Table of Contents
By Geoffrey Booth, Medical Director, LifeSync Malibu
There is an unmistakable connection between alcohol use disorder and co-occurring mental health issues. When a substance use disorder and a coexisting mental health disorder are both present at the same time, it is referred to as a dual diagnosis.
According to the Substance Abuse and Mental Health Services Administration, more than 9 million Americans struggled with co-occurring disorder in 2018. This statistic indicates that roughly 50% of the 19.7 million adults with a substance use disorder also have a co-occurring mental health condition. Data show that rates of dual diagnosis are highest among adults ages 26-49.
Depression is the most common mental health disorder codeupled with alcoholism. In some cases, the depression drives the alcohol abuse and in other cases the alcoholism leads to clinical depression. The initial disorder is considered the primary condition. Regardless of the order of the disorders, this combination presents a serious challenge to a person’s quality of life.
The Connection Between Mental Health Disorders and Alcohol Abuse
Being trapped in the vicious cycle of a mental health disorder and co-occurring alcohol use disorder can be debilitating. On a daily basis, one condition continually aggravates and fuels the other. As symptoms worsen, the co-occurring disorders can lead to major impairment in functioning, impacting all aspects of daily life. Although depression can be linked with any substance of abuse, there is a particularly common connection between depression and alcoholism. About 20% of adults with alcoholism also suffer from clinical depression, according to an article published in the Psychiatric Times.
While alcoholism is linked mostly with depression, there are several other mental health disorders that also co-occur with alcohol use disorders. These include anxiety disorder, bipolar disorder, and eating disorders.
The alcohol is used as a means to self-medicate the uncomfortable or distressing symptoms of the mental health disorder. Unfortunately, too often that strategy will fail, as alcoholism can take hold. This happens when tolerance to the alcohol continues to increase, so the individual begins consuming more alcohol to achieve the earlier effects.
What Happens When You Detox?
When someone with a dual diagnosis decides to get sober, the first stop on the recovery pathway is medical detox. Detoxing from alcohol can be highly unpredictable and even dangerous, which is why it is always recommended that they do so in a medically supervised environment.
Medical detox specialists will guide the individual safely through the stages of withdrawal, providing medications to help minimize the discomforts of detox. Detox will follow a three-stage process:
- Stage I: Emerging Symptoms. The withdrawal symptoms begin to emerge after about 6 hours after the last drink. This stage lasts about 24-48 hours. Symptoms include tremors, fever, agitation, nausea and vomiting, and increased heart rate.
- Stage II: Peak Symptoms. On days 3-4 of detox, the individual will experience peak symptoms. These include fever, elevated blood pressure, shaking, mental confusion, anxiety, intense irritability, insomnia, and seizures. This is also the period when the delirium tremens can suddenly present, which is a serious health emergency.
- Stage III: Subsiding Symptoms. Days 5-7 mark the decline of symptoms, during which the individual begins to feel stable. Some residual depression, insomnia, and anxiety symptoms are common for a few weeks following detox.
Dual Diagnosis Treatment
Treatment for co-occurring disorders requires a specific expertise. It will involve both psychiatric support as well as that of addiction professionals and clinical psychologists. A dual diagnosis treatment program is equipped to provide the appropriate care and support for individuals struggling with mental health disorders and alcoholism.
Treating a dual diagnosis is complicated. It requires an integrated approach that will address both the substance use disorder and the co-occurring mental health disorder simultaneously. Research has confirmed that this approach produces more favorable treatment outcomes, versus treating just the addiction alone or tackling one disorder first and then the other. Combining the treatment elements in one program is the more effective approach for a dual diagnosis.
Treatment will include the following:
- Psychotherapy. Evidence-based psychotherapies are an essential core treatment element for co-occurring disorders. During therapy the individual examines life events that may be contributing to both disorders, and begin the process of healing. Cognitive behavioral therapy helps individuals to identify thought distortions that have perpetuated substance use and emotional instability.
- Group therapy. Group sessions are an integral aspect of rehabilitation, as they provide an opportunity to bond with others in recovery, and offer a safe place to share personal experiences.
- Recovery meetings. 12-step or SMART Recovery meetings are a source of social support and inspiration.
- Psychosocial skills. Treatment for a dual diagnosis entails providing the individual with essential recovery skills, such as better communication skills, emotion regulation techniques, and conflict resolution strategies. Better relating skills reduces stress in relationships.
- Complementary activities. A holistic approach to dual diagnosis treatment includes activities that help manage the symptoms related to the mental health disorder. These include mindfulness, art and music therapy, therapeutic massage, acupuncture, meditation, journaling, and yoga.
Depression After Quitting Drinking
There is a common link between quitting alcohol and depression still continuing anyway. Adjusting to a new lifestyle in recovery can be challenging. It means separating yourself from prior relationships that are not healthy for you. Starting over with new sober friendships takes time, and meanwhile boredom and loneliness can weigh on you.
It is important to realize that the brain takes time to heal. It takes time to return to normal chemistry and dopamine production. Because lingering depression can sabotage recovery by triggering a relapse, it is critical to continue with aftercare efforts. These include:
- Ongoing outpatient therapy. Therapy provides an important backstop for dealing with setbacks in recovery.
- Supportive transitional housing. Sober living is an excellent option when the home environment is not supportive of recovery efforts.
- Recovery community involvement. Participating in a local A.A. group or similar program can provide social support.
- Establishing healthy lifestyle habits. Resurrecting healthy habits, such as daily exercise and a nutritious diet, can help reinforce a positive mindset in recovery.
- Nurturing new friendships. It takes time and patience to establish new sober friendships. Continue to seek out venues that offer opportunities to form new friendships.
With an expert dual diagnosis treatment program and follow-up aftercare, it is possible to overcome the effects of co-occurring disorders and truly enjoy life again.
About The Author
Geoffrey A. Booth, M.D. is the Medical Director of LifeSync Malibu, exclusive rehabilitation program located in the heart of Malibu. Dr. Booth has treated thousands of addicts over the years and now has dedicated most of his clinical time to providing medical care and detoxification to clients who suffer from substance abuse. Dr. Booth has always committed to helping them establish the foundations for long-term sobriety. While not working, Dr. Booth has a rich personal life filled with activities surrounded by friends and family.