Co-Existing Mental Health Disorder and Addiction Must be Treated Together: Expert

Research suggests 50 percent or more of patients with psychiatric disorders abuse some type of drugs, including alcohol. Yet there are relatively few treatment programs that address addiction and mental health disorders together, according to John Tsuang, MD, Director of the Dual Diagnosis Treatment Program at the Harbor-UCLA Medical Center.

“A lot of programs will try to treat either the mental health disorder first, or drug addiction first, but you can’t do that successfully—you have to treat both simultaneously,” said Dr. Tsuang. “A mental health clinic may say, ‘You have to sober up first before we can treat you,’ while a drug and alcohol program may say, ‘You need to get help from a psychiatric program first.’”

Dr. Tsuang, who is also a Clinical Professor at the Department of Psychiatry, Geffen School of Medicine at UCLA, spoke about patients with a dual diagnosis of addiction and mental disorders at the recent American Psychiatric Association annual meeting.

He says that in the past, researchers speculated that people who were depressed were more likely to abuse alcohol, while those who were bipolar were more likely to use amphetamines. Today, however, drug use tends to vary more with age than with the type of mental disorder a person has, he noted.

“We see patients using alcohol, marijuana, meth, cocaine, club drugs, synthetic drugs and prescription opioids,” Dr. Tsuang said. His younger patients are more likely to use marijuana, synthetic drugs or club drugs, while his older patients are more likely to use alcohol, marijuana, cocaine or speed.

He often sees teens with depression or anxiety disorder whose mental health problems are masked by drug use. In some cases, what looks like a psychiatric problem could in fact be caused by drug use, Dr. Tsuang explained. “Mental disorders can increase drug use, or drug use could precipitate mental health issues,” he added.

While there are good treatment options for addiction and for mental health disorders, there is no approved medication that can be used for both, he said. That means patients struggling with both issues might not have medications that can treat both disorders. They might need to take more medications, as well as undergo different types of therapy. As a result, dual diagnosis treatment can be intense and lengthy. His program offers outpatient treatment five days a week.

Because of the complicated regimen required to treat both mental health problems and addiction, Dr. Tsuang said patients and their families should look for a doctor who is certified to treat both areas.

He urged mental health specialists to go deeper in questioning patients about their drug and alcohol use. “A lot of times patients, especially teens, will lie and say they’re not using drugs. In addition to asking the patient, doctors will need to do a urine drug test, talk to the patient’s family members and find out what friends they are hanging out with.”

No one treatment program fits all patients, Dr. Tsuang emphasized. “A lot of programs treat all patients the same. That won’t work with dual diagnosis patients,” he said. “We want doctors to be aware that these patients are difficult to treat. But if they want to get better, they can.”