In the mental health care industry, it has become the standard to refer to a person with both mental illness and a substance abuse disorder as having a Dual Diagnosis.  If not explained, one might otherwise come to the conclusion the phrase refers to a person with two co-occurring mental illnesses.  An example of co-occurring mental illnesses might be schizophrenia combined with a (major depressive) mood disorder, usually called schizoaffective disorder.

Dual Diagnosis is an important term because substance abuse will complicate and undermine any recovery model or therapeutic program for the person with mental illness.  And yet, it is extremely common for a person with mental illness to “self-medicate” with drugs and alcohol.  Being in the company of other mothers with adult children with mental illness, I have witnessed enough outcomes and heard enough stories to know that people with a dual diagnosis behave and respond dramatically different than those with a singular diagnosis.  In fact, there are major differences between those with mental illness who smoke cigarettes compared to those who don’t.  A person with addiction and mental illness is more likely to engage in criminal activity than someone without addiction, even when their judgment in other areas of their life is severely lacking.

Within the mental health care maze and the types of services offered, it is vital for family members and caretakers to tread lightly when using the phrase “Dual Diagnosis” in order to ensure that their loved one is not routed into a Drug Rehabilitation program, without mental health care services included. If your family member is being admitted to a hospital for psychiatric care: emphasize that over their addictions.

I saw with my own eyes how inappropriate it was for my son to live at a Sober Living House. He was very low-functioning with schizophrenia, lumped in with fairly high-functioning people (who had jobs, friends, and their own families). The people living in a Sober Living House have varying degrees of commitment to achieving sobriety.  It was not the ideal environment for an 18 year old with no insight into his serious mental illness.

Even when a person is in the throes of their addiction, you can probably discuss with them how dangerous their habit is and get some agreement from them. The addicted person may acknowledge that they need to stop, understand how it is ruining their life and accept help in achieving sobriety.  However, when a mentally ill person has no insight into their illness, they are certainly not going to have insight into their harmful addictive behaviors either.

Motivation may also come into play:  A high-functioning person with addiction may still have goals in their life, with a desire for healthier relationships and a career. Contrast that with a person whose mental illness is so severe, that they truly don’t recognize they have a problem and they may not have goals or even desire to have a “normal” life.  Serious cognitive disability may prevent a person from even understanding the impact of their actions.   It is also important to address the reality of dual diagnosis because seriously mentally ill people play Russian roulette with their medications if they are simultaneously using street drugs and alcohol.