Welcome to Engage Wellness Acton’ page on Dual Diagnosis Psychotic Disorders.

A dual diagnosis is a group of diagnoses typically including addiction or substance use disorder and a co-occurring mental health condition. Since one often feeds on the other, individuals with a dual diagnosis of addiction and a psychiatric disorder may need ongoing support in the form of rehab to overcome both conditions.

With the right approach to treatment, individuals with dual diagnoses can successfully recover and go on to live healthy and happy lives.

On this page, you will learn what a dual diagnosis is, why psychotic disorders are often accompanied by addiction, and various approaches to psychotic disorder and addiction treatment.

Does One Disorder Cause the Other?

Psychiatric disorders, also known as mental health conditions, range in severity, some being mild and only needing therapy to overcome and others being more severe, requiring medication and hospitalization for treatment. While a psychiatric disorder does not cause addiction directly, it can make developing one more likely.

Common reasons that psychiatric disorders lead to addiction include:

•      Difficulty controlling impulses
•      Genetic predisposition
•      Going through a traumatic event
•      Having difficulty controlling stress
•      Abusing prescription medications
•      Drinking while taking medications
•      Using illicit substances to cope with difficult situations
•      Using drugs to control symptoms

Addiction is the most severe form of a substance use disorder. It causes problems with impulse control and changes that lead to drug or alcohol cravings despite their negative effects. Over time, these changes may cause permanent brain damage and lead to episodes of drug-induced psychosis.

According to research published by the National Institute on Drug Abuse, data shows high rates of comorbid substance use disorders and psychiatric disorders, such as:

•      Generalized anxiety disorder
•      Post-traumatic stress disorder
•      Attention deficit hyperactivity disorder
•      Borderline personality disorder
•      Antisocial personality disorder
•      Bipolar disorder

Signs and Symptoms of Dual Diagnosis

Depending on the psychotic disorder, the signs and symptoms of a dual diagnosis will differ. Additionally, symptoms differ from person to person. However, the most common signs and symptoms of a dual diagnosis include the following:

•       Changes in mood (usually extreme)
•       Changes in sleeping patterns
•       Engaging in risky behaviors
•       Changes in eating patterns
•       Avoiding regular social interaction
•       Needing drugs or alcohol to function
•       Need more than usual
•       Difficulty concentrating
•       Feeling confused
•       Missing school or work frequently

Additional signs of addiction include:

•      Dilated pupils
•      Depression symptoms
•      Low or excessive energy
•      Hallucinations
•      Erratic behavior
•      Impaired motor skills
•      Changes in physical appearance
•      Changes in hygiene habits

How is Addiction and a Co-Occurring Psychotic Disorder Diagnosed?

Diagnosing an addiction with a co-occurring psychotic disorder is difficult because they often have overlapping symptoms. For this reason, a licensed mental health professional must use comprehensive assessment tools to diagnose both conditions.

To gather information and help with diagnosis, the therapist may ask about the following:

•       Family history
•       Medical history
•       History of substance abuse
•       Mental health history

Note on polysubstance use: Polysubstance use occurs when someone uses more than one substance at a time. This can happen accidentally or intentionally. The National Institute on Drug Abuse states that polysubstance use is common amongst individuals with comorbid substance use disorders. This can further complicate diagnosis.

Treatment for Co-Occurring Disorders

The first step in a psychotic disorder and addiction treatment program is detoxification. A mental health treatment like behavioral therapy or a combination of therapies and medication-assisted treatment follows this. Some clients may also attend aftercare programs to support their recovery needs.

Detoxification:

Detoxification is the first step in a dual diagnosis treatment program. It involves abstaining from drugs or alcohol or withdrawing from the substance. During this process, the person will discontinue using or drinking for a specified period. Depending on the substance, this may take several days to a few weeks.

Some people detox at home, but individuals with an addiction will need supervision. At the rehabilitation center, medically trained staff provide supervision to ensure safe and comfortable withdrawal from substances. They continuously monitor the individual’s health and administer medication as needed to prevent serious withdrawal symptoms.

