Dual Diagnosis/Co-Occurring Disorders

Dual diagnosis and co-occurring disorders are psychiatric disorders that are occurring along with substance abuse or substance dependence disorders.

More than half of people experiencing alcohol and drug abuse or dependence disorders are also suffering from a co-occurring mental disorder.

Diagnosing a dual diagnosis/co-occurring disorder condition in substance abusers can be difficult, as drug abuse itself often induces psychiatric symptoms.  In determining the correct dual diagnosis/co-occurring disorder diagnosis it is necessary to differentiate between substance induced and pre-existing mental illness.

Self Medication and Drug or Alcohol Abuse and Dependence

Often people suffering from mental disorders attempt to deal with the problem themselves by "self medicating."  It is common for people experiencing mental disorders to feel relief when drinking alcohol or taking drugs, so it is natural that they should start using these substances to alleviate or control their symptoms.

The problem with self medicating a mental disorder is that prolonged use of alcohol and recreational drugs will likely create a condition of pathological dependence.  In addition, use of certain substances may actually increase the symptoms or create new symptoms.

Treatment for Dual Diagnosis/Co-Occurring Disorders

Summit Malibu's world-class therapists have decades of experience treating the many dual diagnosis/co-occurring disorders that often accompany substance dependence.

Click on the links below to learns more about treatment of dual diagnosis/co-occurring disorders, such as:

• Anxiety Disorder
• Attention Deficit Hyperactivity Disorder (ADHD)
• Bi-Polar Disorder
• Borderline Personality Disorder (BPD)
• Depression
• Obsessive Compulsive Disorder (OCD)
• Panic Disorder
• Post Traumatic Stress Disorder (PTSD)
• Social Anxiety Disorder

Concerta Abuse and Addiction

Concerta (methylphenidate) is a psychostimulant drug approved for treatment of Attention Deficit Hyperactivity Disorder, Postural Orthostatic Tachycardia Syndrome, and narcolepsy.  It may also be prescribed for treatment-resistant cases of lethargy, depression, neural insult, obesity, and Obsessive Compulsive Disorder.

Methylphenidate belongs to the piperidine class of compounds, which increase the levels of dopamine and norepinephrine in the brain.  Methylphenidate is structurally similar to amphetamine, and its pharmacological effects are closely related to those of cocaine.

In the United States, Concerta (methylphenidate) is classified as a Schedule II controlled substance, the designation used for substances that have a recognized medical value but present a high likelihood for abuse because of their addictive potential.

Concerta is approved by the FDA for the treatment of Attention Deficit hyperactivity disorder because of its effects of increasing or maintaining alertness, combating fatigue, and improving attention.  The long term effects of methylphenidate on the developing brain are unknown, and it is not approved for children under six years of age.

Methylphenidate has shown some benefits as a replacement therapy for methamphetamine addiction.  Methylphenidate and amphetamine have also been investigated as a chemical replacement for the treatment of cocaine dependence, in the same way that methadone is used as a replacement for heroin.  Methylphenidate is actually more potent than cocaine in its effect on dopamine transporters.

Methylphenidate has a high potential for drug abuse and drug dependence due to its pharmacological similarity to cocaine and amphetamine.

Methylphenidate abuse is higher among college students compared to non-college attending young adults.  College students abuse methylphenidate as a so-called "study drug" to improve concentration or stay awake.  Methylphenidate has been dubbed "kiddie coke" due to its low price and high availability among young people.  It is one of the top ten stolen prescription drugs in the United States.

Increased alcohol consumption due to abuse of stimulants such as Concerta has additional negative effects on the health, particularly in young adult abusers.

Concerta long term use, and use in high doses, has been associated with higher levels of psychiatric admissions, drug dependence, paranoia, schizophrenia and psychosis.  Psychotic symptoms from Mehyphenidate can include hearing voices, visual hallucinations, urges to harm oneself, severe anxiety, euphoria, grandiosity, paranoid delusions, confusion, and increased aggression.

Tolerance may occur with long-term use of methylphenidate, including cross tolerance with other stimulants such as amphetamines and cocaine.

Withdrawal symptoms of methylphenidate can include psychosis, depression, irritability and a temporary worsening of the original symptoms for which the drug was prescribed, known as rebound.

Methamphetamine Abuse and Addiction

Methamphetamine is a psychoactive stimulant that increases alertness and energy, and in high doses, can induce euphoria, enhance self-esteem and increase sexual pleasure.  Methamphetamine is FDA approved in the United States for the treatment of ADHD and some forms of obesity, under the trademark name, Desoxyn.

Methamphetamine has a high potential for abuse, activating the psychological reward system by increasing levels of dopamine, norepinephrine and seratonin in the brain.

Methamphetamine is a potent central nervous system stimulant that affects neurochemical mechanisms responsible for regulating heart rate, body temperature, blood pressure, appetite, attention, mood and responses associated with alertness or alarm conditions.  Users experience an increase in focus, increased mental alertness, and the elimination of fatigue, as well as a decrease in appetite.

Psychological effects can include euphoria, anxiety, increased libido, alertness, concentration, energy, self-esteem, self-confidence, sociability, irritability, aggression, psychosomatic disorders, hubris, excessive feeling of power and invincibility, repetitive and obsessive behaviors, paranoia, and with chronic and/or high doses, amphetamine psychosis.

Withdrawal is characterized by excessive sleeping, increased appetite and depression, often accompanied by anxiety and drug-craving.

Regular use can lead to amphetamine-induced psychosis, though for most patients these symptoms will stop within 7–10 days of discontinuing the drug.  However, a small percentage of long-term or "heavy" users will continue experiencing intermittent psychotic episodes (experiencing hallucination, delusions, and/or paranoia) on an ongoing basis within the first year of abstinence.  Although not common, these users offer some anecdotal evidence about the neurotoxicity of long-term amphetamine use, and the healing process that a user experiences when these neurotoxic effects are either partially or fully reversed.

Spontaneous and long-term recurrences (akin to "flashbacks") are hypothesized to be triggered (or exacerbated) by high stress and by sleep deprivation.  In extremely rare cases, this condition is documented to persist beyond one year.

The key distinction between amphetamine psychosis and a psychotic disorder or schizophrenia is that the symptoms will eventually subside, but only with abstinence and proper treatment.