In 2013, researchers at the University of North Carolina definitively linked genetics to five major psychiatric disorders, schizophrenia, bipolar disorder, major depressive disorder, autism spectrum disorders, and attention-deficit/hyperactivity disorder.

Being raised in a stressful environment or having an abusive home life are significant risk factors. If you’ve witnessed someone in your family struggle with depression, you may be more likely to develop depression. This holds true for witnessing or being a victim of violence either in the home or in other situations. Other environmental influences include financial stress, chronic medical conditions, death of a loved one, or divorce, which can occur at any time in your life.

Trauma is a significant factor in developing a mood disorder or substance use disorder. For example, it’s estimated that 80% of individuals who have Post-Traumatic Stress Disorder usually have at least one other diagnosis. You don’t need to experience a direct trauma to be traumatized; often, witnessing an event can create trauma.

Evidence suggests that exposure to environmental concerns at an early age can influence if you are likely to develop co-occurring mental health conditions. This exposure can even occur before birth if you were exposed to substances such as drugs or alcohol. But more research is necessary to confirm this link.

None of these causes exist in isolation, and all likely influence each other. If you have a dual diagnosis, it’s difficult to say if it’s clearly because of genetics or because of your environment. It is highly likely that all of the above factors ultimately influence how developed a co-occurring mental health conditions are. What’s most important is to contact your health professional or a mental health clinician to start recovering from both.

A mental health professional will interview you for an evaluation to understand your needs, your background, and your support. Questions will focus on both your substance use and your mental health. This will inform your clinician’s diagnosis, treatment recommendations, and an individualized treatment plan.

Depending on the substance you are using, and how long you’ve used it, medical detox may be your first step in treatment. By addressing the earliest symptoms of withdrawal, individuals can focus on their wellness from the beginning and identify which symptoms can be attributed to menta health (versus addiction).

There are a variety of treatment choices for you. A medical professional can help whether inpatient treatment or an outpatient program would be most appropriate. Some people may start with a partial hospitalization program (PHP) or intensive outpatient (IOP) level of care. Dual-diagnosis treatment programs may also include residential treatment options. Medication may be a part of recovery for you, and that may include anti-depressants and/or mood stabilizers.

It’s important to realize rehab/treatment is the beginning of a lifelong journey of recovery. A crucial piece of treatment is a comprehensive plan that may include therapy, medication management, and sobriety support.

Yes. Integrated dual diagnosis treatment center programs address both conditions simultaneously through therapy, psychiatric care, medication management when appropriate, and addiction treatment.

Not everyone requires medication. If it’s clinically appropriate, a psychiatrist may prescribe and monitor medications to help manage mental health symptoms as part of a comprehensive treatment plan.

The right level of care depends on your symptoms, substance use history, and support system. Treatment may include medical detox, residential care, partial hospitalization (PHP), intensive outpatient (IOP), or outpatient therapy.

Recovery continues after treatment through aftercare planning, outpatient therapy, support groups, medication management, relapse prevention, and other recovery resources tailored to your needs.

Yes. Many programs offer family therapy and education to help loved ones better understand co-occurring disorders, improve communication, and support long-term recovery.

At Crystal Lake, we offer many services for individuals who require dual diagnosis treatment. This includes specialized addiction therapy and holistic treatments like the LIV Adventure Program, which incorporates adventure therapy and outdoor activities to promote healing.

https://www.nimh.nih.gov/health/publications/social-anxiety-disorder-more-than-just-shyness/index.shtml