Dual Pathology: Causes And Treatments And Associated Disorders
According to statistics, six out of ten drug addicts also suffer from some kind of mental disorder
While it is true that they can be considered two separate conditions, in reality people are victims of a chronic disease known as dual pathology
These patients can suffer a large number of symptoms, to the point that their personal and family situation is completely overwhelmed, becoming an unsustainable circumstance for any of them.
Within the field of mental health, dual pathology is called that condition that combines, concomitantly, an addiction with some type of mental disorder
There is a wide range of types of mental disorder that these people can suffer, ranging from an anxiety disorder; to psychotic or schizophrenic disorders, mood disorders such as depression or bipolar disorder; and the different pathological personality traits.
Likewise, while the person suffers from some type of psychiatric illness or condition, He also suffers from an addiction to any type of toxic substances This addiction can be to any substance accepted by society such as tobacco, coffee, alcohol or certain medications; or to some type of narcotic or narcotic such as cocaine, amphetamines or cannabis.
In some cases, behavioral addictions such as gambling addictions or addiction to the Internet and social networks have also been recorded.
From a theoretical perspective, there are different cause-effect links between the two diagnoses of dual pathology. These possible causes are:
1. Mental disorder as a risk factor
Suffering from some type of mental disorder is a risk factor for developing some type of addiction. Psychiatric illnesses constitute a premorbid factor in dual pathology, due to the different features of the disorders such as impulsivity, depressed mood or seclusion and social withdrawal.
2. Consequence of substance use
Pathological personality traits can also be considered a sequel or effect of a substance use disorder (SUD). These effects may be due to the consequences or effects that the drug has on the body, or to stressors related to consumption
3. Common causal elements
Another possible cause of dual pathology is that there are common vulnerability factors surrounding the person which can facilitate both the appearance of a mental disorder and an addiction.
4. Independence of disorders
Finally, there are cases in which both disorders are independent, and no type of cause-effect association can be found between them. In these cases the connection between both diagnoses would be given by the design of the diagnostic classifications, which gives rise to the assessments of the different categories overlapping.
Clinical manifestations or symptoms
In addition to the symptoms of each of the disorders, patients with some type of dual pathology They usually present a series of common clinical manifestations These characteristic symptoms or manifestations are:
1. Emotional instability
In addition to being a typical symptom of any personality disorder, emotional instability and depressed mood are very common manifestations in people with a substance use disorder.
2. Cognitive disorganization
Cognitive disorganization, that is, the tendency for thinking to transform into disorganized or tangential thoughts, is also characteristic of some mental illnesses. However, it is a fairly common symptom among people who suffer from dual pathology, regardless of their mental disorder diagnosis.
Patients diagnosed with dual pathology tend to present impulsive and/or violent behaviors. This angry behavior can occur either in the form of self-aggression causing self-harm, as in the form of aggressiveness towards others expressed suddenly and impulsively.
Dual pathology treatments
Currently, no specific treatment has been developed for people with dual pathology. The action protocol consists of addressing the mental disorder on the one hand and, in addition, carrying out a parallel intervention for the substance use disorder.
These treatments consist of a combination of psychological intervention, which is considered the treatment of choice in practically all cases, with the administration of psychotropic drugs which have a more limited effectiveness but are very useful in reducing the symptoms that interfere with the patient’s evolution.
In addition, intervention with the patient’s family is also necessary with the purpose of facilitating the management of coexistence and coping with the patient’s symptoms and behaviors.
In cases where the substance use disorder underlies the psychiatric illness, Treatment of drug addiction will take priority over mental disorder Since it is very likely that by reducing the symptoms of the first, those of the second will also improve.
Another of the interventions that have been very useful in the treatment of dual pathology are psychoeducational techniques aimed at raising awareness about the effects and dangers of substance use, as well as motivational interviews.
Associated personality disorders
As mentioned above, There are many mental disorders or conditions that can appear or be part of a dual pathology However, there are two of them that stand out for their degree of appearance. They are antisocial personality disorder and borderline personality disorder, for which there is a more specific type of intervention.
Usually, there are two types of difficulties in the intervention with these patients. One of them is that It is not usual for the patient to attend treatment by his/her own determination so both health personnel and the therapist are perceived as “enemies.”
The second complication is that drug use tends to remain and resist psychological treatment a fact that generates high levels of frustration in the clinician.
Because of these two factors, it is advisable to follow a series of guidelines ordered in a hierarchical manner. Throughout which a series of cognitive and behavioral modifications must be implemented. This series of steps are:
Borderline personality disorder
Much like antisocial personality disorder, people with borderline personality disorder are difficult to treat as long as they have a low tolerance for frustration, It is very difficult for them to learn from their own mistakes and they also persist in substance use.
In addition, They present a wide variety of cognitive distortions and a tendency toward dichotomous thinking that makes the professional’s psychological intervention difficult.
One of the steps to follow in the treatment of these patients is to work and provide the tools to improve your social skills, as well as knowing how to manage frustration. Through cognitive restructuring, occupational therapy and family therapy, great advances have been achieved in the treatment of this type of dual pathology.
