Dual pathology: causes and treatments, and associated disorders.

This medical and psychological condition is very difficult to treat, since drugs and disorders are mixed.

According to statistics six out of ten drug addicts also suffer from some kind of mental disorder..

While it is true that they may be considered as two separate conditions, in reality people are victims of a chronic illness known as dual pathology. a chronic illness known as dual pathology.

These patients can suffer a great number of symptoms, to the point that their personal and family situation is completely overwhelmed, becoming an unsustainable circumstance for any of them.

What is dual pathology?

Within the scope of the mental health it is denominated dual pathology to that affection that combines, of concomitant form, an addiction with some type of mental disorder..

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

Also, at the same time that the person suffers from some type of psychiatric disease or condition, he or she also suffers from an addiction to any type of psychiatric disorder, also suffers from an addiction to any type of intoxicating substance.. This addiction can be to any substance accepted by society such as tobacco, coffee, alcohol or certain medications; or to some type of narcotic or narcotic drug such as cocaine, amphetamines or cannabis.

In some cases, behavioral addictions such as compulsive gambling or addiction to the Internet and social networks have also been reported.

Causes of dual pathology

From a theoretical perspective, there are different cause-effect links between the two diagnoses of dual pathology. These possible causes are:

Mental disorder as a risk factor 2.

Having some type of mental disorder is a risk factor when it comes to developing some type of addiction. Psychiatric illnesses constitute a premorbid factor in dual pathology, due to in dual pathology, due to the different features of the disorders such as impulsivity, depressive mood or social withdrawal and reclusion.

2. Consequence of substance use

Pathological personality traits can also be considered a sequela or effect of a substance use disorder (SUD). These effects may be due to the consequences or effects that the drug has on the body, or to stressors related to the use of the drug..

3. Common causal elements

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

4. Independence of the disorders

Finally, there are cases in which both disorders are independent, and no cause-effect association can be found between them. In these cases the connection between both diagnoses would be given by the design of the diagnostic classifications themselves, which give rise to the possibility of overlapping the assessments of the different categories.

Clinical manifestations or symptoms.

In addition to the symptoms specific to each of the disorders, patients with some type of dual pathology usually present a series of common clinical manifestations. These symptoms or characteristic manifestations are:

1. Emotional instability.

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

2. Cognitive disorganization

Cognitive disorganization, i.e., the tendency for thinking to become disorganized or tangential thoughts, is also characteristic of some mental illnesses. However, it is a fairly common symptom among people with dual pathology, regardless of their mental disorder diagnosis.

3. Impulsivity and aggressiveness

Patients diagnosed with dual pathology tend to present impulsive and/or violent behaviors. This choleric behavior can be in the form of self-aggressivenessThe most common form of self-injury is self-injury, as in the form of aggression towards others expressed in a sudden and impulsive manner.

Treatments for dual pathology

At present, no specific treatment has been developed for people with dual pathology. The protocol for action consists of addressing 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 to be the treatment of choice in practically all cases, with the administration of psychotropic drugswhich have a more limited efficacy but are very useful in reducing the symptoms that interfere with the patient's evolution.

Likewise, it is also necessary to intervene with the patient's relativesThe aim is to help them manage the patient's symptoms and behaviors and to help them cope with the patient's symptoms and behaviors.

In cases where the substance use disorder is underlying the psychiatric disease, the treatment of drug dependence will take priority over the treatment of the mental disorder.. Since it is very likely that by reducing the symptoms of the former, the symptoms of the latter will also improve.

Other interventions that have proven to be very useful in the treatment of dual pathology are psychoeducational techniques aimed at raising awareness of the effects and dangers of substance use, as well as motivational interviewing.

Associated personality disorders

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

Antisocial personality disorder

There are usually two types of difficulties in intervention with these patients. One is that it is not usual for the patient to attend treatment on his or her own initiative, so that both the health personnel and the patient's family may have to make the necessary changes.The first is that it is unusual for the patient to come to treatment of his or her own accord, so that both the health personnel and the therapist are perceived as "enemies".

The second complication is that drug use tends to remain and resist tends to remain in and resist psychological treatment, which leads to high levels of drug abuse.The second complication is that drug use tends to remain and resist psychological treatment, which generates high levels of frustration in the clinician.

Because of these two factors, it is advisable to follow a series of guidelines ordered in a hierarchical manner. Along which a series of cognitive and behavioral modifications have to be implemented. This series of steps are:

• Given that the patient's behaviors rewards or the avoidance of punishment, an analysis of the advantages and disadvantages of performing certain behaviors should be carried out together with the patient.Once the patient is aware of the consequences of his actions and the results that this may have on his behavior, an analysis of the advantages and disadvantages of carrying out certain behaviors should be carried out together with him.
• Once the patient is aware of the consequences of his or her actions and the results that this may have on others, we proceed to the long-term consequences of his or her behaviors, using techniques such as guided imagery, guided imagery and guided imagery.using techniques such as guided imagery, which have proven to be effective.
• Act on the person so that he/she assimilates respect and appreciation for the rules and consideration for others.

Borderline personality disorder

Much like antisocial personality disorder, people with borderline personality disorder are difficult to treat in that they have a low tolerance for frustration, it is very difficult for them to learn from their own mistakes.and also persist in substance use.

They also they present a great variety of cognitive distortions and a tendency to dichotomous thinking and a tendency to dichotomous thinking that hinders the psychological intervention of the professional.

One of the steps to follow in the treatment of these patients is to work and facilitate the tools to improve their social skills. to improve their social skills, as well as to know how to manageand to know how to manage frustration. Cognitive restructuring, occupational therapy and family therapy have made great advances in the treatment of this type of dual pathology.