What Is a Dual Diagnosis?

By Genevieve Van Wyden

  • Overview

    Dual diagnosis sounds mysterious, sometimes ominous. For patients who receive this kind of diagnosis and their families, it can mean they and their families will understand where all of their problems and issues have originated. Where do these families go? Do they continue to visit a mental health specialist, or do they begin to concentrate recovery efforts on the drug rehabilitation specialist? Does their loved one have to start taking yet another psychotropic medication? Will she be able to return to school or work? How long will the period of recovery last? Will there be more relapses or emergency hospitalizations?
  • Definitions

    Dual diagnosis exists when a person has two separate and distinct illnesses that relate to each other. One illness is a psychiatric diagnosis; the second illness is usually a substance abuse disorder that interacts with the mental illness in such a way that one or the other might be masked or misdiagnosed. The person suffering from a psychiatric disorder such as depression, schizophrenia or bipolar disorder often knows there is something wrong and is trying to seek relief from his symptoms. He often does so by "self-medicating" or using substances such as alcohol, marijuana or cocaine.
  • Features

    A person with a dual diagnosis faces a particular challenge when his disorders interact with each other. If, for instance, he suffers from schizophrenia or bipolar disorder, he may spontaneously stop taking his psychotropic medications because he begins to fear that the medication is poisoning him or taking his creativity away. He begins to experience psychiatric symptoms and resorts to using illegal drugs to feel better. The two illnesses interact with each other and combine in such a way that he ends up hospitalized or behind bars. This is a hallmark of dual diagnosis, which has a strong effect on all aspects of his life.

  • Issues

    For someone suffering from a dual diagnosis, the issues can feel overwhelming. Because of the unique characteristics of each diagnosis--such as paranoia or significant mood swings, coupled with illegal drug use--brushes with the law can become common. These issues, plus others not included here, can be a regular, unwanted feature of the patient's life because of his psychiatric problems, behaviors and attendant drug abuse.
  • Problems

    Similarly, the patient can experience multiple hospitalizations; financial difficulties; employment or school issues; high-risk behaviors, such as reckless driving; and homelessness. The hallmarks of the patient's psychiatric problems, which may include unexpected acting-out behaviors or outbursts, can lead to incarceration or involuntary hospitalizations. In the case of bipolar disorder, frequent and severe financial difficulties arise because of the impulsive, reckless spending activities during manic phases. The patient may often feel "out of step" with his world or with his family because of the characteristics of his illness or drug use. The schizophrenic patient may have extreme difficulty in trusting his family or the doctors treating him, especially if his schizophrenia has aspects of paranoia.
  • Implications

    All of these factors and issues mean the psychiatric patient/drug user, his friends, family and co-workers will almost certainly face difficulties as they try to adjust to the reality of a dual diagnosis. The possibility of sudden and unexpected death is also another sobering consideration. Everyone involved with a patient who has been given a dual diagnosis realizes the possibility that their family member or friend could find a brutal, final end to his difficulties and pain via suicide. Dual diagnosis encompasses two separate but inexorably linked psychiatric conditions. One is treated with psychotropic medications; the other is treated by working to help the patient to end his reliance on illicit substances.
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