Dual Diagnosis and Mental Illness (Schizophrenia and Drug or Alcohol dependance)
Families who have mentally ill relatives whose problems are compounded by substance abuse face problems of enormous proportions. Mental health services are not well prepared to deal with patients having both afflictions. Often only one of the two problems is identified. If both are recognized, the individual may be bounced back and forth between services for mental illness and those for substance abuse, or they may be refused treatment by each of them. While the picture regarding dual diagnosis has not been very positive at this point, there are now signs that the problem is being recognized and there is an increasing number of programs trying to address the treatment needs of people with both problems. Research studies are beginning to help us understand the scope of the problem. It is now generally agreed that as much as 50 percent of the mentally ill population also has a substance abuse problem. The drug most commonly used is alcohol, followed by marijuana and cocaine. Prescription drugs such as tranquilizers and sleeping medicines may also be abused.The incidence of abuse is greater among males and those in the age bracket of 18 to 44. People with mental illnesses may abuse drugs covertly without their families knowing it. It is now reported that both families of mentally ill relatives and mental health professionals underestimate the amount of drug dependency among people in their care. There may be several reasons for this. It may be difficult to separate the behaviors due to mental illness from those due to drugs. There may be a degree of denial of the problem because we have had so little to offer people with the combined illnesses. Caregivers might prefer not to acknowledge such a frightening problem when so little hope has been offered. Substance abuse complicates almost every aspect of care for the person with mental illness. First of all, of course, these individuals are very difficult to engage in treatment. Diagnosis is difficult because it takes time to unravel the interacting effects of substance abuse and the mental illness. They may have difficulty being accommodated at home and may not be tolerated in community residences of rehabilitation programs. They lose their support systems and suffer frequent relapses and hospitalizations.
