Dual pathology is a term that we use in the field of psychology to describe the condition of an individual who simultaneously suffers from a substance use disorder (alcohol, benzodiazepines, cocaine or methamphetamines, among others) and another psychiatric disorder (anxiety, mood, psychotic, personality or neurodevelopmental disorders , For example).
This term recognizes the additional complexity in symptoms and treatment that can arise when a person has these two conditions simultaneously. In many cases, it involves an interrelationship and mutual influence such that the symptoms of one can aggravate those of the other, creating a cycle of deterioration that can be difficult to break without appropriate intervention and complicate both diagnosis and treatment.
Its importance lies in recognizing the need for an integrated treatment approach that addresses both disorders.
Disorders can be of different types and degrees, including, but not limited to, schizophrenia, bipolar disorder, depression, and anxiety disorders. This is why it is an important public health problem due to its high prevalence and the significant complications it can cause in an individual’s life, and its management requires an integrated approach that addresses both the mental disorder and the addiction problem.
We cannot determine a single cause that explains the appearance of dual pathologies due to its complex and multifactorial condition. Its manifestation, however, will depend on a combination of genetic, biological, psychological and environmental factors:
Some studies indicate that certain genes can make a person more likely to develop mental disorders and addictions.
2. Psychological factors
Mental health problems can make a person more vulnerable to substance use such as a form of self-medication. For example, a person with depression may turn to alcohol to relieve their symptoms, which in turn can lead to the development of a substance use disorder.
3. Environmental factors
The environment and factors such as stress, trauma, peer pressure, availability of substances, and lack of social support can increase the risk of developing mental disorders and addictions.
What comes first: addiction or mental disorders?
Determining which comes first is a challenging procedure since the interaction between both terms is bidirectional and complex. On the one hand, substance use can exacerbate the symptoms of a mental disorder, cause a new one, or worsen the course of a pre-existing one; However, on the other hand as well, mental disorders can increase vulnerability to substance use and make recovery from a substance use disorder more difficult.
Furthermore, we must take into account that They may present various components that may make diagnosis difficult:
Therefore, the important thing is to carry out a thorough evaluation and a team approach that includes professionals with experience in the treatment of mental disorders and substance use disorders.
The evaluation should include a detailed clinical interview and review of the individual’s medical and psychiatric history, where the mental health professional may ask about symptoms, substance use, family history of mental disorders or addictions, and stress factors or recent changes in the individual’s life. Also of particular relevance is the application of psychological tests that can help evaluate symptoms and identify any underlying mental disorders, as well as medical tests, such as blood and urine tests, that can help identify substance use and rule out other conditions. medical conditions that could be causing or contributing to the symptoms.
The treatment of dual pathology must be comprehensive and individualized, taking into account both the mental disorder and the substance use disorder. The main goal is to help the person manage both disorders, reducing symptoms and improving quality of life.
One of the most common forms of psychotherapy used in the treatment of dual pathology is cognitive-behavioral therapy (CBT), in addition to others such as acceptance and commitment therapy, motivation therapy or the medication itself. CBT helps people recognize and change patterns of negative or destructive thinking and behavior, so it can help people manage the symptoms of their mental disorders, resist cravings for substances, and develop healthy coping skills. If we add group interventions to these therapies, we will provide a social support network that will encourage learning from the experiences of others with similar problems. In what areas do we manage to have an impact?:
With the help of these treatments and interventions, we will be able to minimize the negative consequences that the diagnosis of a dual pathology may have, as they can be devastating not only for the patient themselves but also for their environment.
Often, family members and friends face great stress and may feel helpless to help their loved one, so it is essential to provide them with guidance and support to learn how to handle the situation in the best way possible; To this end, helping to understand and raise awareness about dual pathology will also be key to reducing stigma and empathizing with affected people and their families.
We can conclude, therefore, that the diagnosis of dual pathology poses unique challenges in terms of diagnosis and treatment, due to the complexity of symptoms and overlapping challenges associated with each disorder. Despite the difficulties, early detection and diagnosis is essential for effective management. Treatment should be comprehensive and individualized, addressing both the mental disorder and the substance use disorder. Psychotherapeutic therapies play a key role, and in many cases, medication can be a valuable tool as can social support and group therapies.
Society in general, and especially health professionals, must be well informed about dual pathology. Understanding and awareness can help prevent the onset of dual pathology, promote early detection and treatment, and reduce the stigma associated with these disorders. A call to action is needed to increase awareness and improve diagnosis, treatment and support for people with dual pathology. Only through these measures can we work together to improve the lives of people affected by dual pathology and foster a healthier, more understanding society.
