DUAL DIAGNOSIS

DUAL DIAGNOSIS: IS THERE A SINGLE CAUSE?
By Kimberly Bailey

Rebekah, a member of the About, co Bipolar Disorder community, posted the following query in our forum: “Is there any here who also faces a drug addition to bipolar disorder? Are you in recovery? I just wanted to know if there was any relation to my diagnosis and my alcoholism. Could my alcoholism have caused my bipolar disorder? I just wonder if some of my bipolar disorder symptoms are related to coming off of alcohol” (Alcoholism). Rebekah poses some excellent questions—questions that are key in the consideration of the multifaceted dilemma of dual diagnosis, which is defined as a coexisting chronic mental illness and substance abuse disorder (Polcin, 1992).

So what does make those with bipolar disorder turn to alcohol or street drugs? In August, 200, I wrote an article entitled Self-Medicating: When the Cure IS the Disease that sddresses the reality of addiction for those with bipolara disorder as well as one theory about the cause of this. However, research and theories about the cause of the co-co-occurrence of bipolar disorder and addiction bound. Polcin classifies the debates relating to this into two main theories. The first broad theory is that substance abuse is a completely separate disorder and that in many cases may actually cause the symptoms of a mental illness (1992).

However, a great many researchers now hold to the theory that the relationship between severe mental illness and substance abuse is a comorbid condition. Alan I. Leshner, Ph. D., director of the National Institute on Drug Abuse (NIDA), states, “Comorbidity is reality.” He further adds that while “mental and addictive disorders are easier to study and treat as unidimensional concepts, in reality they exist together and feed on each other” (Knowlton, 1995). These coexisting disorders can be primary mental illness with substance abuse, primary substance abuse with mental illness, those where both disorders are primary, and conditions that share a common etiology {cause/origin} (Knowlton, 1995).

Leshner also stressed that it is just not necessarily true that those with a mental illness always use drugs to self-medicate (Knowlton, 1995). Mauricio Tohen, M.D., chief of The Bipolar Disorder Cllinic at McLean Hospital and an associate professor of epidemiology at Harvard School of Public Health, agreed with Leshner, stating that those with bipolar disorder who also abuse substances are, for the most part, not self-medicating. He further adds that the use of street drugs and alcohol “changes the course of bipolar illness by precipitating it in younger populations, worsening and changing the condition, and precipitating rapid-cycling states” (Knowlton, 1995). He cites the use of cocaine in mania and alcohol in depression as further evidence that many patients are not self-medicating, arguing that if these consumers were using substances to self-medicate, the reverse would hold true: a person would use alcohol to moderate the highs of a manic episode and cocaine to alleviate the lows of depression.

Clearly dual diagnosis is a tangled web of problems. Tohen offers that “the take-home message is that dual diagnosis is very complex” (Knowlton, 1005). Even just a few years ago, research literature was very limited in this area and while this is rapidly changing, empirical research is still needed in many areas. Certainly the ongoing research suggests that it is important for the patient who has both bipolar disorder and a substance abuse problem needs to be honest with his or her doctor/therapist, and that mental health professionals need to take careful histories to help determine the relationship between the two halves of the dual diagnosis. In our next article, we will look in more detail at the issues surrounding diagnosing and treating dual diagnosis situations.

http://bipolar.about.com/od/alcoholsubstanceabuse/a/aa010514a.htm?n1=1