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Abuse and Addiction Drug Abuse & Addiction Basics

Substance Abuse Relapses: Could It Be a Dual Diagnosis?

As anyone touched by substance abuse or dependence knows, recovery is not a simple process. People on the cusp of recovery and even those who have been "clean" for years sometimes slip back under the influence of cocaine or alcohol or prescription drugs. More and more research is now showing that one reason many substance abusers have so many setbacks is that they also have an untreated, co-occurring psychiatric illness. In fact, approximately 21 percent of the American adults living with a serious mental illness abused or were dependent upon alcohol or an illicit substance, compared to 7.9 percent of adults without a serious mental illness, according to the 2003 National Survey on Drug Use and Health.

Someone is said to be a substance abuser when they use drugs or alcohol in ways that interfere with school, work or relationships. Likewise, people with a psychiatric disorder may experience mood changes or other symptoms that interfere with their lives. "Clearly, people with substance abuse are significantly more likely to have a psychiatric disorder and vice versa," says Roger Weiss, MD, a professor of psychiatry at Harvard Medical School and clinical director of the Alcohol and Drug Abuse Treatment Program at McLean Hospital in Belmont, Mass.

Dr. Weiss has investigated what is known as dual diagnosis for many years, focusing largely on substance abuse and bipolar disorder, which is a mood disorder that causes cycles of depression and mania, or an abnormally elevated mood, or hypomania, which is a less severe form of mania. Below, Dr. Weiss explains why both conditions must be treated in order to achieve recovery.

Are there certain disorders that are particularly likely to be linked to substance abuse?
Bipolar disorder is the psychiatric disorder that puts people at highest risk for having a substance abuse problem. People with bipolar disorder are much more likely to have a substance abuse problem than people without bipolar disorder. But other disorders, such as major depressive disorders, schizophrenia, panic disorder and posttraumatic stress disorder, all have a higher rate of substance abuse.

Is that because people with these illnesses are trying to relieve their symptoms?
Part of it is that. Some people initially find some sort of symptom relief when they use drugs or alcohol, although, as they continue using drugs and alcohol, ultimately the substances of abuse often make their symptoms worse than they were before.

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