Dual Diagnosis: A Clinical Challenge


The literature concerning dual diagnosis has largely identified and defined the mental health “element”of this phenomenon as the presence of a functional psychotic illness(such as schizophrenia, bipolar disorderdelusional disorder, schizo-effective disorder, or depressive illness with psychotic symptoms), but is less specific when identifying the substance use “element” of the dual diagnosis (Phillips, 1998; Phillips & Johnson,2001)

From a clinical perspective it can be argued that this definition is excessively narrow since it excludes those patients with non-psychotic mental health problems(such as personality disorder, depressive illness, anxiety, or phobic or eating disorders) from the potential benefit of any specialist help or evidence based intervention available to those with substance use disorders and functional psychotic illness. This is especially pertinent since the presence of non-psychotic mental health problems is well established among those with substance use disorders (Baker et al.,2004; Farrell et al., 2003)


Dual diagnosis is a term for when someone experiences a mental illness and a substance abuse problem simultaneously. Dual diagnosis is a very broad category. It can range from someone developing mild depression because of binge drinking, to someone’s symptoms of bipolar disorder becoming more severe when that person abuses heroin during periods of mania. Either substance abuse or mental illness can develop first. A person experiencing a mental health condition may turn to drugs and alcohol as a form of self-medication to improve the troubling mental health symptoms they experience. Research shows though that drugs and alcohol only make the symptoms of mental health conditions worse. Abusing substances can also lead to mental health problems because of the effects drugs have on a person’s moods, thoughts, brain chemistry and behavior.


Why Do Some People Develop a Co-occurring Disorder While Others Don’t?

Researchers continue to search for a definitive answer to this question. Currently, the belief is that dual diagnoses come about as a result of a combination of variables. Chief among them are genes, stressful or traumatic events, and early drug exposure, all of which can overlap and interact with each other at various times in someone’s life.1

Which psychiatric illness comes first – substance abuse or the other co-occurring disorder – depends on the person and their circumstances. Sometimes substance abuse can lead to mental illness. For example, the onset of depression is common among those whose relationships, careers and/or health have deteriorated as a result of substance abuse. Conversely, mental illness can bring on drug abuse. Anxiety, for example, can lead people to abuse alcohol and other drugs to find relief from their symptoms.

It can be difficult to determine which illness came first and which is responsible for the other. This is why seeking professional help from trained clinicians and medical experts is a vital component of successful treatment. Determining in what ways one or more psychological disorders are interacting with a drug use disorder can be extremely beneficial to one’s recovery.

While most people with concurrent disorders get better with treatment, there are some factors that can inhibit or slow down their progress.

  • Most important is an undetected co-occurring mental illness. Undetected illnesses pose a risk to treatment dropout and relapse.
  • Those who develop a mental illness before a substance use disorder may be at higher risk of enduring a difficult treatment process.
  • Severe, co-occurring major depression and/or post traumatic stress disorder (PTSD) may also provide additional strain and hinder treatment progress.
  • And, lastly, recent evidence suggests that continued use of tobacco during treatment can be a risk for post-treatment relapse.

There are a number of different talk therapies, but the following have been shown to be especially effective in treating a number of dual diagnoses:

  • Cognitive-behavioral therapy (CBT) involves recognizing and changing thoughts and behaviors that encourage drug use and negative thinking.
  • For people with self-harm and impulsive tendencies, Dialectical Behavioral Therapy (DBT) may be particularly helpful.  
  • Some individuals prefer group therapy, which can also improve social skills and provide a support group.  
  • Exposure therapies are especially helpful for individuals suffering from severe anxiety and panic attacks, as well as post-traumatic stress.  
  • Therapeutic communities are designed to help those suffering from domestic violence or homelessness.
  • Assertive Community Treatment targets those with severe mental illness such as schizophrenia.  
  • There are also separate facilities that treat dual diagnoses in adolescents.  


The following posts have some case studies and their results. Care, read and share to help!






Highway To Hell

“The intellect, potential and existing abilities: all is watered away when a person succumbs to drug abuse.”

