Dual Diagnosis: Mental Health Lows and Drug Highs

Which comes first, the mental health condition or the drug addiction?


In order to get to the heart of America’s substance abuse problem it’s important to know that drug addiction and mental health struggles are not always mutually exclusive. As we search for more holistic ways to address drug addiction, we must include assessment of a person’s mental health to determine what can be done. Peeling back the layers to find the root causes of addiction can be an arduous task because it could mean unearthing mental health challenges as well.

Ultimately, some questions must be answered. Why do people seek this high? Is that hit of marijuana for recreation or for relief? Are they seeking a stronger heroin high because they like the thrill of the chase or because they’re chasing away demons?

Once the problem has been identified, the next step is to treat it. Where to start is a question with a complicated answer.

Contributing Factors
Possible causes for mental health disruption include living in high-crime neighborhoods, poverty, childhood abuse and neglect, and sexual abuse. Even homelessness and unemployment can contribute to drug use because of the depression they bring. Overcoming these challenges takes time and requires professional help.

There are also social contributors to black mental health that sometimes go under the radar. A stigma against acknowledging mental health issues is still rampant in the black community. According to the National Alliance on Mental Illness (NAMI), only one-quarter of African-Americans who suffer from mental illness seek treatment. What does the other three-quarters do?

Typically, when a person has a medical issue at home they will go to their local pharmacy to find some over-the-counter relief. The same can be expected when a person’s mental health is askew. But there are no OTC pills or liquids to consume for depression, anxiety, post-traumatic stress disorder, or the like. It’s going to take more effort to relieve that discomfort.

Dr. Barbara Brown, psychologist and founder of the Capitol Hill Consortium for Counseling and Consultation (CHCCC) in SE, says that people may misuse substances as a coping mechanism at first. “There is a saying that if you drink when you have problems, then you have a problem drinking. That’s true for many other issues. We see marijuana becoming a go-to rather than dealing with the stress someone has. You hear a lot of rationalization like, ‘I need it to go to sleep.’ But it’s really because they are not managing their emotions properly or anxiety or depression or post-traumatic stress disorder very well.”

Chicken vs. Egg Debate
If someone is suffering from a mental health problem and uses drugs to self-medicate, which one does the clinician address first? It’s a complex question with no easy answers.

Drugs can be used to mask mental health symptoms but they can also cause the onset of new mental health conditions as well. For example, if a person is abusing a drug and is violated while intoxicated, that incident can create a new problem with post-traumatic stress disorder, depression, or anxiety. Intoxication can lead to poor decision making, such as having unprotected sex, which can put one at risk for HIV or other sexually transmitted infections. That can lead to depression or deep regret.

Dr. Tanya A. Royster, director of the DC Department of Behavioral Health, states that mental health and substance abuse are often intertwined. “We always get into the chicken-or-egg debate, but there is a substantial amount of evidence that supports that when people do have some mental health or emotional issues they use the illicit drugs to make themselves feel better or to mask symptoms or to escape.”

Where do you start treatment? It depends. Dr. Royster explains that there are two different components to addiction. “One is psychological, where people start using drugs because they want to escape something or erase a feeling. Then there’s the physiological or physical escape. The body physically demands the drug, and if it doesn’t get it you are physically ill.”

Treatment begins with an honest conversation and introspection. Dr. Brown explains the approach her clinicians take at CHCCC. “People come to us for their mental health, but we always ask about risk factors, which include suicidal or homicidal thoughts, abuse, and trauma issues. We have them do a self-report on their substance abuse. We see a range of people who have mental health issues who are also using substances. Some are social drinkers, some are abusing it, and some are dependent on it. We make that assessment. And then we treat them for the mental health issues that are creating or that they are using the substances for a coping mechanism.” 

Self-Care Over Self-Sabotage
The breakthrough is very important when overcoming mental health struggles and addiction. There is hope. It starts with admitting to having a problem and seeking treatment.

Dr. Brown explains how her team addresses getting help. “We will often see a person who we know is dependent on medication or street medications, but we will use our mental health relationship with them to get them to a point where they are self-caring enough to get treatment for it. We will help someone get help so they can see that it’s in their best interest to focus on self-care versus self-sabotage.” CHCCC does not provide substance abuse treatment but can treat mental health issues and refer patients to substance counselors as needed.

When it comes to drugs such as heroin, the risk is much higher. Heroin on the streets nowadays may be adulterated or mixed with fentanyl, a deadly additive. Unfortunately, it’s nearly impossible to spot the bad batch. Users may self-medicate with a lethal dose.

Dr. Royster describes a campaign by the Department of Behavioral Health to help users make better decisions. “We have an awareness campaign to encourage heroin users to do something different. First of all, we would love for you to get treatment. But if you can’t get treatment we want you to save your life and do something different. One of those things is use naloxone, the opioid reversal drug. We are working with the Department of Health’s needle-exchange programs to encourage people to not use alone and make sure someone has naloxone on them.”

Whether you’re grappling with mental health challenges or substance misuse problems or both, know that help is available when you’re ready. The right team can get you back on track to enjoying a full, healthy life.

Need help in a mental health or substance use crisis? Call the District’s Mobile Crisis Services 1-888-7WE-HELP (1-888-793-4357).

Do you want to touch base with a mental health professional just to talk? Contact Capitol Hill Consortium for Counseling and Consultation, 202-544-5440.