DUAL PATHOLOGY: SYMPTOMS, CAUSES AND TREATMENTS - ECONOMÍA - 2025

The dual pathology is the concurrency in the same individual substance abuse, along with the presence of severe mental disorders, particularly psychotic and / or affective.

In dual pathology, the addiction can be to a substance or behavioral (gambling). Regarding substances, they can be culturally accepted, such as xanthines (coffee, theine), alcohol, tobacco or those not accepted such as cannabis, opiates or stimulants.

On the other hand, mental disorders are usually mood disorders (for example major depression or bipolar disorder), anxiety disorders, personality disorders, psychotic disorders or attention deficit disorder (ADHD).

The importance of this comorbidity has been evidenced in numerous studies due to the influence it has on clinical treatment, on the evolution of both disorders, and the costs it generates.

The use of psychoactive substances is strongly associated with psychiatric morbidity, not only in adults but also in early life.

In our society, substance abuse is a problem that concerns public health. Within the general population the percentage of people who consume or have consumed some type of legal / illegal substance at some point in their life is very high.

Dual Patient Epidemiology

Dual pathology is a serious problem given its epidemiological rates. Different studies in the general population and in the clinical population have shown that the comorbidity between a mental disorder and a substance use disorder is between 15 and 80%.

It is also noted that about 50% of people with a mental disorder meet criteria for substance use disorder at some point in their life cycle.

About 55% of adults with a substance use disorder also had a psychiatric disorder diagnosis before the age of 15.

Furthermore, different studies have shown that the prevalences of comorbidity in psychiatric patients with substance use disorders are higher than those in the general population, which are between 15 and 20%.

Dual patient profile (symptoms)

Hospitalization

Patients with dual pathology, compared to those with only a diagnosis of substance use or only a mental disorder, usually require longer hospitalization and more frequent emergency care.

In addition, they involve an increase in healthcare spending, greater medical comorbidity, higher suicide rates, poorer adherence to treatment and their treatment results are scarce.

Worse social adaptation

They also present higher unemployment, marginalization, disruptive and risky behaviors. In addition, a higher risk of infections such as human immunodeficiency virus (HIV), hepatits, etc., and more self and hetero-aggressive behaviors.

Very often they lack social support networks, they live in circumstances that we can consider stressful, they suffer from various drug addictions (polydrug use pattern) and they have a high risk of becoming homeless.

Lack of awareness of illness

They tend to present a lack of awareness of the disease, difficulty in assuming and communicating that they have an addiction. In addition, they are usually identified with only one of the disorders, drug dependence or psychiatric disorder.

They have a high failure rate in previous therapeutic interventions and are highly likely to relapse.

Most frequent drugs

Regarding substances, excluding nicotine, the drug most frequently used in dual pathology is usually alcohol, then cannabis, followed by cocaine / stimulants.

The natural evolution of severe dual pathology tends to worsen social adaptation, aggravate maladaptive behaviors, and often end in problems such as prison admissions, psychiatric hospitalization, and social exclusion.

Causes

Most dual pathology scholars (such as Casas, 2008) indicate that dual pathology is the result of different etiological variables.

These are both genetic and environmental and also feed into each other, generating neurobiological changes in which cognitions, emotions and behaviors are created that give rise to mental illness formed by two entities: a mental disorder and an addiction.

Diagnosis and treatment guidelines

The dual patient requires more attention and time, greater skills on the part of the professional when caring for him, and greater acceptance and tolerance. Goals that the patient can achieve, reduce consumption and increase adherence to treatment should be established.

We must make the patient aware of their problem, work on the desire to consume and prevent relapses, their social support and social skills and coping strategies.

It is key to work on improving family dynamics and rehabilitation at different levels, be it family, social, work…

The intervention must be at the motivational, psychoeducational, socio-family level and through techniques such as relapse prevention, contingency management, problem-solving techniques and relapse prevention.

Psychoeducation

It is about the patient knowing his illness, complying with the treatment, preventing the consumption of toxins and psychiatric symptoms, learning to manage his symptoms and to solve and face problems.

It is intended to increase well-being, communication with others and know how to face different social situations.

Cognitive-behavioral approach

This approach argues that the symptom is an expression of maladaptive thoughts and beliefs that are due to the personal history of learning.

Multi-component programs are used to treat additive behaviors.

Motivational intervention

It is crucial because adherence to treatment depends on it. It is about taking into account the patient, their opinions, needs, motivations, solutions, their characteristics…

It is about the patient participating in the treatment and promoting change from himself.

Social and family intervention

Dual pathology has a negative effect on the families of patients. The family feels fear, anger, guilt, etc.

It is also about working with families to work on maintaining treatment, working on inappropriate behaviors, etc., also offering them emotional support.

References

1. Arias, F., Szerman, N., Vega, P., Mesias, B., Basurte, I., Morant, C., Ochoa, E., Poyo, F., Babin, F. (2012). Cocaine abuse or dependence and other psychiatric disorders. Madrid study on the prevalence of dual pathology. Journal of Mental Health Psychiatry.
2. Baena Luna, MR, López Delgado, J. (2006). Dual disorders. Aetiopathogenic mechanisms. Addictive Disorders, 8 (3), 176-181.
3. Barea, J., Benito, A., Real, M., Mateu, C., Martín, E., López, N., Haro, G. (2010). Study on etiological aspects of dual pathology. Addictions, 22, 1, 15-24.
4. Spanish Confederation of Groups of Relatives and People with Mental Illness, FEAFES (2014). Approach to dual pathology: intervention proposals in the Feafes network.
5. Forcada, R., Paulino, JA, Ochando, B., Fuentes, V. (2010). Psychosis and addictions. XX Conference on drug addiction: dual pathology, diagnosis and treatment, 3-8.
6. de Miguel Fernández, M. The psychotherapeutic approach in dual pathology: scientific evidence. Provincial Institute of Social Welfare, Diputación de Córdoba.
7. Torrens Mèlich, M. (2008). Dual pathology: current situation and future challenges. Addictions, 20, 4, 315-320.
8. Website: National Institute on Drug Abuse (NIDA).
9. Rodríguez-Jiménez, R., Aragüés, M., Jiménez-Arriero, MA, Ponce, G., Muñoz, A., Bagney, A., Hoenicka, J., Palomo, T. (2008). Dual pathology in hospitalized psychiatric patients: prevalence and general characteristics. Clinical Research, 49 (2), 195-205.
10. Roncero, C., Matalí, J., Yelmo, YS (2006). Psychotic patient and substance consumption: dual disorder. Addictive Disorders, 8 (1), 1-5.
11. Touriño, R. (2006). Dual pathology and psychosocial rehabilitation. Psychosocial Rehabilitation, 3 (1): 1.
12. Usieto, EG, Pernia, MC, Pascual, C. (2006). Comprehensive intervention for psychotic disorders with comorbid substance use disorder from a dual pathology unit. Psychosocial Rehabilitation, 3 (1), 26-32.