Depending on the severity of the addiction, individuals with dual diagnosis may require a medical workup that includes the following tests:

•       Metabolic panel
•       Urinalysis
•       Complete blood count (CBC)
•       Arterial blood gas (ABG)
•       Glucose
•       Cardiac markers
•       Prothrombin time
•       Toxicology screening
•       Liver function tests (LFT)
•       ECG
•       Computed tomography (CT)
•       X-ray

According to the National Institute of Health, withdrawal symptoms are part of withdrawal syndrome. Withdrawal syndrome occurs when a substance is overused and is removed rapidly.

This causes the following effects:

Alcohol, barbiturate, and benzodiazepine withdrawal:

• Tremors
• Delirium
• Hallucinations
• Loss of appetite
• Sweating
• Nausea or vomiting
• Agitation
• Anxiety and nervousness
• Fast heart rate
• Disorientation
• Difficulty sleeping
• Seizures
• Headache

Opiate withdrawal:

• Yawning
• Sneezing
• Nausea or vomiting
• Diarrhea
• Dilated pupils
• Flu symptoms

Cocaine and amphetamine withdrawal:

• Depression
• Increased appetite
• Excessive fatigue
• Slow motor skills

Inpatient Treatment:

After going through detoxification, most individuals with dual diagnosis will enter an inpatient treatment program. The length of time they must stay in an inpatient program depends on the severity of their addiction or mental health condition. However, the average stay in inpatient treatment ranges from 30 days to six months.

During inpatient treatment, clients receive behavioral therapy and may be able to sign up for other forms of treatment, such as nature, adventure, or experiential therapy. They will also attend group workshops or group therapy sessions.

Depending on the nature of the dual diagnosis, some individuals will receive medication-assisted treatment while in rehab.

Outpatient Treatment:

Outpatient treatment is an alternative to inpatient care for individuals with outside obligations and a less severe form of dual diagnosis. Clients in an outpatient program can continue residing at home and visit the rehab to receive therapy, peer support, and other services to reach their treatment goals. After leaving therapy, some clients sign up for outpatient treatment to help them prevent relapses.

Behavioral Therapy:

Behavioral therapists focus on helping individuals change self-destructive or unhelpful behaviors. They assist in coping with troubling symptoms related to mental health or drug addiction and teach strategies and skills to overcome these symptoms.

The type of behavioral therapy someone will receive in rehab depends on their mental health treatment goals but may include any of the following:

• Cognitive behavioral therapy (CBT)
• Dialectical behavior therapy (DBT)
• Eye movement desensitization and reprocessing (EMDR)
• Acceptance and Commitment Therapy (ACT)
• Exposure therapy

Medication-Assisted Treatment:

Medication-assisted treatment involves the use of prescribed medications to reduce the severity of withdrawal symptoms or treat underlying or comorbid conditions.

Most individuals with addiction will need medication-assisted treatment to help them through the withdrawal process during detox. These medications may include pain relievers, glucose, selective serotonin reuptake inhibitors (SSRIs), and/or the following:

• Methadone
• Buprenorphine
• Naltrexone
• Acamprosate
• Disulfiram
• Nicotine replacement
• Bupropion
• Varenicline

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), these medications can contribute to lowering a person’s risk of contracting HIV or hepatitis by reducing their potential for relapse.

Overall, the goal of medication-assisted treatment is to help individuals fully recover from addiction.

Peer Support Groups:

Peer support groups are often attended as part of an aftercare program; however, some attend them during their stay in rehab. In a peer support group, members help each other by sharing their experiences with addiction and mental health. They provide tools like coping strategies and tips for preventing relapse to support each other in achieving their recovery goals.

Examples of peer support groups are:

• Alcoholics Anonymous
• Narcotics Anonymous

Benefits of Treatment

The benefits of dual diagnosis treatment include:

• Improved survival rate
• Improved ability to gain employment
• Improved ability to maintain employment
• Improved mental health
• Strategies to avoid drug or alcohol relapse
• Renewed sense of self-awareness
• Renewed confidence

Discover Engage Wellness Acton’ Dual Diagnosis Program

Impact Wellness Mass’ dual diagnosis program provides a safe and supportive environment where clients receive 24/7 care, daily therapy, and medication support to help them overcome addiction. We understand the difficulties individuals with dual diagnoses face and are here to help them reclaim their lives and reach a lasting state of sobriety.

If you’re ready to take the first step, we’re here to help you. Contact us to learn more.