Running Head: The Impact of Dual Diagnosis (Mental Illness and Substance Abuse Disorder)

Change in Communities: Resolving a Crisis

Eldah Elias
Independent Research G/T
May 1, 2018

Advisor: Shereen Cabrera-Bentley

Instructor: E. Leila Chawkat
The Impact of Dual Diagnosis (Mental Illness and Substance Abuse Disorder) Elias 1

Abstract

Dual diagnosis of mental illness and substance abuse exerts a profound burden on
individuals and society. This major health care problem should be properly addressed,
communicated to the public, and treated with improved, comprehensive treatment methodology.
The research stems from​ ​the researcher’s evaluation and use of surveys, document analysis, and
interviews, all which have been conducted by other researchers to support the claims that
comorbid illness affects a wide range of people, especially those in the United States. Individuals
with comorbid illness are subject to greater harm than individuals diagnosed with either a mental
illness or a substance abuse disease. Society is not sufficiently aware of the impact comorbid
illness on individual patients and families. Individuals with dual diagnosis should have access to
long-term, comprehensive treatment programs regardless of race, gender, socioeconomic status,
geographic location, and other demographic factors. Appropriate government funding to
evidence-based, effective treatment programs, increased public awareness, and public advocacy
is critical for addressing the unremitting health care problem.
The Impact of Dual Diagnosis (Mental Illness and Substance Abuse Disorder) Elias 2

Table of Contents

Abstract……………………………………………………………………………………………2

Introduction​………………………………………………………………………………………3

Review of Literature​……………………………………………………………………………..4

About Co-occurring Disorder​………………………………………………………….. 4

Comprehensive Treatment Plans​……………………………………………………….

5

Accessibility to Comprehensive Treatment​….…………………………………………7

Public Awareness​………………………………………………………………………...8

Data Collection​…………………………………………………………………………………...9

Rationale​………………………………………………………………………………………….9

Data​……………………………………………………………………………………...11

Analysis of
Data​………………………………………………………………………....15

Conclusions​……………………………………………………………………………………...16

Conclusion​………………………………………………………………………………………17

Works Cited​…………………………………………………………………………………….18
The Impact of Dual Diagnosis (Mental Illness and Substance Abuse Disorder) Elias 3

Introduction

Mental illness and substance abuse disorder is the leading cause of disease burden in the

United States, according to reports from Peterson-Kaiser Health System Tracker, from 2015. It’s

an issue which affects all people, regardless of race, age, socioeconomic status, or geographic

location. This staggering fact invokes questions about what can be done to treat comorbid illness

in the United States which has reached an epidemic level due to a sharp increase in substance

abuse, especially related to the opioid crisis. Dual diagnosis of mental illness and substance

abuse, also referred to as comorbid or co-occurring illness, has effects on individuals and society,

at large, altering the overall well-being of communities. Dual diagnosis is a greater burden to an

individual’s health than isolated occurrences of either mental illness or substance abuse. To

remedy the issues associated with comorbid illness, treatment, recovery, reintegration, and

retention of treatment are all possible, with the right approach. Therefore, it is crucial that special

attention is given to this unremitting health problem.

The Impact of Dual Diagnosis (Mental Illness and Substance Abuse Disorder) Elias 4

Review of Literature

About Co-occurring Disorder

While the prevalence of dual diagnosis is high, there is no established, direct, cause and

effect relationship between mental illness and substance abuse. In several instances, the

root cause of substance abuse has been mental illness and a need to self-medicate.

Likewise, mental illness has occurred as a result of substance abuse. From SAMHSA’s

report on Mental and Substance Use Disorders in 2014, it is estimated that about 43.6

million Americans aged 18 and up experience some form of mental illness and 20.2

million Americans have substance abuse disorders. Of these, about 7.9 million had a

co-occuring mental illness and substance abuse disorder (“Mental and Substance Abuse

Disorders.”). Additionally, Science News, from 2009, reports “​Nearly 60 percent of the

[world’s] population experiences at least one of these mental disorders​ [(Depression,

anxiety​ disorders, alcohol dependence and marijuana dependence)]​ by age 32”​ (​Bower​)​.