Drug abuse is on the rise and ceases to leave the lifestyles of youngsters as it is deep embedded in our social system and is hence carried forward from generation to generation like an ancient tradition. The causes of its existence are sowed in ignorance because of which uprooting the problem becomes a not so easy task. The most common form of drug abuse that is observed in today’s India is alcohol addiction, consumption of cannabis etc. The following are the grave causes for this rising substance abuse-

  • Becoming a part of culture- 

Culture is very close to the hearts of people and anything cultural is clung to closely by people. A culture is the soul of any human society. The way people meet, greet and do things is all what culture is. It includes the practices that a group of people relate with themselves as a part of their lifestyle. Alcohol is a habit among people because it has its history in culture. So does hookah, beedi and others. The men of the household used to smoke pot and consume alcoholic mixtures. In some areas, even women consumed these substances. Family functions and joyous occasions were incomplete without them. This was the scenario in rural India and has transcended to the growing metropolitans rapidly. The young generation also has get-togethers around a table where they are drinking or smoking. Lord shiva himself used to take weed. In India, where the revered deities are worshiped and idealised blindly, people are unable to differentiate right from wrong based on scientific study and facts. Invariably, what is ingrained in culture is hard to get rid of.

  • Aiding the social life of the young- 

The young lot parties and their idea of celebration is incomplete without getting high. Also, when 80% are involved in an activity in any social gathering, the rest 20% are very much bound to also try it. Getting wasted has also become a way to relieve boredom. Youngsters feel like it is an exciting thing to do. It has fit into the definition of fun. Friends meet over a round of drinks and can often be found saying that alcohol makes their banter lively or meeting exciting. Young people sometimes use drugs or alcohol to escape from their home, or personal, problems. Friends may suggest that coming out for a night’s drinking or smoking a spliff might help if they’re feeling down. People feel like getting high on a substance can align their thoughts, cool their mind, enable them to perform better and have more fun.

  • Relieving depression and low mood-

People have a lot of problems and confusions to deal with in the middle phase of their life. Sorting career and relationships becomes a source of stress as they feel they have a lot to deal with. Mid life crisis makes people very vulnerable to substance abuse. The temporary alterations that substance abuse does to the chemistry of the brain gives a feeling of comfort. The subconscious mind is elevated to another level and there are experiences of soothing feelings, reduced anxiety and stress, less hesitations and more confidence. Everything that substance abuse causes in its immediate aftermath gives the feeling that it is the perfect solution to all problems even if the long term impact is adverse.


These are the popular reasons for which substance abuse is far from diminishing and remains intact as a part of life of people from all walks of life.

– Apoorva Gaba

Drugs take you to Hell, disguised as Heaven… 

-Donald Lynn Frost

If you’re struggling to overcome an addiction, no one needs to tell you it’s tough – you’re living it. Sometimes you could use a few encouraging words to remind you that you’re not in this alone and that, yes, change really is possible.


How HIGH is your drug test score??

Club drugs are a group of psychoactive drugs. They act on the central nervous system and can cause changes in mood, awareness, and how you act. These drugs are often abused by young adults at all-night dance parties, dance clubs, and bars.

These are the drugs normally classed as club drugs :

  • Ecstasy
  • GHB
  • Ketamine
  • Rohypnol
  • LSD
  • Methamphetamine
  • drug4


Preventing the Abuse of Club Drugs

The likelihood that your child will at some point be surrounded by people drinking or using drugs and will be offered drugs is overwhelming. He must know to expect this, he must expect his peers to ridicule him if he refuses the offer to join in and he must know in his heart that he must walk out of this environment if he is to stay sober. He must truly understand the damage that can occur if drugs are abused, all the way up to and including overdose and addiction. Obviously, this information must be shared very gently in the earlier years, with more specific knowledge being offered when the child is in his teens.

One of the most essential messages to send is that both the child’s parents are united in their opposition to any kind of substance abuse until after the child is 21 years of age. This is an important message whether the family all lives in the same household or not. According to the National Center on Drug Addiction and Substance Abuse, if a person can avoid drinking or using drugs until after they turn 21, they are virtually certain to never have a problem with substance abuse.

