Dual Diagnosis: Substance Dependence and Mental Illness

Definition & Prevalence mon hypothesis, for example, is that individuals with mental health disorders who abuse substances do so in an attempt to self-medicate their symptoms. On the other hand, prolonged abuse of some drugs may produce lasting psychological symptoms (Schottenfeld, 1993). A recent National Comorbidity Survey of the general u.S. population found that 56% of respondents with at least one psychiatric disorder had two or more disorders, and that women have a higher prevalence than men of three or more disorders (Kessler et a!., 1994). Consistent with this study, Marcus and Katz (1990) found that more than half of female patients in a substance abuse inpatient unit had an eating disorder with significant depression (Morris & Wise, 1992). Individuals who abuse substances are also at higher risk for HIV, which adds another clinical problem. HIV contributes to the already existing mental health problems through direct effects (e.g., secondary infections or neoplasms involving the central nervous system), and psychosocial factors associated with AIDS (e.g., isolation, ostracism, awareness of a terminal illness, and loss of health and sexuality) (Batki, 1990). Experience indicates that individuals with comorbid illnesses tend to have: sporadic and bingeing substance abuse patterns, a history of job instability, impaired social interactions and love relationships, and low tolerance for frustration (Riley, 1994; Walker, 1992; Sheehan, 1993). There is also evidence that these Over the past decade, there has been growing recognition that alcohol and other drug dependency and mental illness can coexist in a noncausal relationship. Various studies have found that between 20% and 80% of patients treated for psychiatric disorders have an active drug or alcohol problem (i.e., abuse or dependence), with higher rates generally found in patients receiving in-patient services (Barr, 1994; Robertson, 1992; Schottenfeld, 1993; Sheehan, 1993). Conversely, an estimated 14% to 60% of substance abusers have a mental health disorder (Robertson, 1992; Schottenfeld, 1993; Walker, 1992). A study conducted at an alcohol and drug abuse treatment center at a psychiatric hospital found that the most common comorbid conditions among abusers of all drugs were mood disorders-most prevalently, major depression (Weiss et a!., 1992). Hesselbrock, Meyer, and Keener (1985) found that of women hospitalized for alcohol abuse or dependence, 52% had concomitant major depression, 44% had phobias and 20% had antisocial personality disorders (Riley, 1994). More recently, AlA programs, and others serving chemically dependent women, are finding that a majority of their clients suffer from Post Traumatic Stress Disorder (PTSD). Since 1980, PTSD has been codified in the Diagnostic Statistical Manual (DSM), and more recently has been recognized as applying to women who experience such traumatic events as ........ ,~ ~