According to statistics, six out of ten drug addicts also suffer from some kind of mental disorder .

Although they can be considered as two separate conditions, in reality people are victims of a chronic disease known as dual pathology .

These patients can suffer a great number of symptoms, to the point that their personal and family situation is completely overwhelmed, becoming an untenable circumstance for any of them.

What is dual pathology?

In the field of mental health, a condition that combines, concomitantly, an addiction with some type of mental disorder is called dual pathology .

There is a wide range of types of mental disorder that these people may suffer, ranging from an anxiety disorder; to psychotic or schizophrenic disorders; mood disorders such as depression or bipolar disorder; and various pathological personality traits.

Likewise, while the person suffers from some kind of illness or psychiatric condition, he or she also suffers from an addiction to any kind of toxic substances . This addiction may be to any socially accepted substance such as tobacco, coffee, alcohol or certain medications; or to any type of narcotic or narcotic drug such as cocaine, amphetamines or cannabis.

In some cases, behavioural addictions such as gambling or addiction to the Internet and social networks have also been recorded.

Causes of dual pathology

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

Having some kind of mental disorder is a risk factor when it comes to developing some kind of addiction. Psychiatric illnesses constitute a premorbid factor in dual pathology, due to the different features of the disorders such as impulsivity, depressive mood or reclusion and social withdrawal.

2. Consequences of substance use

Pathological personality traits can also be considered a sequel or effect of a substance use disorder (TUS). These effects may be due to the consequences or effects that the drug has on the body, or to the stressors related to consumption .

3. Common causal elements

Another of the possible causes of dual pathology is that there are common vulnerability factors surrounding the person , which can facilitate the appearance of both a mental disorder and an addiction.

4. Independence of disorders

Finally, there are cases in which both disorders are independent and no 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 themselves, which result in the overlapping of the assessments of the different categories.

Clinical manifestations or symptoms

In addition to the symptoms specific to each of the disorders, patients with some type of dual pathology usually present a series of common clinical manifestations . These symptoms or characteristic manifestations are:

1. Emotional instability

In addition to being a symptom of any personality disorder, emotional instability and depressed mood are very common in people with a substance use disorder.

2. Cognitive Disorganization

Cognitive disorganization, that is, the tendency for thought to become disorganized or tangential, is also characteristic of some mental illnesses. However, it is a fairly common symptom among people suffering from dual pathology, regardless of their diagnosis of mental disorder.

3. Impulsivity and aggressiveness

Patients diagnosed with dual pathology tend to present impulsive and/or violent behaviors. This choleric behaviour can occur both in the form of self-aggression , provoking self-harm, and in the form of aggression towards others expressed in a sudden and impulsive manner.

Treatments for dual pathology

At present, no specific treatment has been developed for people with dual pathology. The protocol of action consists of addressing the mental disorder on the one hand and, on the other, carrying out a parallel intervention for the substance use disorder.

These treatments consist of a combination of psychological intervention, which is considered to be the treatment of choice in practically all cases, with the administration of psychotropic drugs , which present a more limited efficacy but are very useful in reducing the symptoms that interfere with the patient’s evolution.

Likewise, it is also necessary to intervene with the patient’s relatives , in order to facilitate their management of coexistence and to confront the patient’s symptoms and behaviours.

In cases where the substance use disorder underlies the psychiatric illness, the treatment of the drug dependency will be prioritized to that of the mental disorder . Since it is very likely that by decreasing the symptoms of the former, the symptoms of the latter will also improve.

Another intervention that has proved very useful in the treatment of dual pathology is psycho-educational techniques aimed at raising awareness of the effects and dangers of substance use, as well as motivational interviewing.

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. These are antisocial personality disorder and borderline personality disorder, for which there is a more specific type of intervention.

Antisocial personality disorder

There are usually two types of difficulties in the intervention with these patients. One of these is that it is not usual for the patient to attend the treatment by their own determination , and therefore both the healthcare personnel and the therapist are perceived as “enemies”.

The second complication is that drug use tends to remain and resist psychological treatment , which generates high levels of frustration in the clinician.

Because of these two factors, it is advisable to follow a series of guidelines arranged in a hierarchical manner. Throughout which a series of cognitive and behavioural modifications must be implemented. This series of steps are:

  • Given that the patient’s behaviours have the goal of obtaining rewards or avoiding punishments , an analysis of the advantages and disadvantages of carrying out certain behaviours should be carried out together with the patient.
  • Once the patient is aware of the consequences of his actions and the results that this may have on others, he is guided around the consequences of his behaviour in the long term , using techniques such as guided imagination, which have been proven to be effective.
  • To act on the person so that he or she assimilates respect and appreciation for rules and consideration for others.

Borderline personality disorder

Much like antisocial personality disorder, people with borderline personality disorder are difficult to treat as they have a low tolerance for frustration , are very difficult to learn from their own mistakes , and persist in substance use.

Likewise, present a great variety of cognitive distortions and a tendency to dichotomous thinking that makes it difficult for the professional to intervene psychologically.

One of the steps to follow in the treatment of these patients is to work and provide the tools to improve their social skills , as well as to know how to manage frustration. Through cognitive restructuring, occupational therapy and family therapy, great advances have been made in the treatment of this type of dual pathology.