Origins of Dual Diagnosis

The term dual diagnosis is a common, broad term that refers to the presence of two independent disorders. In the fields of mental health, psychiatry, and addiction treatment, dual diagnosis has been commonly used to describe the coexistence of a mental health disorder and drug and alcohol addiction. The acronym MICA, which stands for mentally ill chemical abusers, is occasionally used in reference to individuals who have a problem with drug or alcohol abuse along with a markedly severe and persistent mental disorder such as schizophrenia or bipolar disorder.

Establishing an accurate diagnosis for patients that are addicted to alcohol or other drugs and who may also be struggling with mental health problems is an important and multifaceted aspect of the treatment process. Establishing a dual diagnosis has made it possible for counselors and doctors to discriminate between acute primary psychiatric disorders and psychiatric symptoms caused by Alcohol and Other Drugs. To be able to correctly diagnose the individual, clinicians must obtain a thorough history of drug use as well as psychiatric symptoms and disorders.

Studies have found that there are several possible relationships between alcohol and drug use and psychiatric symptoms and disorders. Alcohol and drugs may induce, worsen, or diminish psychiatric symptoms which can complicate the diagnosis process. Alcohol and drugs use may also mimic psychiatric disorders and can cause symptoms associated with almost any psychiatric disorder. It has been found that both short-term and long-term use of drugs and alcohol can prompt the development, provoke the reemergence, or worsen the severity of psychiatric disorders.

Research has also found that alcohol and drug abuse can mask psychiatric symptoms and disorders. Individuals may use these substances in an attempt to dampen unwanted psychiatric symptoms and to lessen the unwanted side effects of medications that have been prescribed for their psychiatric disorder. Therefore, it has been found that drug and alcohol use may inadvertently hide or change the character of psychiatric symptoms and disorders. Drug and alcohol withdrawal can also cause psychiatric symptoms and mimic psychiatric syndromes. Sudden cessation of the use of drugs or alcohol following the development of tolerance and physical dependence causes an abstinence phenomenon, with clusters of psychiatric symptoms that can also resemble psychiatric disorders.

Examples which could be used to describe dual diagnosis include the combinations of major depression with cocaine addiction, alcohol addiction with panic disorder, alcoholism and polydrug addiction with schizophrenia, and borderline personality disorder with episodic polydrug abuse. The combination substance abuse problems and psychiatric disorders vary along important dimensions, such as severity, chronicity, disability, and degree of impairment in functioning. For example, either disorder may be severe or mild, or one may be more severe than the other. Likewise, the severity of both disorders may change over time. The level of disability and impairment in functioning may also change greatly.

It is very common for individuals with dual disorders to show up in certain treatment settings. For example, some methadone treatment programs treat a high percentage of opiate-addicted patients with personality disorders. Patients with schizophrenia and alcohol addiction are frequently found in psychiatric units, mental health centers, and programs that provide treatment to homeless patients.