Club drugs are seldom the first drug a child abuses. A parent may choose to begin educating a child the problems caused by drug abuse in general, then move on to the primary drugs that youth start with – marijuana, alcohol and prescription drugs, and then explain the specific dangers of club drugs. It is most likely that a young person will run into these drugs at parties, music festivals or dance clubs. But if he or she runs around with older youth who are living risky lifestyles, exposure to these dangerous substances may come earlier.

Continue reading

Marijuana- The Poison loved by most

“Marijuana is… self-punishing. It makes you acutely sensitive and in this world what worse punishment could there be?”


Pot, weed, grass, 420, dope, herb, joint, blunt, cannabis, mary jane, bhang and much more are the names given to the infamous natural drug- Marijuana.


Picture credit: http://dazedimg.dazedgroup.netdna-cdn.com/746/azure/dazed-prod/1150/3/1153017

I myself don’t have any idea why I chose this particular topic when there are many more drugs which are way more harmful and have way more case studies about them online. Maybe it’s the fact that according to Hindu mythology, Lord Shiva used to consume it or the fact that out of all the drugs only this drug is herbal in nature.


Picture credit: http://ramawat.deviantart.com/art/Lord-Shiva-Wallpaper-417882741

I honestly have no problem with people who consume it, after all, it does have some medicinal uses. I was not even aware of its existence until I got to read a very interesting news as to how 2 sisters were growing weed in their church’s backyard and using it to make medicines. I was very curious as to what weed is.


Picture credit: http://www.dailymail.co.uk/femail/article-3516262/Inside-world-weed-nuns-Sisters-run-medicinal-marijuana-business-pictured-smoking-cannabis-tending-plants-making-pot-infused-products-striking-picture-series.html

Most kids are when they get to hear about it, especially from their friends who are already using it to “relieve” themselves from the stress in their lives. Let alone friends, but even our culture has made it a part of our religion. Bhaang is consumed the most on holi by mixing it in thandai (a famous Indian drink).


Picture credit:http://img.indiaonline.in///holi/bhang

If that doesn’t make you interested then stars like Bob Marley does. And this by far leads most to start using it just out of sheer curiosity. All the experiences that people have while using this drug differ a lot due to the fact that it amplifies the emotions and the thoughts that you have while using it. Some find it very relaxing while a few also find the experience very scary.

 It also tends to amplify sounds that you hear, no matter how far they may be but you will feel as if the source of the sound is just next to your ear.


Picture credit: http://rebloggy.com/post/trippy-weed-high-acid-stoner-scarf-stoned-trippy-gif-tie-dye-lamma/46806940510

It is the most used drug not only because of all the influences in our society but also due to the fact, it is very easy to get, in fact, just go outside and you can find places nearby you where weed is growing on its own.

It is easy to cultivate and also has a demand in the market, which also makes it very profitable to grow. Go to any hill station, any and you can find a government bhang store.

What about the people who can’t get access to the drug? They find other herbs like the mango leaves or green tea leaves to smoke and you will be very surprised how common it is.

  The problem of drug abuse has always existed but most of them were not used to the point where it becomes an addiction but during the British rule, the problem of addiction truly started to take a shape in our country.

Drugs were the only way to survive in that time of insanity and it was also promoted by the British rulers as they were able to exploit the poor farmers and many other worker class and so they fed them to the point they were not able to retreat.

Now we are left with the side-effect of that exploitation, it is seen as acceptable to use drugs in our society to the point where our elders also tell us to use it if feel sick.

I always thought to myself, is there really any ending to all of this? Maybe, has always been the answer as our society is built in such a way that we all are using drugs, be it by choice or by force. We all are addicts. Living on pills or the “herb” is your choice but being an addict, maybe not.

The only solution is if the world stops seeing profit and rather the health of individuals. We all can help with that by not judging other people for drug abuse and rather help them in realising that it truly is not worth it, it can be a short-term escape from your problems but that’s all. It all ends there. You can’t run from your problems forever and you will eventually need to face it, that even while you are all sober.

