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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.
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

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
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
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
Cognitive Behaviour Therapy Ireland
Dual Diagnosis Ireland


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