One US study has found that 50% of people with mental health problems were also abusing drugs or alcohol at a problematic level. Very little research has been conducted in the UK, however it is a very real problem here.
What does dual diagnosis mean?
It is a relatively new term originating from the States that describes people who are diagnosed as having problematic drug use or alcohol abuse and a serious mental illness (often schizophrenia). This can take two forms:
- Those who have firstly been diagnosed with a serious mental health problem who are later also found to be using recreational drugs that may have an adverse effect on their illness, for example, a schizophrenic who takes speed. Their drug-induced psychosis may well mask real mental health problems. One UK study found that 40% of people with schizophrenia also abused drugs/alcohol.
- Those who have been diagnosed with drug dependency which triggers/leads to a later diagnosis of a mental health problem. This is more likely with excessive use of stimulants (speed, coke and crack).
More recently the term complex needs has begun to be used to describe the social needs of someone with dual diagnosis. It is an attempt to use a more holistic way of both diagnosing and treating the problem.
A study conducted by Maudsley Hospital, London interviewed people diagnosed with schizophrenia and found a lower number of dual diagnoses than in the states.
Another study, this time of people with mental health problems in the criminal justice system, found a dual diagnosis rate of more than 50%.
Some UK drug service experts estimate that up to a third of those who come into contact with drug services will also have a mental health problem of some kind.
Why is it a problem?
The combination of recreational drug use and symptoms of mental illness is that it's very difficult to tell whether there is a real problem, or just simply the side effects of recent drug use. The symptoms of schizophrenia or manic depression can be almost identical to those when someone is intoxicated, suffering from amphetamine psychosis, or withdrawing from excessive dependant drug use.
It is also quite common for people with added stress or the beginnings of a mental illness to try to escape their problems and symptoms through alcohol or drugs, although often it only makes the initial problem worse.
A period of three to six weeks abstaining from drug use is generally needed to help make a clear diagnosis. However this is often easier said than done, as some may not want to give up drugs, or may not be able to. If managed, and the symptoms vanish it was merely a result of the drug use. However if symptoms remain it means that either there is a real mental illness needing treatment, or the person has not stopped taking drugs.
Dual diagnosis is also a significant factor in suicide figures, as during the waiting time to decide whether the person's symptoms are drug-induced or an indication of a mental health problem, the person's illness may worsen and they could become more at risk of a suicide attempt. It is a fairly impossible situation for mental health professionals, and while they are trying to work out a better solution to dual diagnosis, the risks for young people are high.
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