Get addicted to life, not drugs.

There will be a second part to this where I will talk in-depth about this drug and will include the interpretation of one of the case study related to this drug to show how harmful it can be.

-Nehal Hardat

Can you feel the despair?

Addiction begins with the hope that something “out there” can instantly fill up the emptiness inside.

—  Jean Kilbourne

This is dedicated to those who have touched the woes of life… To those who fall but stand back up. To those who get weak but find new strength. To those who break but rebuild themselves. To those who lose hope but believe again. This is for those who chance upon the recovery road. There is a life that awaits you. Your story matters. 

poem addiction drugs abuse alcohol substanceabuse

A poem on Addiction

  • Addiction is always knowing where my cigarettes are.
  • Addiction is a clove cigarette and a Pepsi for breakfast.
  • Addiction is showing up for a date high.
  • Addiction is missing my mother’s birthday because I was high.
  • Addiction is taking naps in the car in the company parking lot because I was so tired I couldn’t make it through the afternoon.
  • Addiction is claiming that smoking is a social activity, but smoking alone anyway when all my smoking buddies are busy.
  • Addiction is the tingling on both sides of my tongue, near the back, when I haven’t had a cigarette in 2 hours.
  • Addiction is knowing that it’s 10:15, because my tongue is tingling again.
  • Addiction is having sex high and not telling her.
  • Addiction is cutting a date short so I can go home and get high.
  • Addiction is not feeling myself until the third cup of coffee.
  • Addiction is that involuntary fluttering that my eyelids do after a double espresso.
  • Addiction is spending the afternoon running to the bathroom to piss out all the caffeine I had to drink in the morning to start my day.
  • Addiction is lying about how many drinks I’ve had already.
  • Addiction is drinking so much in the first 30 minutes of the party that I have to go lie down for an hour.
  • Addiction is Rumplemintz, pizza, and throwing up out the window into the courtyard the night before parents’ visiting day.
  • Addiction is giving a dinner party and getting high before the guests come.
  • Addiction is the very concept of an emergency joint.
  • Addiction is cigarette burns in the carpet.
  • Addiction is picking out burnt carpet fibers one by one before my parents come over.
  • Addiction is rearranging the furniture to hide the cigarette burns.
  • Addiction is a shirt, a bedsheet, and the afghan my mother made for me, now all with cigarette burns.
  • Addiction is leaving the party thinking I’m sober enough to drive, backing up the car, and realizing that I’m not.
  • Addiction is sneaking a cigarette before a date.
  • Addiction is knowing that washing my hands with Listerine does a pretty good job of hiding the cigarette smell on my fingers.
  • Addiction is a box in the back of my closet where I hid my cigarettes.
  • Addiction is keeping track of that box when I moved into a new apartment.
  • Addiction is the first cigarette on a Sunday night, after a sober weekend visting my parents.
  • Addiction is the sound of my ceiling fan, always on to help clear the smoke.
  • Addiction is never having quiet, much less peace.
  • Addiction is calling in sick because I was up until 6 AM getting high, sleeping until noon, and waking up and getting high again.
  • Addiction is going to the office at midnight while high and fixing a bug, just to say that I had done it.
  • Addiction is noticing that I use more global variables when I’m high.
  • Addiction is finding comments like /* drunk, fix later */ and /* too high to make this work */.
  • Addiction is getting drunk four times in one weekend.
  • Addiction is passing out on the Sherman Bus on the way home from an away football game.
  • Addiction is the burp in the morning that is one step away from throwing up.
  • Addiction is $500 worth of liquor in one cabinet.
  • Addiction is going to work and reading e-mails from myself from the night before that I don’t remember writing.
  • Addiction is a permanent towel under the door to block the smell of smoke from escaping into the hallway.
  • Addiction is being high when I heard that Princess Diana was in a car crash, and lighting up another joint later when she was confirmed dead.
  • Addiction is coming home at 3 AM from a long evening of movies at a friend’s house and immediately getting high, then waking up at 8:30 AM and going to work.
  • Addiction is the smell of smoke on all my clothes, sheets, towels, and furniture.
  • Addiction is the taste of everything, always the same.
  • Addiction is realizing that all of my friends at work are smokers too.
  • Addiction is smoking for seven years through four girlfriends and never telling any of them.
  • Addiction is realizing that I can never introduce my girlfriend to my friends at work, because they know I smoke and she doesn’t.
  • Addiction is the tiredness I feel after the third joint when I’m coming down but am too exhausted to smoke any more tonight.
  • Addiction is not having any programming projects for six years.
  • Addiction is not reading any books for six years.
  • Addiction is giving up playing a music instrument after playing it for eleven years.
  • Addiction is ordering “Dancing With Cats”. (This is why drugs and one-click shopping do not mix.)
  • Addiction is taking a box that my parents gave me engraved with the words “graduate with honors” and using it to store pot, pipes, papers, cigarettes, rolling tobacco, and ashtrays.
