Dual Diagnosis: Treating Depression and Opioid Addiction
Dual diagnosis, also commonly known as co-occurring disorders, is used when individuals experience a mental health disorder and a substance use disorder simultaneously. The Key Substance Use and Mental Health Indicators in the United States noted that of the 10.4 million Americans suffering from a severe mental illness and the 19 million suffering from a substance use disorder in the past year, 8.2 million had a co-occurring disorder.
Dr. Daniel Bober, Lifeskills South Florida Medical Director, says the most common dual diagnosis he sees in clients is depression and opioid abuse. Not a surprising fact considering by 2015, there were enough opioids prescribed in the U.S. for every American to be medicated around the clock for three weeks, and the Centers for Disease Control and Prevention (CDC) estimates the number of opioid overdoses and the number of prescription opioids has quadrupled in the past 18 years.
Opioids are often commonly used by those suffering from depression as a form of self-medication to temporarily alleviate symptoms such as hopelessness, feeling empty, and sadness. Research estimates that 48% of people dependent on opioids will often experience depression. Some individuals are predisposed to the development of mental health disorders that may be triggered by substance abuse. Opioids have been known to cause a change in the brain’s chemistry and in hormone levels, which can lead to depressive symptoms. Continued substance abuse will worsen mental health symptoms, and if there is an already existing mental health disorder, symptoms will still be present long after the substance use has ended.
Dr. Bober stated,
“At Lifeskills South Florida, co-occurring disorders tend to be the rule rather than the exception. More often than not when someone has a substance use disorder, they have a mental health disorder to go along with it.”
Although it is common for drug addiction, such as opioids, to co-occur with a mental illness, figuring out which disorder came first and why can be difficult. Dual diagnosis can be difficult to diagnose due to the complexity of the symptoms; often individuals receive treatment for one disorder while the other still is untreated. Treatment for one disorder and not the other may occur for multiple reasons, such as the treatment provider not being well-versed in both disorders, or symptoms are masked or overlap leaving the treatment provider challenged to decide the comprehensive clinical needs.
Of the millions of adults living with dual diagnosis, only 40% receive treatment for either disorder and less than 5% receive treatment for both issues. Simultaneous treatment of the mental health disorder and substance abuse is critical and improves patient outcomes and quality of life. At Lifeskills South Florida, we are aware of the opioid crisis, and those seeking help. “We specialize in treating those who have a strong mental health component to their disease as well as substance use disorders,” says Dr. Bober. Ending addiction is the first step to recovery, and often people need added help to manage cravings and triggers which lead to substance abuse.
While there is no single treatment way for treating a dual diagnosis, it can include a combination of medication stabilization and traditional therapeutic sessions. Dr. Bober uses Cognitive Behavior Therapy (CBT), Dialectical Behavior Therapy (DBT), two of the most effective evidence-based therapies for treating dual diagnosis.
Using CBT, our clinicians work with clients to identify behaviors, thoughts, and feelings that have prevented the client from functioning effectively, and how changing the mental evaluation of situations can modify the behavior. Originally designed to treat borderline personality disorder, DBT has shown effective in treating substance abuse and depression. DBT focuses on mindfulness and learning to control self-destructive behaviors such as life threating behaviors, therapy-interfering behaviors, quality of life behaviors and skills acquisition. DBT emphasizes a balance between accepting beliefs and actions.
In combination with evidence-based therapies, we use a holistic approach to treatment that incorporates elements of mindfulness, meditation, certified yoga, and integrated primary care, where we teach nutrition, meal planning, and cooking with a certified nutritionist. We focus on equipping clients with coping and self-care skills for reintegration back into life once out of treatment. Our program goes above and beyond to empower individuals during their recovery.
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