Knowing the origin may be irrelevant in some diseases, but it is crucial to arrive at the most effective therapy in others. This is the dual pathology, in which not knowing the psychiatric pathology underlying drug addiction can lead to therapeutic failure.
According to Miguel Casas, professor of psychiatry at the Autonomous University of Barcelona and president of the Spanish Society of Dual Pathology (SEPD), dual pathology is “a way of seeing drug addiction and psychiatry in an integrated way.” Accept that there is an undeniable interconnection between mental illness and drug abuse.
Ignacio Benito, a psychologist at the Ita Addictions and Dual Pathology centre in La Garriga (Barcelona), explains that dual pathology is called “the concurrence in the same individual of, at least, one substance use disorder and another psychiatric disorder”. The expert adds that these patients “are frequent and more serious, both from a clinical and social perspective, than subjects who only suffer from one type of disorder (addictive or another psychiatric illness)”.
The question that arises is the following: which is the cause and which is the consequence? For example, do people with psychiatric pathologies have a greater tendency to consume addictive substances, or is drug addiction what leads to the development of mental disorders?
Mental illness as a vulnerability factor
Casas is clear about the most frequent order of the factors. It is estimated that up to 25% of the population will suffer from a serious psychiatric disorder at some point in their lives. “These problems are the main vulnerability factor for people who come into contact with drugs to get hooked,” he asserts, arguing that, compared to the large number of people who try alcohol, tobacco, cocaine, heroin and other drugs, far fewer develop an addiction.
A good example is an alcohol: a very large percentage of the population consumes it from time to time or, at least, has tried it, but there are many fewer (although the figure is not negligible) who can be considered alcoholics. “Usually the psychiatric pathology appears first and then the drug addiction“, concludes the psychiatrist.
Benito adds that “people who have a genetic predisposition to suffer from a mental illness, that is, they have a certain vulnerability – the pathology is dormant or latent – and due to the consumption of a certain substance, they end up developing it”.
Most suitable treatment
Treating these patients is complex, but there are effective therapeutic measures. For example, Casas considers that the fundamental thing is “to locate the psychiatric pathology and treat it; it is essential to look for the origin of drug abuse, which is almost always a mental illness”.
Instead, Benito points out that “to work in multidisciplinary teams and tackle both problems at the same time is very important.” The first step would be “performing good detoxification and stabilisation to make a good differential diagnosis. There are people who, due to consumption, develop another mental pathology and others in whom we observe that the associated pathology remits”.
Profile of those affected by dual pathology
As far as the profile of the patients is concerned, the experts agree that it is necessary to banish the old myths that relate drug addiction to educational level, cultural level or social class.
The image of a person suffering from mental illness and abusing substances due to separation from their parents, having a broken family or living in a marginal neighbourhood does not correspond to the reality of dual patients, who may belong to any socioeconomic stratum. “Having adequate social and family support can be important to get out of this situation, but not for the beginning”, alleges Casas.
Today there is an increasing trend in these people towards polydrug use (using multiple substances simultaneously), although Benito confirms that “alcohol, cannabis and cocaine are the most common substances”.
How to act with patients
The attitude of the environment of those affected exerts a great influence on the start and good follow-up of the treatment of dual pathology. Here are some of the factors to consider:
- Those affected often resist receiving treatment and abandon substance use. In moments of vulnerability, they may ask for help but then dismiss the idea.
- The family’s involvement during the process is vital: they must accept the disease, know it and follow the professionals’ instructions.
- Labelling patients as vicious or lazy does not help to understand their pathology and initiate the most appropriate therapy.