Double pathology: causes and treatments and associated disorders

According to the statistics, six in ten drug addicts also suffer from some form of mental disorder.

While it is true that they can be seen as two distinct conditions, people are in fact victims of a chronic disease known as double pathology.

These patients can continue to suffer from many symptoms, to the point that their personal and family situation is completely overwhelmed, becoming an unbearable circumstance for any of them.

    What is double pathology?

    In the field of mental health, double pathology is called a this condition that concomitantly combines an addiction with a certain type of mental disorder.

    There is a wide range of types of mental disorders that these people can suffer from, ranging from anxiety disorder; psychotic or schizophrenic disorders, mood disorders such as depression or bipolar disorder; and the various pathological personality traits.

    In addition, at the time when the person is suffering from some type of psychiatric illness or condition, he also suffers from an addiction to all types of toxic substances. This dependence can be on any substance accepted by society such as tobacco, coffee, alcohol or certain drugs; or certain types of narcotics or narcotics such as cocaine, amphetamines or cannabis.

    In some cases, behavioral addictions such as gambling addiction or internet and social media addiction have also been reported.

    Causes of double pathology

    From a theoretical point of view, there are different cause and effect links between the two diagnoses inherent in the double pathology. These possible causes are:

    1. Mental disorders as a risk factor

    Suffering from a certain type of mental disorder is a risk factor when developing a certain type of addiction. Psychiatric illnesses are a premorbid factor in double pathology, due to different traits of disorders such as impulsivity, depressed mood or social isolation and withdrawal.

    2. Consequence of substance use

    Pathological personality traits can also be seen as a sequel or effect of a substance use disorder (SUD). These effects may be due to the consequences or effects of the medicine on the body, or stress factors related to consumption.

    3. Common causal elements

    Another possible cause of double pathology is that there is common vulnerability factors surrounding the person, Which can facilitate both the onset of a mental disorder and an addiction.

    4. Independence from disturbances

    Finally, there are cases in which the two disorders are independent and no cause and effect association can be found between them. In these cases, the link between the two diagnoses would be given by the design of the diagnostic classifications, which leads to the overlap of the assessments of the different categories.

      Clinical manifestations or symptoms

      In addition to the symptoms of each of the disorders, patients with a kind of double pathology they usually have a series of common clinical manifestations. These characteristic symptoms or manifestations are:

      1. Emotional instability

      In addition to being a symptom of any personality disorder, emotional instability and depressed mood are very common manifestations in people with substance use disorders.

      2. Cognitive disorganization

      Cognitive disorganization, that is, the tendency of thought to transform into disorganized or tangential thoughts, is also characteristic of some mental illnesses. However, it is a fairly common symptom in people with dual pathology, regardless of their diagnosis of a mental disorder.

      3. Impulsiveness and aggressiveness

      Patients diagnosed with a dual pathology tend to behave impulsively and / or violently. This angry behavior can occur both in the form of self-harm, Induce self-harm, as in the form of aggression towards others expressed suddenly and impulsively.

        Double pathology treatments

        At present, no specific treatment has been developed for people with dual pathology. The action protocol consists of tackling the mental disorder on the one hand and, in addition, carrying out a parallel intervention for the substance use disorder.

        These treatments consist of a combination of psychological intervention, which is considered the treatment of choice in virtually all cases, with administration of psychotropic drugs, Which have more limited effectiveness but are very useful in reducing symptoms that interfere with the patient’s progress.

        Likewise, intervention with relatives of the patient is also necessary, In order to facilitate the management of coexistence and to cope with the symptoms and behaviors of the patient.

        In cases where a substance use disorder is underlying a psychiatric illness, treatment for drug addiction will prevail over treatment for mental disorders. Since it is very likely that by reducing the symptoms of the first, those of the second will also improve.

        Another of the interventions that have been very useful in the treatment of double pathology are psychoeducational techniques aimed at raising awareness of the effects and dangers of substance use, as well as motivational talks.

        Associated personality disorders

        As mentioned above, there are many mental disorders or conditions that can appear or be part of a dual pathology. However, there are two that stand out for their degree of appearance. These are antisocial personality disorder and borderline personality disorder, for which there is a more specific type of intervention.

        Antisocial personality disorder

        Usually there are two types of difficulty in dealing with these patients. One of them is that it is not uncommon for the patient to present for self-determination treatment, So that health professionals and therapists are seen as “enemies”.

        The second complication is that drug use tends to stick around and resist psychological treatmentThis generates high levels of frustration for the clinician.

        Because of these two factors, it is advisable to follow a series of hierarchical guidelines. During which a series of cognitive and behavioral changes must be implemented. This series of steps is:

        • Since the patient’s behavior their goal is to get rewards or avoid punishment, An analysis of the advantages and disadvantages of implementing certain behaviors must be carried out in parallel.
        • Once the patient is aware of the consequences of their actions and the results this may have on others, proceed to guide you on the long-term consequences of your behavior, Use of techniques such as guided imagination, proven effectiveness.
        • Act on the person so that he assimilates respect and esteem to standards and consideration for others.

        Borderline personality disorder

        Much like Antisocial Personality Disorder, people with Borderline Personality Disorder are difficult to treat as they experience a low tolerance for frustration, it is very difficult for them to learn from their own mistakes, And also persist in substance use.

        Likewise, they present a wide variety of cognitive distortions and a tendency to think dichotomously which slows down the professional’s psychological intervention.

        One of the steps in the treatment of these patients is to work and provide the tools to improve their social skills, In addition to knowing how to manage frustration. Thanks to cognitive restructuring, occupational therapy and family therapy, great progress has been made in the treatment of this type of double pathology.

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