Despite this widespread occurrence of comorbid illness, societal stigma persists, and dual

diagnosis patients suffer from it. As a result, incidents of violent behavior towards

oneself and others can ensue (“Studies from East Carolina University Provide New Data

on Mental Health (Risks go beyond the violence: Association between intimate partner

violence, mental illness, and substance abuse among females admitted to a rural Level I

trauma center)”), which can even directly, and often, result in incarceration (Slate). The

illness, once instilling mental affliction in a patient, continues to compromise the

patient’s well being (James), especially if they cannot adhere to medication under certain

circumstances such as imprisonment (Swartz). The consequential outcomes of

The Impact of Dual Diagnosis (Mental Illness and Substance Abuse Disorder) Elias 5

insufficient measures taken to treat comorbid illness as well as low public awareness are

relapse, job loss, frequent patterns of homelessness (Padgett), low aspirations, suicide,

incarceration, and more, which is a vicious cycle for dual diagnosis patients. The

National Institute on Drug Abuse addresses additional health factors which can further

contribute to the evolution of comorbid illness, such as “underlying brain deficit, genetic

vulnerability, and early exposure to stress or trauma”. Even one’s environment and

familial relationships can shape their development of a mental illness or substance

addiction (Bhatt). It has been shown that comorbid illness is not sufficiently treated by

isolating substance abuse disorder from mental illness and aiming to treat one separately

(Drake et al), owing to the shared factors that may influence mental illness and substance

abuse disorders. Therefore, accessibility to comprehensive treatment plans and increased

public awareness are the cornerstone of successful dual diagnosis treatment.

Comprehensive Treatment Plans

Comprehensive treatment plans are an integrative process which address the dual

diagnosis of mental illness and substance abuse using the fields of psychiatry and

addiction treatment. These plans are successful in reducing relapse and effectively

treating mental illness by thorough assessment of both substance abuse and mental

illness, by highly specialized health care providers in both fields (“Treatment Protocol

Effectiveness Study”). On the other hand, the standard case management program for

substance abuse and the standard mental health treatment programs are not as effective

(Teague), due to the lack of flexibility and inclusivity of the treatment. Comprehensive

treatments continue to prove successful in reducing the rate of relapse and increasing
The Impact of Dual Diagnosis (Mental Illness and Substance Abuse Disorder) Elias 6

treatment retention, even decreasing the rate of suicide and overall disability (“Substance

Abuse and Suicide Prevention: Evidence & Implications”). Numerous studies

demonstrate that individual substance addiction programs or psychiatry-based treatment

does not have the same long-term beneficial effects for patients because they are not

always holistic like comprehensive treatment methodology. Another institution attests

that treatment for dual diagnosis must be “comprehensive, taking into account… stress

management, social networks, jobs, housing and activities” (National Alliance on Mental

Illness), and a report detailing discrimination in healthcare yields that treatment should

aim to have homogeneous methods amongst different ethnicities or backgrounds (Mays).

Factors such as cultural sensitivity training and more can further affect treatment

outcomes for the better. As a part of combined treatment methodology, case management

strategies are implemented with highly-trained and certified social workers who work

closely with patients and their families over a long period of time, increasing awareness

and coping mechanisms within the family unit. This has been proven to accelerate the

patient’s healing and significantly reduces the likelihood of relapse (Treatment Protocol

Effectiveness Study). Hospitals and treatment centers in all communities should provide

this comprehensive treatment program for individuals with dual diagnosis. Healthcare

coverages, including the Affordable Care Act, require coverage of essential benefits,

including mental illness and substance abuse treatments (Behavioral Health Treatments

and Services. The most crucial action to be taken, by citizens, to further improve access

to comprehensive treatment plans is to advocate for improved allocation of government

funding.
The Impact of Dual Diagnosis (Mental Illness and Substance Abuse Disorder) Elias 7

Accessibility to Comprehensive Treatment

Overall, comorbid illness is draining to economic welfare on both an individual and

national spectrum. “Spending on mental illness treatments accounts for $89 billion of

total health spending” in the United States (Kamal), and an estimated $193.2 billion is

lost, annually, in earnings, due to mental illness (Insel). Similarly, the “a​buse of tobacco,

alcohol, and illicit drugs is costly to our Nation, exacting more than $740 billion annually

in costs related to crime, lost work productivity and health care” (Trends and Statistics).