  • Addiction is the little crease I put in the paper before I put the pot and tobacco in to keep it from spilling out and getting long strands of tobacco stuck in my teeth.
  • Addiction is spitting out strands.
  • Addiction is a thousand little skills I wish I didn’t have.
  • Addiction is getting high on my birthday.
  • Addiction is the dog getting diarrhea, not on days that I get high, but on days that I don’t.
  • Addiction is getting caller ID and dividing the world into two groups: people whose phone calls I could answer while high, and those I couldn’t.
  • Addiction is not answering the door on Halloween because I’m high.
  • Addiction is scraping the bowl and smoking the resin.
  • Addiction is moist sticky tar on my fingers.
  • Addiction is having a folder of bookmarks to drink mix web sites.
  • Addiction is moving to the other side of the room to see if I’m higher over there.
  • Addiction is losing track of how many brands of cigarettes I’ve smoked.
  • Addiction is giving a friend a joint for her 30th birthday with an inscription that read, “Take years off your life while you still have them.”
  • Addiction is smoking while sick.
  • Addiction is a persistent cough.
  • Addiction is the taste of phlegm first thing in the morning.
  • Addiction is the dry roughness on the top of my throat that no amount of water can quench.
  • Addiction is the taste of Halls cough drops every day, despite the warning on the bag that said that they should not be taken for more than seven days or for persistent conditions such as smoker’s cough.
  • Addiction is unrolling the butt of a clove into a bowl and smoking it because I’m out of cigarettes.
  • Addiction is going to sleep high.
  • Addiction is being too high to sleep.
  • Addiction is learning to pace myself throughout the night so I could be sober enough to sleep.
  • Addiction is a cold sweat.
  • Addiction is a permanent stain on my pillow where my mouth rests.
  • Addiction is not being able to sleep sober.
  • Addiction is always dreaming of myself smoking.
  • Addiction is waking up feeling like my eyes are sunk into the back of my head.
  • Addiction is really messy shits.
  • Addiction is my heart racing after a fat joint and not knowing if it’s a heart attack.
  • Addiction is demons scratching on the inside of my skull.
  • Addiction is still drinking mixed drinks when everyone else has switched to soda.
  • Addiction is being recognized by all the clerks at the liquor store.
  • Addiction is keeping track of who knows what.
  • Addiction is a lot of lying to a lot of people.
  • Addiction is not being able to account for all my time.
  • Addiction is the constant fear of being discovered.
  • Addiction is sleeping on my own couch for months.
  • Addiction is waking up in the middle of the night to find that I had rearranged the furniture.
  • Addiction is gaining 40 pounds because I just wasn’t paying any attention.
  • Addiction is getting drunk on the weekends with my girlfriend because we couldn’t think of anything else to do.
  • Addiction is waiting for the knock on the door that never comes.
  • Addiction is the flashing of police sirens outside, and wondering if they’re coming for me, but they never do.
  • Addiction is wondering when someone will please notice that I’m a fuckup and come take away my apartment, my dog, my high-paying job, my charmed life, but no one ever does.
  • Addiction is smoking a joint and hearing a knock on the door, freaking out, looking through the peephole, seeing that it’s only my best friend, and then not letting him in until I smoke a cigarette to cover up some of the smell.
  • Addiction is knowing how to refill a Zippo lighter.
  • Addiction is the nod that means we’re all going to the back room to get high.
  • Addiction is an ashtray in every room.
  • Addiction is hiding the ashtrays before taking pictures of my new apartment to send to my parents.
  • Addiction is hiding the ashtrays before going out, on the off chance that we’ll end up at my place tonight.
  • Addiction is not being able to let my girlfriend into my apartment after she drove me home from a car accident because my ashtray was on my desk in plain sight.
  • Addiction is thinking about all the things I could do, but never getting anything done.
  • Addiction is thinking every year that this year will be different, then finding out it’s exactly the same.
  • Addiction is figuring that I’ll quit “someday”.
  • Addiction is trying to quit, and lasting eight hours.
  • Addiction is feeling like this is the only way life could ever be.
  • Addiction is always near.
  • Addiction is like this.
  • Addiction is like this.
  • Addiction is like this.
  • Addiction is like this.
  • Addiction is like this.
  • Addiction is like this.
  • Addiction is like this.
  • Addiction is like this.
  • Addiction is like this.
  • Addiction is like this.
  • Addiction is like this.
  • Addiction is like this.
  • Addiction is like this.
  • Addiction is like this.
  • Addiction is like this.
  • Addiction is like this.
  • Addiction is like this.
  • Addiction is like this.
  • Addiction is like this.
  • Addiction is like this.
  • Addiction is like this.
  • Addiction is like this.
  • Addiction is like this.
  • Addiction is like this.
  • Addiction is like this.
  • Addiction is like this.
  • Addiction is like this.
  • Addiction is like this.
  • Addiction is like this.
  • Addiction is like this.
  • Addiction is like this.
  • Addiction is like this.
  • Addiction is like this.
  • Addiction is like this.
  • Addiction is like this.
  • Addiction is like this.
  • Addiction is like this.
  • Addiction is like that: the same thing repeated over and over until it drowns out everything else.
    — Mark Pilgrim

