Breaking the Stigma of Dual Diagnosis

Although awareness around mental health has improved among the general public, there is still much taboo around mental illness in some circles. Substance use disorders (SUD) are generally viewed less judgmentally, with a more widespread understanding that they are actual medical conditions. The stigma of dual diagnosis, negative stereotypes, and misconceptions surrounding both types of conditions remain strong, particularly when they are co-occurring.

What is Dual Diagnosis?

The term dual diagnosis refers to cases where a mental health disorder and an alcohol or drug abuse problem occur simultaneously. Co-occurring disorders, dual pathology, and comorbidity are synonyms.

Examples of Common Co-occurring Conditions

The following are among the most common dual pathologies:

• PTSD and alcohol abuse or opioid abuse
• Bipolar disorder and alcohol
• ADHD and alcohol addiction
• Depression and cocaine (stimulant) addiction

Alcohol is frequently present in dual diagnosis, as is polydrug abuse.

What Causes Dual Diagnosis?

There is no easy answer to this question. This is partly because it can be hard to determine which condition appeared first – the mental disorder or the substance use disorder. It is very much a case-by-case analysis. Simply put, there are three main possibilities:

Mental Illness Leads to Substance Abuse

People with a mental health disorder may quite simply use alcohol and drugs for the same reason as other people – to feel good, or to experience the drug rush or high. Unlike other people, however, they may find the burden of their mental condition hard to bear. Drugs and alcohol can become a way to self-medicate, and to cope with the unpleasantness, pain, or distress caused by their illness.

Both Conditions Appear Simultaneously

Sometimes substance abuse and mental health issues begin at the same time, and have a common cause. Stress or trauma can affect a person’s mental health, and they may start to turn to substances to alleviate their symptoms. PTSD is a good example of this. Genetics, too, can predispose people to both mental and behavioural issues.

Substance Abuse Causes Mental Health Issues

Prolonged nonmedical use of prescription medications, taking illegal drugs, and alcohol abuse can all cause serious disruption to brain chemistry. This, in turn, can cause mental and emotional problems, such as paranoia or depression. Substance use can also interfere with or aggravate pre-existing mental illness. This, in turn, can drive an individual to continue or increase their substance use.

There is currently still much social stigma around dual diagnosis, and mental illness in particular. People with mental illness may feel ashamed of their condition. They may be afraid to reveal it, even to health professionals. They may be worried their neighbours or work colleagues will find out. As a result, they may not reach out for the help and appropriate treatment they need – and turn to substances for solace instead.

Stigma Associated with Dual Diagnosis

What is Stigma?

Stigma here refers to the negative beliefs, stereotypes, and opinions prevalent in society with regard to dual diagnosis. This includes the lack of knowledge, awareness, and understanding among the general population that give rise to, and perpetuate, the above preconceptions. People with dual diagnosis are frequently subjected to discriminatory behaviours and the prejudice.

As mentioned above, generally speaking, there is more stigma attached to mental illness than substance abuse. However, knowing that an individual is affected by both, many people jump to negative conclusions. They may consider the person untrustworthy, unreliable, inefficient, erratic, dangerous, unpredictable, violent, antisocial, irresponsible, and more.

Common types of stigma include:

• Social stigma: This describes prejudices people have around race, religion, gender, education, degree of wealth, and so on. Society labels people, puts them in boxes, or even dismisses them as inferior citizens or undesirables, based on their characteristics and attributes. Mental illness and addiction can lead to people being rejected, alienated, and discriminated against.
• Self-stigma: This is when an individual starts to believe that any negative image society reflects back to them is accurate and true. They begin to buy into, and take on board, the stereotypes surrounding people with their condition.
• Structural stigma: This refers to cultural and societal norms, and the general mentality prevalent in institutions and organisations, and how these limit opportunity for people with mental illness or dual diagnosis.
• Courtesy stigma: The family and friends of those with mental illness or dual diagnosis can be seen as “guilty by association”. They, too, may suffer discrimination, and be perceived as somehow abnormal because someone in their close circle is unwell.

Causes of Stigma

From the above, we should not conclude that the average person is cruel, bigoted, and judgmental. Prejudice always stems in large part from insufficient knowledge and understanding of a condition, or of a group of people. Lack of direct experience of contact with the group in question also contributes. Other factors include:

• Fear and anxiety: People can be wary of those whose behaviour or way of functioning they don’t understand.
• Guilt: They may feel guilty that they hold judgmental opinions.
• Neglect: They may make no effort to educate themselves.
• Media portrayal: The media often helps perpetuate ignorance and negative images.

Breaking the Stigma of Dual Diagnosis

This can only come about through a significant shift in general attitudes. Educating the general public and changing entrenched beliefs is the key.

The government has a role to play so that educational institutions become less biassed, and the criminal justice system less punitive towards the mentally ill. Mainstream media need to adopt more informed views and become more supportive. Co-occurring disorders need to be brought out of the shadows and discussed openly, intelligently, and empathetically.

Individuals with dual diagnosis need not feel entirely powerless. They can choose to speak more confidently and frankly about their struggles with mental health and substances. In this digital age, social media can be a platform to spread information, create support networks, and start conversation forums. Stigma, just like mental health and substance abuse, can be treated.