Category Archives: Dual Diagnosis

How Many Americans Experienced Mental Illness in the Past Year?

Recent data suggests that 19.9% of adults in the United States have experienced mental illness within the past year. Of the 45 million adults, nearly 9 million (20%) also had a substance use disorder.

SAMHSA’s report, Results from the 2009 National Survey on Drug Use: Mental Health Findings indicates that 11 million, or nearly 5%, of adults had a serious, diagnosable, mental illness that substantially interfered with one or more major life activities in the past year.

In many cases, those experiencing a serious mental disorder also had a co-existing substance use disorder. A substance use disorder is defined as abuse or dependency on alcohol or an illicit drug.

Among those with a serious mental illness in the past year, 25% had a substance use disorder in the past year. This is approximately four times the amount experienced by people who didn’t have a serious mental illness.

Less than 4 in 10 adults with mental illness received mental health services. 

In 2009, an estimated 8 million adults aged 18 or older had serious thoughts of suicide within that year; 3.9% of thoughts occurred among women while 3.5% occurred among men.

Among the adults aged 18-25, 6% had serious thoughts of suicide. Adults aged 26-49 had 4.3% and adults aged 50 or older had 2.3%.

In 2009, 2 million adults made suicide plans in the past year. Among the 1 million adults who attempted suicide last year, 0.8 million reported having made plans for the suicide while 0.2 million hadn’t made suicide plans.

The report concluded that mental illness is more likely among adults who were unemployed (27.7%) vs. adults who were employed full time (17%).  Obviously America’s overall unemployment rate is high, but if you are unemployed and feeling depressed, take the time to volunteer somewhere. Sitting in your house day after day with nothing to do is only going to make you feel worse. Animal shelters, hospitals, senior homes, and zoos are all great places to volunteer. The Humane Society or local shelter can always use volunteers, and giving animals attention who otherwise would have none is a great use of one’s time.

Age and gender may have an effect on mental illness. Young adults (aged 18-25) reported the highest level of mental illness (30%), while participants aged 50 and older had the lowest at 13%. 23% of women and 15% of men reported having a mental illness.

Drug and alcohol use also effects mental health. Out of 10% of adults with a substance use disorder, 2.2 million adults aged 18 and older had serious thoughts of suicide in 2009.  Suicidal thoughts were higher in adults who had abused drugs within the past year over those adults who had not.

Adults with substance abuse dependence or abuse were also more likely to make a suicide plan or actually attempt suicide then adults without substance abuse.

At Apex Behavioral Health, we offer co-existing treatment for substance abuse and mental disorders. Both issues need to be treated in order for a person to get better. Many clinics will focus treatment strictly on substance abuse, but substance abuse and depression or whatever mental disorder it is need to be addressed and treated too. Substance abuse and depression exist simultaneously and need to be treated as such.

Dual Diagnosis

A recent survey regarding the homeless people in the Detroit area found that 51% of the people questioned are at risk of dying on the streets, a 9% increase above the national average.

The Neighborhood Service Organization, in coordination with Detroit area homeless service providers, surveyed Detroit, Hamtramck, and Highland Park identifying and counting people to find those that are most at risk of dying on the streets. 211 people were surveyed during three nights during the hours of 4 and 7 a.m.

The survey found that the average number of years homeless is 5.38. 99 people reported a dual diagnosis of mental illness and substance abuse. 29 of the people surveyed were veterans and 32 people reported having a history of foster care. There were a total of 358 inpatient hospitalizations in the past year with a total of 456 emergency room visits in the past three months. 103 people reported having no insurance; 74 people reported having been in prison and 149 people reported having been in jail.

13% of the people were aged over 60, the oldest respondent being 72 years old.

Treating a dual diagnosis of mental illness and chemical dependency is very difficult. Some mental health services are not equipped to deal with patients having both disorders and as a result, only one  issue is identified. However, if both diagnoses are identified, the patient may be bounced between treatments for mental health and substance abuse.

Research studies have concluded that a minimum of 50% of the mentally ill population also have a substance abuse problem. People with mental illnesses may have a chemical dependency problem that their family is not aware of; or the family may underestimate the extent of drug dependency. It may be difficult to determine which behaviors are attributed to mental illness versus what behaviors are caused by chemical dependency.

 In order to have an accurate diagnosis of a mental disorder, the cause of behavior has to be determined. If a person is experiencing delusions or hallucinations, the delusions may be a result of schizophrenia, depressive  disorders, mania, Alzheimer’s related dementia, panic attacks, or drug or alcohol intoxication.  Treatment for schizophrenia is different from treatment for chemical dependency, which is why it is important to pinpoint the cause of behavior to ensure the most effective treatment.

