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Depression & Alcoholism Public Lecture Series What is Dual Diagnosis?
A person who has both an alcohol or drug problem and an emotional/psychiatric problem
The term Comorbidity is also used, and of course there may be more than two problems.
To recover fully, the person needs treatment for both (all) problems.
What Kind of Mental or Emotional Problems How Common Is Dual Diagnosis? are Seen in People with Dual Diagnosis?
Dual diagnosis is more common than one might
The following psychiatric problems are common to
imagine. According to a report published by the
occur in dual diagnosis - i.e., in tandem with alcohol or drug dependency:
Journal of the American Medical Association:
· Depressive disorders, such as depression and bipolar
• 37 percent of alcohol abusers and fifty-three
percent of drug abusers also have at least one
· Anxiety disorders, including generalized anxiety
disorder, panic disorder, obsessive-compulsive disorder, and phobias.
• Of all people diagnosed as mentally ill,
· Other psychiatric disorders, such as schizophrenia 29 percent abuse either alcohol or drugs. Treatment of Dual Diagnosis Criteria for Depression
• psychomotor agitation or retardation nearly every day (observable
by others, not merely subjective feelings of restlessness or being depressed mood most of the day, nearly every day, as
indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears
• fatigue or loss of energy nearly every day
• feelings of worthlessness or excessive or inappropriate guilt markedly diminished interest or pleasure in all, or
(which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
almost all, activities most of the day, nearly every day
significant weight loss when not dieting or weight
• diminished ability to think or concentrate, or indecisiveness,
nearly every day (either by subjective account or as observed by
gain or decrease or increase in appetite nearly every
• recurrent thoughts of death (not just fear of dying), recurrent insomnia or hypersomnia nearly every day
suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
Criteria for Substance Dependence
Pattern of substance use, characterised by:
1) Tolerance, as defined by either of the following:
a) a need for markedly increased amounts of the substance to
achieve intoxication or the desired effect;
b) markedly diminished effect with continued use of the same amount
2) Withdrawal, as manifested by either of the following:
The characteristic withdrawal syndrome for the substance.
the same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms.
3) The substance is often taken in larger amounts or over a
4) There is a persistent desire or unsuccessful efforts to cut down or control substance use.
5) A great deal of time is spent in activities necessary to
obtain the substance, use the substance, or recover from its effects. Depression
6) Important social, occupational or recreational activities are given up or reduced because of substance use. Alcohol Dependence?
7) The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
• Addictions can cause psychiatric symptoms and mimic psychiatric disorders.
• Acute and chronic addictions can prompt the development, provoke the re-emergence, or worsen the severity of psychiatric disorders.
• Addictions can mask psychiatric symptoms and disorders.
• Withdrawal from active addiction can cause psychiatric symptoms and mimic psychiatric syndromes.
• Psychiatric and addictive disorders can coexist.
(Landry et al., 1991a; Lehman et al., 1989; Meyer, 1986). But only works short-term The danger is Dependence/Addiction
Goodman (1998) proposes the following definition
A condition in which a behavior that can function both to produce pleasure and to relieve painful affects is employed in a pattern that is
recurrent failure to control the behavior, and
continuation of the behavior despite significant harmful consequences. Addiction Cycle Preoccupation Emotional low Substance use
Most mental health services and addiction treatment
centres in Ireland are currently not organised to treat
dual diagnosis sufferers holistically.
Need to start with the addiction, if it has taken hold,
quickly and intensely mood-altering
which usually means at least a period of abstinence. CBT works on changes in Vicious Cycles PCI College Thoughts Cognitive Behaviour Therapy Ireland Emotions Behaviour Dual Diagnosis Ireland Physiology
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