Millions of people in India legally use drugs responsibly every year, but many others use legal drugs illegally or use illegal drugs for recreation. A solid substance abuse definition is using legal drugs illegally for recreation and/or using illegal drugs at all. There are some general signs and symptoms that can be red flags of substance abuse; several treatment options for substance abuse also exist.

Abuse vs. Addiction

In some cases, substance abusers can abuse drugs according to the substance abuse definition without actually becoming addicted to them. For example, a person can drink more alcohol than he should, yet not become addicted to alcohol — at least not that time. The person might become addicted to alcohol after abusing it multiple times, but abuse doesn’t necessarily mean or lead to addiction. Even if a person never becomes addicted to a particular drug, the individual will still likely experience negative effects from the drug on the body.

Abuse vs. Misuse

Some people take drugs non-medically for pleasure but don’t exceed the prescribed dosage; this is referred to as misuse rather than abuse. Drug misuse is fairly frequent and generally not as harmful as drug abuse. For example, a person could take cough syrup with codeine in it as a sleep aid rather than to help suppress a cough. This isn’t likely going to negatively impact the person too much — especially if this is a one-time instance of insomnia rather than a pattern — but harm can arise from misuse when it turns into abuse due to needing more of a drug to achieve a satisfactory result. If a person continues misusing the cough syrup with codeine, for example, he could end up addicted to it due to continually taking more of it to sleep — and eventually because the body demands it.

Healing from addiction takes time. Making up your mind to stop using drugs is a big step. Being addicted makes you afraid of what will happen if you don’t keep taking the drug. I know it might be challenging but it is going to be worth it and your future self will thank you for the recovery.


The following blog-posts will explore various types of substance abuse, signs, symptoms, treatments and other useful information. So, do not forget to follow.

What is your story of substance abuse?