Individuals who develop Substance Use Disorders (SUDs) are also at greater risk to suffer from other mental illness. Individual who have mental illness are also at greater risk to develop Substance Use Disorders. While this concept has been well recognized for many years, there are significant problems with making accurate diagnoses.
Many patients with SUDs manifests symptoms that mimic other mental illnesses. For example, if one has an active addiction to drugs and alcohol, one is very likely to manifest disordered behavior from the chemical use even without the presence of another mental illness. Thus, doing a psychiatric evaluation on such an individual who is in his or her active disease state is likely to lead to misdiagnosis of mental illness. Furthermore, someone who suffers from SUDs may very likely not be entirely candid with the evaluator in discussing his or her use of alcohol or drugs. This would mean the the evaluator is trying to make an evaluation without adequate information, which may also lead to misdiagnosis.
In order to do an adequate and valid psychiatric evaluation, on must have a patient whose body is free of mind-altering chemicals. Many times these individuals take multiple medications that may not be necessary. Until the person is clean and sober it is simply impossible to know what tricks are being played by chemicals on the brain and subsequent behavior.
It is not suggested that all patients that have dual diagnosis are incorrectly diagnosed. What is being observed is that those patients that have mental illness who were diagnosed while they actively engaged in their addiction need to be reevaluated when they have achieved some stability in their recovery. At an absolute minimum this would be something on the order of three months clean and sober before there is an opportunity to do a valid psychiatric examination and reach a reasonably certain diagnosis.
One must remember that the medications used to treat mental illness are not entirely without side-effects. They all have risks, as well as benefits.
We will discuss some of these risk specifically, and with what medications, in future post.