A dual diagnosis occurs when an individual is struggling with both a substance use disorder and a coexisting mental health disorder. Dual diagnosis is a complex and prevalent condition that impacts about 25% of those with a drug or alcohol addiction, according to the Substance Abuse and Mental Health Services Administration. Of those, the most common is the dual diagnosis alcohol and depression combination.
There are two ways the dual diagnosis alcohol and depression can develop. In some cases, the individual is experience a major depressive episode and may turn to alcohol as a means of self-medicating their emotional pain away. Over time, the tolerance to alcohol increases, resulting in more excessive drinking and potentially alcohol addiction. This is a situation where depression was a precursor to alcoholism. In others, the individual develops alcoholism first. As the consequences that result from the alcohol addiction mount, depression can set in, indicating that alcoholism can trigger a depressive disorder. In both scenarios, the dual diagnosis alcohol and depression is the outcome.
This particular dual diagnosis is a particularly dangerous one. Because alcohol is a depressant, and can cause major devastation in all aspects of one’s life, when co-occurring with depression there is a higher risk of suicide. In fact, suicide rates among alcoholics are exorbitantly high. According to a study published in the International Journal of Environmental Research and Public Health, among alcoholics, the lifetime risk of suicide is 10%-15%, and that, in fact, depression and alcoholism were comorbid in 85% of 100 cases of completed suicide.
Treatment for individuals who present with this dual diagnosis of alcohol and depression will need to be provided through a specialized dual diagnosis provider where both disorders will be treated simultaneously for the best recovery outcome. These programs include psychiatric expertise on staff that are trained to respond to the issues that may emerge during detoxification and rehab.
Signs of the Dual Diagnosis Alcohol and Depression Co-Occurrence
The symptoms of both disorders, depressive disorder and alcohol dependency, will be evident in individuals who have developed this dual diagnosis. These symptoms include:
- Sadness, despair, hopelessness
- Loss of desire to participate in usual activities
- Weight loss or gain
- Insomnia or hypersomnia
- Slowed motor and cognitive functioning
- Inappropriate feelings of shame or guilt
- Trouble concentrating or making decisions
- Suicidal thoughts
- Tolerance increases causing increased alcohol consumption
- Experiences blackouts
- Increasing time spent thinking about, obtaining alcohol, and recovering from drinking
- Continue to drink despite negative consequences
- Secretive behavior, hiding alcohol, lying about how much is being consumed
- Efforts to quit or cut back are ineffective
- Physical signs include bloating, glassy eyes, ruddy complexion
- Withdrawal signs commence when alcohol is not available
Characteristics of Alcoholism and Coexisting Depression
The fallout for this dual diagnosis can be exceptional. Struggling with both depression and alcohol dependency can result in a slew of negative consequences. This can be due to the increased impulsivity of the alcoholic, an increase in risk-taking behaviors, and neglecting obligations, among other causes.
Consequences of the dual diagnosis of alcoholism and depression might include:
- Loss of job
- Divorce or interpersonal relationship issues
- Loss of custody
- Financial consequences due to job loss
- Legal problems, such as getting a DUI
- Health problems, such as pancreatitis, liver disease, heart disease, cancer
- Accidents that result in injury to self or others, or damaged property
Individuals with a dual diagnosis of alcoholism and depression should not ignore the need for professional help. Loved ones who recognize these signs and symptoms are encouraged to seek out treatment for the individual.
One of the more devastating consequences of alcoholism/depression co-occurring disorders is the dramatically increased risk of suicide. Primary care providers are being trained to assess for risk of suicide among patients who are alcohol dependent, hopefully increasing referrals to addiction treatment programs. These patients should be questioned about possible presence of depression symptoms as a way of identifying suicide risk in this group.
Suicide awareness includes recognizing symptoms such as:
- Prolonged and persistent sadness, signs of hopelessness
- The individual conveys the opinion that his or her loved ones are better off without them
- Isolating behaviors
- Successive setbacks that occur, such as relationship problems, loss of employment, financial difficulties
- Appear to be giving away prized possessions
- Making end of life arrangements
- Saying goodbye to loved ones and friends
- Acquiring the means to commit suicide, such as a firearm, rope, pills
If there is a present danger of suicide, immediately contact the National Suicide Prevention Lifeline at (800) 273-8255.
Comprehensive Treatment for Dual Diagnosis
Treatment for the dual diagnosis will involve a full spectrum of therapeutic interventions that work together in an integrated approach to recovery. These treatment elements include:
Medically supervised detox and withdrawal: Alcohol detox should always be medically supervised, as potentially dangerous withdrawal symptoms can suddenly emerge. Detoxification is treated using benzodiazepines and other medications to ease symptoms.
Individual psychotherapy: Therapy is an essential core element for treating both disorders. The therapist will guide the individual to examine sources of emotional pain and help them resolve these. In addition, cognitive behavioral therapy helps shift addiction responses toward positive, productive behavioral responses, as well as teaching coping skills.
Group counseling. Group therapy supports peer interaction and is a source for sharing and accountability.
Medication management. Medications for the mental health disorder and/or the alcoholism may include antidepressants and naltrexone.
Relapse Prevention: Individuals create a detailed relapse prevention strategy by identifying specific triggers or situations that could lead to relapse, and response strategies as well.
Continuing care services: Following completion of the program, sober living housing, 12-step group participation, and outpatient counseling are strongly encouraged.
Ken Seeley Communities Provides Expert Dual Diagnosis Treatment
Ken Seeley Communities is a Palm Springs-based addiction and dual diagnosis recovery program. The expert dual diagnosis clinical staff is trained to treat both disorders, alcoholism and depression, concurrently, providing detox, rehab, and sober living transitional housing. Ken Seeley Communities features a unique approach to guiding individuals into recovery, including intervention services and a subsequent continuum of care throughout the recovery process. For more detail about the program, please contact Ken Seeley Communities today at (877) 744-0502.