Most of this spending occurs through the use of non-comprehensive treatment plans in

hospitals and treatment centers. Therefore, appropriate funding of comprehensive

treatment programs, which are also known as integrated treatment programs, for the

treatment of dual diagnosis is cost-effective because it significantly reduces the risk of

relapse, which would require additional treatment and thus additional costs, and more.

However, these treatments are not widely accessible for patients which need them due to

a lack of funding and resources (​Comorbidity of Substance Misuse and Mental illness in

community mental health and substance misuse services​). Though substance abuse and

mental illness is a global matter, it’s a major healthcare problem in the United States

which needs appropriate funding and the necessary public awareness to address this

public health problem.

Public Awareness

Due to the multitude of substances used in the United States amongst various ethnicities,

socioeconomic statuses, ages, and geographic locations, and the general widespreadness

of mental illness, it impossible to deduce that a single demographic is more likely to be

The Impact of Dual Diagnosis (Mental Illness and Substance Abuse Disorder) Elias 8

affected by comorbid illness. Therefore, overall, greater public awareness of comorbid

illness is absolutely necessary. In order to reduce the occurrence of comorbid illness and,

as a result, provide long term prevention of an epidemic, it is essential for comorbid

illness to be emphasized to all people as a major public health concern. Though it is a

widespread issue, the condition of comorbid illness is often so alienated from discussion

that persons struggling with dual diagnosis and its traumas are most likely ignored by an

audience of non-medical professionals. However, obtaining knowledge of these

conditions can serve the neglected, as public support can greatly stimulate healthcare

delivery and government funding. Finally, another critical measure of public support

would be to integrate patients coming out of long-term programs into society.

Community support of vulnerable members of society provide stability and reassurance,

which in turn allow for a functional, well-rounded organization of people working for

mutual and proliferating benefit. With additional impacts of dual diagnosis such as

self-inflicted harm and the increased likelihood of relapse, incarceration, suicidal

behavior, and more, public attention can help these susceptible individuals feel regarded

and, as a result, less likely to inflict harm. Therefore, to best avert harm of oneself or

others, support systems must be instituted by surrounding communities, for dual

diagnosis patients.

Data Collection

Rationale

In researching comorbid illness and the dual presence of mental illness and substance

abuse, the research question asked “How can the comorbidity of mental illness and
The Impact of Dual Diagnosis (Mental Illness and Substance Abuse Disorder) Elias 9

substance abuse be emphasized as deteriorative, and then in what ways can communities

concentrate their efforts on healing/highlighting the health problem?” Meta-analysis (or

document analysis) mixed-method research was conducted, and it was most beneficial

way in gathering data on the findings regarding comorbid illness. Article-based research

of this topic resulted in numerous findings in which multiple factors could be observed,

so the researcher aimed to objective was to find multiple, corroborative studies with a

centralized theme. A three-step call to action was then derived, and all sources related to

comorbid illness were located based upon three criteria- first, an understanding of the

impairments comorbid illness causes, then addressing the lack of diligent treatment and

public awareness of comorbid illness, and finally, investigating a wholesome way to

show care for persons in the community suffering from comorbid illness. Data attained

through document analysis avoids the obstructions of observing mental health/substance

abuse challenges on a living person. A researcher who is not a medical professional

should not conduct an experiment on humans with psychosis or substance abuse

disorders, since it is difficult to speak with sensitive individuals about their experience(s)

with comorbid illness, and not all programs overseeing dual diagnosis are open to the

public about the internal, controlled handling of patients. An experiment is not a plausible

method of conducting research for the topic because it would most likely yield results

which lack either a uniform opinion or the needed depth gained from investigating

several difficult-to-quantify factors, such as prior traumas which are not measurable by

live experiments. Meanwhile, a survey of patients with comorbid illness may not be truly

reflective of the population with dual diagnosis regarding that many patients remain in
 The Impact of Dual Diagnosis (Mental Illness and Substance Abuse Disorder) Elias
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rehabilitation facilities and are not easily accessible. Duly, meta-analysis, a process which

limits bias and increase the likelihood of agreeable findings, allows access to a wide

variety of information from medical professionals, often providing information which is

as close as the researcher can be without directly investigating a group of patients. From

meta-analysis, the largest limitation of the mixed-method research is the lack of a

patient’s personal account of information, but that flaw lies within the limitations of the

topic rather than than the method of data collection. However, an alternative way to

obtain personal accounts with similar information to scholarly articles is in interviewing a

health professional, like a physician, because one can attain a personal account that

documented reports do not include, as supplemental insight.

