The Problem With Dual-Diagnosis in Addiction Treatment

Dual-diagnosis - diagnosing someone with both a substance abuse problem and a mental or emotional condition at the same time - is a growing trend in the field of addiction treatment. Alcoholics or drug addicts are treated for both their addiction and their other problems concurrently. However, many of those treated for dual-diagnosis may never get the help they need for either problem.

How can dual-diagnosis prevent successful treatment?

The major pitfall is the risk of labeling the person with a condition they don't have. Just about every substance abuser displays symptoms of some disorder or other simply as a side effect of the addiction. Until they're off the drugs and well on the road to recovery, it can be impossible to tell which symptoms are associated with the alcohol or drug addiction and which are not.

The effect is similar to that of any wrong diagnosis - when they're treated for the wrong thing, the real problem they have continues, and may actually get worse.

A good example of the danger of incorrect diagnosis is a recent story about a woman who, while her family doctor was out of town, went to emergency reeling with irrational confusion, difficulty breathing, and heart palpitations. The doctors did blood tests and an EKG, and, finding nothing wrong, concluded that the problem was anxiety and prescribed Prozac.

Fortunately, the woman did not take the Prozac and the next day was able to see her own doctor. The problem turned out to be potassium deficiency - a condition which could have been fatal. Thanks to her family doctor's correct diagnosis, the condition was easily resolved. Within a few hours of following his advice she was completely back to normal.

What would have happened had she accepted the 'anxiety' diagnosis and taken the Prozac?

- She would have had to cope with the possibly severe side effects of Prozac.

- She would be living with the stigma of being diagnosed as 'mentally ill.'

- Since the diagnosis was incorrect, she might be desperately trying to figure out why she suddenly developed this 'mental problem' and would be assigning cause to situations in life that, in fact, were not really problems. This in itself can be extremely disruptive to a person's life - she could suffer years of mental anguish trying to figure out what was wrong with her mind when, in fact, there was nothing wrong in the first place.

- She could have developed an addiction to or dependence on Prozac.

- Since her 'mental problem' did not resolve with the Prozac (how could it when it didn't exist in the first place?), she may have been prescribed additional harmful drugs and had to cope with the side effects of those.

- Because she was driving herself crazy trying to figure out what was really wrong with her mind and never really finding an answer, she could have developed other emotional symptoms and been incorrectly labeled with yet another disorder.

- Last, but not least, she could have died from the undiagnosed and untreated potassium deficiency.

If she lived, her life could well have been ruined.

Had his happened to a drug addict who was already coping with sometimes severe physical, mental and emotional side effects from the drugs alone, what would their chances be of recovery? Pretty slim. The combination of the effects of drug addiction and the consequences of the incorrect diagnosis could really drive them around the bend.

Also, whatever started them on the road to drug addiction in the first place may never be found or addressed - which is pivotal in addressing addiction successfully - and if the person did manage to quit drinking or taking drugs, chances are they would revert.

If you or someone you care about is having a problem with alcohol or drug addiction, make sure they're treated for that problem first. The treatment should be thorough - get them through withdrawal, put them on a nutrition and exercise program to get their body back in shape and enable them to get rid of more of the drugs in their system and, when they're in better shape, dig into what caused the addiction in the first place so those issues can be addressed, and then develop a program for them to follow when they leave rehab. This is the sequence followed in a good addiction treatment center.

Once they're well on their way, any other problems will surface independent of their addiction and can be addressed as needed.