Complex Addiction and Dual Diagnosis


In the addiction treatment field, the term “dual diagnosis” refers to someone who is not only addicted, but also has an underlying psychological disorder. This makes for a complicated situation where it is difficult to tease out whether the addiction resulted from the other illness or vise versa. There’s no obvious answer – addiction symptoms include depression and anxiety related to obtaining a drug, and some people self-treat their depression or social phobias by taking drugs.

A new study from researchers at John Hopkins has now linked existing mood disorders to a propensity for taking opiates. The drugs in question: oxycontin, Vicodin and codeine containing products, are used to treat pain.

Researchers tried to eliminate one pool of participants – those who become dependent on prescription narcotics because of an underlying physical condition. Instead, they wanted to see the relationship between a diagnosed mental illness and non-medical (not approved by a doctor) use of these drugs. They found a strong association between using opiates and already having a mental issue. The diagnosis categories were mood disorders (such as depression) and anxiety disorders.

The question then becomes how self-administering narcotics to feel better changes the course of the underlying disease. The assumption is that while narcotics do make someone feel fewer symptoms, as the addiction progresses, the highs and lows become more severe. A case in point would be when drug supplies run low and a crisis ensues.

It is also known that taking narcotics long-term leads to changes in the brain. The lead author states, ““Lifetime non-medical prescription opioid use was associated with the incidence of any mood disorder, major depressive disorder, bipolar disorder and all anxiety disorders. Non-medical opioid-use disorder due to non-medical prescription opioid use was associated with any mood disorder, any anxiety disorder, as well as with several incident mood disorders and anxiety disorders.

Understanding the link in any one patient may be critical to the success of their treatment. If a mood disorder is driving the addiction, it may re-emerge long after withdrawal and even after an extended period of abstinence. This would put them at risk to repeat the same cycle again: using narcotics to self-treat and triggering an active addiction all over again.


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