Data

Source Public Awareness Initiative Support System

“Implementing Co-occurrence of substance The study emphasized the The source emphasizes

Dual-Diagnosis abusiveness and mental underachievement of that social skills which

Services for Clients illness is common. The 12-step groups because of a need to be advanced in

with Severe Mental source explains that diverse population. This fact the cases of dual

Illness.” (2015) knowledge of comorbid important to handling diagnosis. Society plays

illness must be incorporated comorbid illness because the a large role in the

into society because population of patients with recovery of these

dual-diagnosis is linked to comorbid illness is diverse. individuals. In

higher levels of When traditional methods of integrating them into

The Impact of Dual Diagnosis (Mental Illness and Substance Abuse Disorder) Elias
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incarceration, relapse, treating substance abuse or society, they can assume

homelessness, and violence. mental illness are positions of power they

This is damaging to the conducted, the outcome on didn’t previously have

public, therefore, care needs the patient is control over. Generally,

to be directed to the needs of underwhelming- results patients are redirected to

comorbid illness patients. show negative responses to community support from

non-conjoined treatment. hospitals, but the impact

Adversely, multidisciplinary of surrounding

treatment yielded positive individuals is greater

outcomes in the health of than that of a treatment

patients. The evidence facility.

concludes that effectiveness

of treating dual diagnosis is

in combined use of

treatments to assess the

overall condition, rather

than isolating the two

factors (mental illness and

substance abuse) and

treating them individually.

 The Impact of Dual Diagnosis (Mental Illness and Substance Abuse Disorder) Elias
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“Assessing the Economic Many of the indirect costs of Excessive costs of mental The other ways to reduce

Costs of Serious mental illness – reduced illness and substance abuse homelessness, job loss,

Mental Illness” labor supply, public income affect all of the institutions and incarceration, and

(2008) support payments, reduced in which dual diagnosis other impactful factors is

educational attainment, loss patients are influenced by – through community

of earnings, etc. – are the prisons, hospitals, and the action. The authors stress

major attributes of the streets. The source stresses that the public is not

substantial costs of this impact as fiscally invested in the actions of

comorbid illness. Most of drastic, highlighting the high dual diagnosis

these have large effects on rate of medical individuals, primarily

the population not complications associated because they believe they

personally affected by with serious mental illness. are not affected.

comorbid illness, as their As a result, overall Recognition of all the

benefits are also limited by expenditures in the United factors surrounding

indirect costs. It is necessary States are limited, and the comorbid illness help in

for the general public to access for these comorbidly reducing the overall cost,

understand comorbid illness ill individuals to reach helping the public and

for this reason as well as effective treatment centers is the patients by creating

wanting to reduce the limited. The authors room and incentive for

suffering of their explicitly state that the better treatment. In doing

community members. solution to the high costs of so, the relationship

dual diagnosis is better between comorbidly ill

 The Impact of Dual Diagnosis (Mental Illness and Substance Abuse Disorder) Elias
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treatment methods/facilities, patients and their

and this would involve communities is

properly handling the dual strengthened on both

presence of the two illnesses ends, and the safety of

which reinforce each other. those patients is also

increased because there

is less withdrawal and

thus lesser probable

harm.

“Social Consequences of The detrimental effects of Concurrent with the other The primary statement

Psychiatric substance abuse reduce the sources, the authors express regarding reinstating

Disorders, I: likelihood of dual-diagnosis concern for the current these persons into society

Educational patients continuing with methodology of treating is that that can only be

Attainment” (1995) receiving an education or comorbid illness. achieved through

pursuing a job. This has Consequently, the belief is addressing the persistent

negative impacts on the that, based on scientific negative effects of

whole of society, one being research, psychiatric care comorbid illness.

the prevention of resources facilities should attend to

by people who cannot do dual diagnosis through

their jobs because of their alternative treatment

illness. methods (such as combined

 The Impact of Dual Diagnosis (Mental Illness and Substance Abuse Disorder) Elias
14

treatment plans) because

comorbid illness continues

to be a harm society as it

goes untreated.

