Substance use and mental health (dual diagnosis)

The term ‘Dual Diagnosis’ is used to describe when a person is experiencing issues arising from both their mental health and substance use. It is also referred to as co-morbidity, or co-occurring mental health and substance use problems.

There is a continuum of use from abstinence (no use at all) to physical dependency (using the drug to feel ‘normal’).

• Experimental use is defined as trying a substance for the first time, and is usually infrequent. Experimental use can still be unsafe. For example, there is a risk of overdose, particularly when your body is not used to the substance. Experimental use can also lead to more frequent use, needing more and more of the substance to get an effect, and dependence.
• Recreational use is defined as regular use in particular settings. For example, drinking alcohol when out with friends.
• Bingeing is defined as heavy use of a substance within a short space of time. Bingeing is associated with specific risks including accidental overdose (especially when other substances are combined).
• Dependence usually occurs when a person is using a substance regularly and in high amounts. A person who is dependent can tolerate much higher doses of the substance, tends to experience withdrawal symptoms when they are not using the substance, and spend a lot of time, energy, and money, getting and using the substance.

It is estimated that anywhere between 40 – 80% of consumers/service users who experience mental illness also have issues with substance use and vice versa. At most treatment services, dual diagnosis is the rule rather than the exception.

Services funded through the Department of Health are mandated to work with consumers with a dual diagnosis.

People experience Dual Diagnosis differently. For example, some people might notice that their mood and anxiety gets worse after drinking alcohol for long periods. Others might find that their cannabis use is making their schizophrenia worse.

There are a number of harms linked to dual diagnosis. Some of these are depicted below. NDARC Comorbidity Guidelines (click for larger view)

However, it’s also known that earlier and appropriate treatment results in:

• Lower rates of relapse, hospitalisations and use of emergency services
• Increased adherence to treatment
• Decreased rate of offending and reduced likelihood of incarceration
• Reduction in positive symptoms (delusions/hallucinations/thought disorder)
• Reduced risk of suicide and early mortality
• Increased stability in areas such as housing, employment, and personal relationships
• Increased quality of life and personal wellbeing
• Better overall functioning and engagement with family, friends and community

Having both mental health and substance use issues can make accessing treatment complicated. Because of this, integrated treatment is often the most effective response for people experiencing dual diagnosis. Integrated treatment occurs when ‘consumers receive combined treatment for mental illnesses and substance use disorders from the same practitioner or treatment team. They receive one consistent message about treatment and recovery’. (SAMHSA, 2009)

In Victoria, all AOD and Mental Health Services (Clinical services and Mental Health Community Support Services (MHCSS)) are encouraged to provide integrated treatment.

People experience Dual Diagnosis in different ways, and many people will respond to different treatment options. It is important to persevere and find the treatment that works the best for you. It’s also a good idea to check that your services are all talking to one another.

Remember that your mental health and substance use can impact on each other, so it can often be helpful to seek assistance for both challenges at the same time.

Where and how you participate in this treatment depends on many different factors, including what makes you more comfortable and what you feel works.

Both Mental Health Services and Alcohol and Other Drugs Services are funded to treat Dual Diagnosis as their core business. Speak with your case manager or counsellor about what types of assistance they can provide you with, or where to find other forms of support.

Most people with dual diagnosis can achieve recovery, which means different things to different individuals. For most people, recovery includes satisfying activities such as a job, friendships with people outside of substance use, a safe place to live, and enjoying leisure activities that are fun and relaxing.

Building a rewarding and meaningful life without substances can take time time, support, education, courage and the learning of new skills. While families and clinicians can help in the recovery process by providing support and hope, recovery is the person’s own choice.

It can be very stressful when a loved one is experiencing difficulties with their mental health and substance use. Often, the people closest to them, such as family, friends or carers, can find it difficult to know how to help and how to access services for both their loved on and themselves.

Many services offer assistance to a person’s family to help them understand what is going on, what sort of treatments are being provided and how they can best provide support and assistance. Have a look at our carer resources at the top of this page to get you started.