Chemical dependency complicates treatment of mental illness. The individual may be difficult to engage in treatment, they may be in denial; and their diagnosis is further complicated because of the interacting effects of substance abuse and mental illness. Individuals may frequently relapse and require hospitalizations and may not be tolerated in community rehabilitation programs.

Some individuals may begin to drink or use drugs for recreational reasons, but their reasons for continuing use may differ. It is likely that many individuals continue using as a way to treat symptoms or side effects from the medication. Drug use may reduce the level of anxiety or depression, at least short term. It is possible that an underlying vulnerability exists in the individual that precedes mental illness and chemical dependency.

Social factors, such as living environment, may also account for continued drug use. People may find themselves living in neighborhoods where drug use is prominent. An individual may find himself more easily accepted in a social setting when the group’s activity is based on drug use, particularly if he or she has difficulty establishing social relationships.

Typically, there are separate treatment programs for mental health and substance abuse. Clients with a dual diagnosis are referred back and forth between the treatments, but hybrid programs that address both issues prove to be extremely beneficial. Such a program is available at Apex Behavioral Health, in our Westland office.

Drug program treatments are limited in helping mental illness patients because the programs are too confrontational and people with severe mental illness are too fragile to benefit from that particular type of treatment. Confrontation, emotional jolting, and discouraging use of medications has proven to be detrimental to mental health patients. The treatments may lead to stress which can cause relapse.

Desirable treatment programs for a dual diagnosis should be less confrontational and take a more gradual approach. Clients have to proceed at their own pace during treatment and credit should be given for any accomplishments regarding their drug use decreasing.

It is argued that substance abuse treatment programs are more geared toward the young male population. Rehabilitation, substance abuse, and gerontology literature pay little attention to elderly drug abuse and largely ignore it, therefore, little information is known about prevalence or occurrence about drugs in the elderly population.

The types and extent of drug and alcohol use among the elderly is elusive. Individuals aged over 65 make up 12.4% of the total US population; however, by 2030 this group is expected to double in size.  At that time, the elderly population will include baby boomers, many of whom have already been exposed to drugs or alcohol in the 1960s.

Researchers have noted that drug or alcohol symptoms seen in the elderly are often mistaken for various symptoms of aging, such as dementia or depression. It is unknown if elderly patients would require unique substance abuse treatment since little research has occurred on senior illicit drug use.

However, significant data is available for the elderly population on prescription drug use. Elderly adults consume more over-the-counter and prescription drugs than any other age group on a daily basis.  One researcher noted that elderly adults are 2-3 times more likely than younger individuals to be prescribed psychoactive drugs, including benzodiazepines.

The elderly population is not immune from chemical dependency;  there is not an age limit for addiction. Further research needs to be conducted to determine the prevalence of drug abuse among the elderly population. The seniors may require different substance abuse treatment then the youth. There has not been enough research done to prove that the generic substance abuse treatment is effective for all age groups.

It is probable that a 70-year-old male will require different substance abuse rehabilitation treatment than an 18-year-old female. A 70-year-old female suffering from depression and drug use will require different treatment from a 75-year-old male who has PTSD and an alcohol problem.

Treatment is unique for each individual and this is especially true for individuals with a dual diagnosis. Treatment for depression is different than treatment for substance abuse, and a person who has a dual diagnosis will require a different, combined treatment which is available at Apex Behavioral Health.

It is important that the elderly get treated for depression. While the elderly population accounts for 13% of the US population, they account for over 18% of all suicides.

Some people believe that depression is a normal component of aging, but that is not true. Physical ailments and medications can cause depression.

The following diseases or physical problems may result in depression. 

  • thyroid disorders  
  • diabetes  
  • Parkinson’s disease  
  • multiple sclerosis  
  • strokes  
  • tumors  
  • some viral infections 

The following medications may cause symptoms of depression: 

  • blood pressure medication  
  • arthritis medication  
  • hormones  
  • steroids

Many elderly people will hide their depression or substance abuse so it is important to notice subtle hints. Untreated depression is the number one cause of suicide.

Suicide warning signs include:

  • Appearing depressed or sad most of the time.
  • Talking or writing about death or suicide.
  • Withdrawing from family and friends.
  • Feeling hopeless.
  • Feeling helpless.
  • Feeling strong anger or rage.
  • Feeling trapped — like there is no way out of a situation.
  • Experiencing dramatic mood changes.
  • Abusing drugs or alcohol.
  • Exhibiting a change in personality.
  • Acting impulsively.
  • Losing interest in most activities.
  • Experiencing a change in sleeping habits.
  • Experiencing a change in eating habits.
  • Losing interest in most activities.
  • Performing poorly at work or in school.
  • Giving away prized possessions.
  • Writing a will.
  • Feeling excessive guilt or shame.
  • Acting recklessly.
  • A dual diagnosis can be treated effectively with the proper treatment for a person of any age. Please call Apex Behavioral Health if you or someone you know needs treatment.