“Estimates of Economic As previously mentioned, Rehospitalization is Homelessness is not

Costs of Alcohol and society fails to realize the continuous for comorbidly unusual for persons who

Drug Abuse and hazardous effects of ill patients in many suffer from

Mental Illness, 1985 comorbid illness, but the circumstances because dual-diagnosis. The

and 1988.” (1991) source also draws attention facilities propose ineffective authors put focus on this

to the patients who are treatments to the diagnosis. point as it is extremely

unaware of what they’re As a result, advocacy for harmful to the well being

predisposed to. As a result, better government funding of the patient, because it

when homelessness or grows because this would predisposes them to

relapse reoccurs, it is due to yieldpla better treatment relapse or heavier

factors they cannot options in newer facilities. addiction and affliction.

recognize. The problem lies in the Additionally, it does not

inability to access adequate benefit society, therefore,

treatment, not the it can be limited by the

inexistence of such plans. proper treatment of

comorbid illness.

Analysis
The Impact of Dual Diagnosis (Mental Illness and Substance Abuse Disorder) Elias
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The most alarming result was the substantial impact of comorbid illness on the

economy, as one report writes the cost for treatment, alone, for mental illness, in the

United States, amounts to $129 million in a single year (Rice et al.). Another $58 billion

is attributed to drug abuse costs and $86 billion for that of alcohol abuse (Rice et al.).

This enormous cost adds greater importance to the discussion of mental illness and

substance abuse within society and government. In addition, the public also lacks the

familiarization of how their lives are impacted by the indirect costs of comorbid illness.

Costs continue to accumulate because of inappropriate government funding and the waste

of resources in ineffective treatment plans. Access to comprehensive medical treatment

programs should be the right of all citizens, through appropriate health coverage. Instead

of billions of dollars being lost each year to providing inadequate treatment for comorbid

illness, government funds should be allotted to effective, evidence-based programs.

Conclusions

Alcohol, drug addiction, or both, aggravate existing mental conditions, and similarly, if

untreated, mental illness can predispose patients to substance use. Individuals struggling

with the dual diagnosis of mental illness and substance abuse are neglected socially,

medically, and economically, and that reinforces the damage that they exert upon

themselves and others around them. Therefore, it is evident there is a dire need for action

in order to end the abuse of substances which has risen to epidemic levels and thoroughly

treat the illnesses associated with it. Citizens must be active for the seldom represented,

yet highly-demanding of a voice, and effective treatment programs for health conditions

should be accessible to all people in need of it, regardless of race, socioeconomic status,
 The Impact of Dual Diagnosis (Mental Illness and Substance Abuse Disorder) Elias
16

age, or geographic location. For scientists and researchers, the research conducted can

serve as a basis of knowledge on how to better address related conditions that can be

effectively treated by addressing both simultaneously rather than individually. For

humanity, it is an insightful resource to understand the importance of identifying major

health concerns and how all people, even those not personally afflicted, are affected by

them. Additionally, patients suffering from dual diagnosis of any illnesses can be better

addressed with diligence, knowing that comprehensive treatment plans maximize their

results. Lastly, the will to hold government accountable for their actions is a strong,

mobilizing force which will provide benefits for the lives of all citizens. Conclusively,

obtaining an overall understanding of the depths of dual diagnosis of mental illness and

substance abuse as well as every person’s influential role is of paramount importance to

dissipating the recurrent epidemic of comorbid illness.

Conclusion:

Dual diagnosis is a chronic condition involving mental illness and substance

abuse that needs to be managed over a long period of time, with proper follow-up, in a

comprehensive treatment program that is found to be effective. Access to comprehensive

treatment programs through appropriate government funding and increased public

awareness are the cornerstones of change for addressing comorbid illness. The funding of

the existing ineffective treatment program should be directed to the proven more effective

comprehensive treatment program that shows the reduction in the rate of relapse,

long-term adherence to treatment, and a reduction in suicide and mental health disability.

By effectively treating dual diagnosis patients and providing them the necessary social
The Impact of Dual Diagnosis (Mental Illness and Substance Abuse Disorder) Elias
17

support, they can be integrating into society to be productive members of it. In

conclusion, properly addressing dual diagnosis is crucial for the overall well-being of

individuals and society through economic welfare and social stability.

 The Impact of Dual Diagnosis (Mental Illness and Substance Abuse Disorder) Elias
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