Imagine you have a tumor in your shin that causes the bone to break. Now imagine the doctor only puts a splint or a cast on the leg and doesn’t address the tumor. Or bandaging an infected wound without cleaning it or disinfecting it.
That’s kind of like substance use disorder treatment in the US. Often co-occurring with the addiction – in as many as 60 percent of cases – is mental illness. It’s called dual diagnosis, and both conditions have to be treated or else both are likely to re-occur.
Too often they aren’t, and they do It’s one of the reasons there are so many relapses, though not the only one.
The connection between mental illness and substance use disorder/addiction isn’t always clear, but in some cases, patients are self-medicating for their mental illness with drugs. Kat Lotti told WBUR that she’s been was diagnosed with both anxiety and bipolar disorder. The first time she used drugs, “I used like an addict from day one. I didn’t use for fun. It was as if I found a missing piece of my life.”
Yet when she went to rehab, the mental illness not only wasn’t addressed at the same time as the addiction – it wasn’t addressed at all. Even the addiction was treated mostly with 12 steps-based therapy, not cognitive behavioral therapy or other psychotherapy. She was ill before her addiction began, but the underlying illness didn’t get treated.
Complicating matters further is that even when health care providers are aware of dual diagnosis, they don’t want to touch it. Some mental health exclude drug abusers, and some drug abuse programs screen out patients with mental illness.
Partly it’s due to liability issues (violence, overdose deaths) and partly to inertia (health care providers tend to continue to believe the things they were taught in medical school – addiction and mental health are separate issues, to be treated separately and serially – even if the science has moved on).
A good addiction rehab center will have staff trained to identify and treat dual diagnosis. Ask about it when looking for substance use disorder treatment
