There are many things the general public doesn’t understand about substance abuse. One of the most important things is that substance abuse doesn’t always stand alone. Frequently substance abuse is complicated by a second disorder, most commonly a mental illness of some sort. It also is the case that many people with a mental illness also abuse drugs.
According to a 2014 National Survey on Drug Use and Health by the Substance Abuse and Mental Health Alliance (SAMHSA), “an estimated 43.6 million (18.1%) Americans ages 18 and up experienced some form of mental illness”; “20.2 million adults (8.4%) had a substance use disorder”; and “7.9 million people [3.3%] had both.”
Addiction and mental health professionals refer to this variously as co-occurring disorders, co-morbidities or dual diagnosis. Substance abuse may have started as an attempt to self-medicate the disorder, but it’s more likely to make the condition worse. Drug use sometimes can cause mental illness (though not as often as those “Just Say No” or DARE programs used to suggest).
In both cases, a correct diagnosis is important because treating only one condition will solve nothing. At best, one condition will persist. At worst, even the treated condition will return. According to the National Alliance on Mental Illness (NAMI), “The best treatment for dual diagnosis is integrated intervention, when a person receives care for both their diagnosed mental illness and substance abuse. The idea that ‘I cannot treat your depression because you are also drinking’ is outdated—current thinking requires both issues be addressed.”
Not all substance abuse professionals or clinics are prepared to treat mental illness on top of substance abuse, or even to identify it necessarily. The reverse is true of mental health professionals. There is probably still enough of an old guard of professionals who think the more serious of the two should be treated first. That may not work.
If you or a loved one need substance abuse treatment, ask any drug rehab or doctor you consult if they are trained to recognize a dual diagnosis. If they say no, or doubt that dual diagnosis is real, look elsewhere for treatment.