What Is A Dual Diagnosis And How Is It Treated?
Mental illnesses like dissociative disorders often coexist with substance use disorders (SUDs). This is referred to as a co-occurring disorder or dual diagnosis. Within treatment, an individualized, person-centric approach is key to unlocking emotional and mental freedom, especially for those who suffer from a dissociative disorder due to a past trauma.
Compassionate dual diagnosis treatment exists which can treat both dissociative and substance use disorders within the same program. This treatment is best addressed in an inpatient drug rehab. These residential programs offer comprehensive care and greater treatment lengths which are essential to managing both concerns.
What Is A Dissociative Disorder?
“Dissociative disorders are characterized by an involuntary escape from reality characterized by a disconnection between thoughts, identity, consciousness, and memory,” according to the National Alliance on Mental Illness (NAMI).
Broadly speaking, symptoms may manifest as a sense of being separated from one’s experience, going so far as to create an out-of-body experience for some. A person may also lose memories (amnesia) and experience dulled emotions.
During an episode the connection between what is actually experienced and that which is perceived becomes dangerously skewed, in a way which changes a person’s:
- Behaviors
- Emotional state
- Memory
Sense of
- Environment
- Identify
- Self
Within this altered state, a person may feel removed from these things and become unable to fully, if at all, grasp how they connect to and influence one another. Dissociative episodes jeopardize a person’s safety and well-being, a risk that exponentially increases with substance use.
What Causes A Dissociative Disorder?
Traumatic experiences, especially ones in childhood, are often at the root of these conditions. The American Psychiatric Association (APA) elaborates, noting that: “Among people with dissociative identity disorder in the United States, Canada, and Europe, about 90 percent had been the victims of childhood use and neglect.”
Use may take the following forms:
- Emotional
- Physical
- Sexual
- Verbal
But certain events encountered as an adult (like the shock and experiences of military combat) can precipitate this disorder as well. The initial onset of the disorder rises as a reaction to these events, but future episodes can be triggered by intense emotional and/or mental stress. Additionally, all of these have been linked to or are considered risk factors for addiction.
What Types Of Dissociative Disorders Are There?
There are three types of dissociative disorders, each of which varies in levels of severity:
Dissociative Amnesia
During these periods a person is unable to remember specific information about their identity, life, and/or a traumatic event. These episodes can occur at any point within one’s life. They typically occur quickly and may last anywhere from minutes to in lesser cases, months, as explained by NAMI.
Depersonalization (Derealization) Disorder
A person may feel as if they’re not taking part in their behaviors, experiences, feelings, and thoughts, almost as if they’re viewing a film. Derealization occurs when people and one’s surroundings don’t seem real. This can stand alone or accompany depersonalization. Episodes typically begin around age 16 or earlier and may happen briefly or intermittently throughout a person’s life.
Dissociative Identity Disorder (formerly Multiple Personality Disorder)
More common in women, individuals with this disorder may have several, distinct identities (or alters), each of which has a competing voice. As detailed by NAMI, a person’s memory will lapse and they will struggle to recall the day’s events, information regarding who they are, and traumatic experiences.
Are Dissociative Disorders Related To Other Forms Of Mental Illness?
As a person strives to cope with these experiences they could develop other chronic and debilitating mental illnesses or conditions, such as:
- Anxiety
- Borderline personality disorder (BPD)
- Depression
- Post-traumatic stress disorder (PTSD)
- Suicidal ideation (contemplating suicide)
Alone, a dissociative disorder is a risk factor for addiction. The threat of substance use becomes far direr when any of these conditions are present as well.
How Are These Disorders Linked To Substance Use and Addiction?
As a person involuntarily moves into a dissociative state they can lose touch with who they are and what they need to do to manage their self-care. This obstructs their understanding of what behaviors are and are not detrimental to their health.
When this happens a person may not be aware of or adhere to their opinions regarding drug and alcohol use. This can lead them to use drugs when they might otherwise not. Also, as a person’s life continues to be disrupted by the dissociative disorder they may use drugs or alcohol to self-treat the symptoms of it and/or any mental illness(es) it may cause.
An active SUD can increase the severity of the dissociative disorder and the accompanying mental illness(es). Subsequently, many people may begin using more intensely to counter this effect, which only serves to worsen both disorders. This is due to the way drugs alter your brain chemistry and reduce the neurotransmitters which regulate mood and stress response.
Drugs, including alcohol, alter a person’s perception of reality. The extent of this shift is dependent on the drug of use and the frequency and duration of use. But one thing remains clear: these drug-induced chemical changes can trigger or intensify the existing symptoms of a dissociative disorder.
How Does Dual Diagnosis Care Shape Treatment?
If a person has a mental illness and a substance use disorder it’s very counterproductive and harmful to treat only one. Doing so allows the untreated disorder to aggravate and trigger episodes of the other.
Choosing dual diagnosis care means that both disorders are being treated side-by-side. Here, the circumstances and treatment of one inform the treatment of the other. Many therapies are actually used to treat both, including:
- Behavioral Therapies: Psychotherapies are a critical element of treatment for dissociative disorders. The good news is that the two recommended by NAMI, cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT), are both researched-based treatments for SUDs.
- Eye Movement Desensitization And Reprocessing (EMDR): This has been shown to be an effective adjunct therapy for dissociative disorders, and in certain cases, substance use.
- Medications: Antidepressants may benefit a person greatly who has a dissociative disorder. Other medications will be used as needed to address any secondary forms of mental illness or the addiction itself (especially within detox.)
Individual and/or group therapies, family therapy and support, mindfulness, and stress management practices, and motivational interviewing may also be used within the therapeutic process. Good programs should offer medical detoxes and aftercare support, the latter of which is very important for individuals with a dual diagnosis.
While treating a dissociative disorder and addiction will be hard work, it isn’t impossible. A good dual diagnosis program helps to treat the disorders so that you can better preserve your sense of self and identity, in a way that enhances and protects your pursuit of sobriety.
