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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
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
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
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
or decrease or increase in appetite nearly every
• recurrent thoughts of death
(not just fear of dying), recurrent
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:
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
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
5) A great deal of time is spent
in activities necessary to
obtain the substance, use the substance, or recover from its effects.
6) Important social, occupational or recreational activities are
or reduced because of substance use.
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
• Addictions can cause psychiatric symptoms and mimic
• 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
• 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
is employed in a pattern that is
recurrent failure to control the behavior, and
continuation of the behavior despite
significant harmful consequences
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.
works on changes in
Cognitive Behaviour Therapy Ireland
Dual Diagnosis Ireland
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