Dual pathology: causes and associated treatments and disorders

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

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

These patients may suffer from a large number of symptoms, to the point that their personal situation and family is completely overwhelmed, becoming an untenable circumstance for none of them.

• Related article: "Addiction: disease or learning disorder?"

What is dual pathology?

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

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

Likewise, while the person suffers from some type of illness or psychiatric condition,

he also suffers from an addiction to any type of toxic substances. This addiction can be to any substance accepted by society such as tobacco, coffee, alcohol or certain medications; or to some type of narcotic or narcotic such as cocaine, amphetamines or cannabis.

In some cases, behavioral 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 type of mental disorder is a risk factor when it comes to developing some type of addiction. Psychiatric illnesses are a premorbid factor in dual pathology, due to the different features of the disorders such as impulsivity, depressed mood or seclusion and social withdrawal.

2. Consequence of substance use

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

3. Common causal elements

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

4. Independence of disorders

Finally, there are cases in which both disorders are independent, and no type of 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, which give rise to the possibility of overlapping the evaluations of the different categories.

• You may be interested: "The 16 most common mental disorders"

Clinical manifestations or symptoms

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

1. Emotional instability

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

2. Cognitive disorganization

Cognitive disorganization, that is, the tendency for thinking to transform into disorganized or tangential thoughts, is also typical of some mental illnesses. However, it is a fairly common symptom among people who suffer from dual pathology, regardless of their diagnosis of mental disorder.

3. Impulsiveness and aggressiveness

Patients diagnosed with dual pathology tend to present impulsive and / or violent behaviors. This angry behavior can occur both in the form of self-aggression, causing self-harm, as in the form of aggressiveness towards others expressed suddenly and impulsively.

• Related article: "Non-Suicidal Self-Injury: Who is Affected and Why Does It Occur?"

Dual pathology treatments

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

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

In addition, intervention with the patient's family is also necessary, in order to facilitate the management of coexistence and coping with the symptoms and behaviors of the patient.

In cases where the substance use disorder is underlying the psychiatric illness, drug addiction treatment will be a priority over mental disorder treatment. Since it is very likely that by reducing the symptoms of the first, those of the second will also improve.

Another of the interventions that have been very useful in the treatment of dual pathology are the techniques psychoeducational programs aimed at raising awareness about the effects and dangers of substance use, as well as interviews motivational.

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. Are the antisocial personality disorder and the Borderline personality disorder, for which there is a more specific type of intervention.

Antisocial personality disorder

Usually, there are two types of difficulties in the intervention with these patients. One of them is that it is not usual for the patient to attend treatment on their own accordTherefore, both the health personnel and the therapist are perceived as “enemies”.

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

Due to these two factors, it is advisable to follow a series of hierarchically ordered guidelines. Throughout which a series of cognitive and behavioral modifications have to be implemented. These series of steps are:

• Since the patient's behaviors are aimed at obtaining rewards or avoiding punishmentAn analysis of the advantages and disadvantages of carrying out certain behaviors must be carried out together with it.
• Once the patient is aware of the consequences of her actions and the results it may have on others, we proceed to guide you around the long-term consequences of your behaviors, using proven techniques such as guided imagery.
• Act on the person so that he assimilates respect and appreciation for the rules and consideration for others.

Borderline personality disorder

Much like antisocial personality disorder, people with borderline personality disorder personality are difficult to deal with as long as you feel a low tolerance for frustration, it is very difficult for them to learn from their own mistakes, and also persist in substance use.

In addition, exhibit a wide variety of cognitive distortions and a tendency to dichotomous thinking that hinders the psychological intervention of the professional.

One of the steps to follow in the treatment of these patients is to work and provide tools to improve your social skillsas well as knowing 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.