What does Dual Diagnosis Mean?

Although no one knows for sure what causes illnesses such as depression, schizophrenia or bipolar affective disorder, most people agree that when these illnesses occur, chemical changes take place in the brain. Drugs and alcohol also cause a chemical change within the brain and, depending on what is being used, either stimulate the brain or slow it down.

Yes, because the symptoms of a person misusing drugs/alcohol are often very similar to the symptoms of mental illness, and vice versa. Alternatively, both problems may exist at the same time.

To make an accurate diagnosis, it is important that as much as possible should be made known about the person. Vital background information can be gathered by talking to the person and, if possible, by talking to their family/whanau and friends.

Where there appears to be a dual diagnosis it is important to try to identify the primary problem so that the most appropriate treatment can be given.

• Feel anxious or wish to 'block out' the symptoms of medication
• There may be peer pressure or the desire to fit in with a group
• They may feel that it gives them confidence and boosts their self esteem
• They may use it because they are bored, lonely or depressed, or because they have difficulties sleeping

For some, a significant minority, substance abuse becomes an addictive pattern of obsessional behaviour.

In understanding the effects of substance use, it is important to state that the effects of any substance will vary from individual to individual according to the quality and quantity of; the substance, age, gender, weight, mood, culture expectations and state of physical and mental health.

Stimulants speed the body up, constrict blood vessels, speed the heart and raise blood pressure and so are particularly risky for people with heart and blood pressure problems. They can also cause or mimic mania, anxiety and/or depression or paranoid psychosis.

Overall, depressants, particularly where there is excessive use, can cause or mimic the depressed mood causing loss of motivation and lack of interest in people and surroundings. Self neglect and even self-harm including suicide may result. It is also easy to overdose on downers, particularly where there is alcohol use.

Hallucinogens cause intensified and mixed up sensations, illusions, delusions, hallucinations, stimulation and impaired judgement and reasoning. Hallucinogens are generally unpredictable and can trigger a latent mental illness. They can also cause or mimic delusional hallucinations and paranoia associated with a major psychosis.

They act on the central nervous system sometimes as a stimulant but generally as a depressant and can cause loss of inhibitions. 'Sniffers' of all kinds of volatile substances often experience hallucinations.

If someone has a dual diagnosis does that mean there will be additional problems?

• Make symptoms worse.
• Lead to a relapse and more frequent re-hospitalisation.
• Cause social and behavioural problems.
• Make people more vulnerable to suicide.
• Introduce associated health risks (e.g. HIV, poor eating habits, liver damage).
• Lead to violence or unsociable behaviour.
• Lead to difficulties with receiving treatment.

As illegal substances have become increasingly available and fashionable, more people, particularly young people are experimenting with a wider variety of them at a younger age. This includes the excessive use of alcohol.

The onset can vary. When mental illness has been triggered by alcohol use, its use has often been over a long period of time, often over many years. With illegal substances, the person may have only been taking them for a short period, sometimes on just one occasion, before the mental illness or a drug induced psychosis is triggered.

People with a dual diagnosis have complex, and many long term needs for care and treatment, including easy access to psychiatric services, psychological and social support and alcohol/drug agencies.

• Providing a structured but flexible programme of multi-agency care coordinated by an experienced case manager of key worker.
• Regular monitoring and assertive outreach services to prevent people 'slipping through the net'.
• Education to raise awareness about the effects of alcohol/drug use on physical and mental health.
• Help with developing coping/life skills to help them recognise the symptoms, cope with the anxiety of withdrawal and prevent relapses.
• Cognitive behaviour therapy and other psychological interventions.
• Help with developing better support systems within the community.
• Family support - having to deal with a family member who has both a mental illness and drug/alcohol problems can be a devastating experience for many families and they also need help and support.

Ring for help:

• Talk to the School Guidance Counsellor
• Talk to a Doctor
• Ask a family member or friend to find you help

• Phone the Alcohol Helpline on: 0800 787 797

Resources in Taranaki:

Ngati Ruanui (Kaupapa Maori Service)
P O Box 72, Hawera
Tel: 06 278 3169
Email: ngaruahine.health@xtra.co.nz

Taranaki Health A & D Service (Mainstream)

Taranaki Base Hospital, New Plymouth
Tel: 06 753 7836

The following websites provide information on drug and alcohol issues:

Alberta Alcohol and Drug Commission
Addictions information ABC Fact Sheet on Alcohol

Mental Help Net Alcohol & Substance Abuse Link
An international (Dublin) website with data on most mental illnesses

Mental Health Foundation - NZ
A most useful NZ website with resource data on most mental illnesses

The Ministry of Health

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