How to Treat a Dual Diagnosis

It is not uncommon for workers who sustain an injury to develop psychosocial issues during recovery, which can intensify as a patient remains off work. For example, fear that their injury has caused irreparable damage, anxiety about returning to the scene where their injury occurred, or feeling unsure about performing the job duties upon returning to work can cause anxiety, provoke stress and lead to depression. Early treatment for psychosocial issues can help workers avoid a downward spiral; however, if treatment is delayed, or worse, never received, workers may turn to substance use, in order to cope—a situation that results in dual-diagnosis.

What is a dual diagnosis?

Also known as co-occurring disorders (COD), the dual diagnosis was identified in the 1980s and recognizes those who suffer from coexisting mental illnesses while simultaneously dealing with one or more substance abuse disorders. Hence, someone with an alcohol or substance use disorder and a mental health or emotional issue, including depression, anxiety or PTSD, is struggling with a dual diagnosis.

How prevalent is dual diagnosis?

Results from the National Survey on Drug Use and Health from the Substance Abuse and Mental Health Services Administration (SAMHSA) report that in 2015, 8.1 million U.S. adults experienced both a mental illness and a substance use disorder concurrently.  By 2019, this number increased to 9.5 million people. Unfortunately, only 742,000 received treatment for their substance use disorder and mental health issues.

How is dual diagnosis treated?

Historically, a patient’s illnesses were treated independently, beginning first by treating the substance use disorder. However, further understanding of dual diagnosis revealed that this complex situation requires an integrated plan that approaches both disorders as related issues because in some cases, it is not always apparent which diagnosis is exacerbating the other. For instance, if someone struggles with depression and an alcohol dependency, it may be difficult to discern whether the patient is using alcohol to alleviate the symptoms of depression or if the alcohol dependency is causing the depression. Thus, if the substance dependency requires the patient to detoxify, then treatment for the mental health condition may be delayed or minimized until the substance dependency is under control. 

In most cases where substance use escalates to unmanageable levels, it’s used as a coping tool for depression, trauma, anxiety, etc. An ineffective, long-term solution, this coping strategy increases the user’s reaction to triggers. Therefore, treatment for the mental issue cannot move forward until the patient controls the substance use. So while the patient receives treatment for both conditions, treatment for one may be interrupted if the other condition takes precedence.

How can cognitive behavioral therapy help?

Cognitive behavioral therapy (CBT) focuses on changing negative thinking patterns. When negative emotions such as fear, anxiety or stress cloud productive thinking, recovery is slowed or reversed. Therefore, patients must become aware of what causes their negative thoughts and behaviors to learn how to replace unproductive rumination with strategies for recovery. Otherwise, a patient is likely to entertain thoughts that increase pain or hopelessness and repeat destructive habits such as substance abuse, for example. An evidence-based and proven effective strategy for helping patients recover faster, CBT instructs patients on how to better manage stress and anxiety, which, in turn, speeds recovery and improves return-to-work outcomes.