What Came First Mental Illness or Addiction?


The Chicken or the Egg debate is one that has been ongoing as far as mental illness and addiction in dual diagnosis patients is concerned.

This debate is centered on whether substance abuse caused mental illness or mental illness caused substance abuse.

Two Different Groups in this Debate

There are two different factions in this debate, which each believing mental illness or substance abuse came first, respectively.

While the two differing groups may never agree, there are some points that stand out as far as this debate is concerned.

These form very important foundations of the debate and they are:

1. It is a fact that there is a correlation between substance abuse and mental illness.

There have been documented instances of substance abuse inducing mental illness. This includes cases of alcohol-induced depression, cocaine-induced psychotic disorder and stimulant-induced manic disorder.

2. When diagnosing co-occurring disorders, there needs to be a line drawn between substance dependence and abuse.

Unfortunately, this does not always happen and some people will use the two terms interchangeably when in fact they are very different. This comes into play when debating which one of mental illness or addiction came first in that until dependence vs abuse is determined, the effective treatment applied is accidental.

3. During dual diagnosis, clinicians will treat the case as if there is one primary diagnosis and a secondary diagnosis.

For instance, in the case of alcoholism, the diagnosis is one of a primary disease which is not caused by mental illness.The genes that cause addiction have been isolated and in the case of alcohol use, mental illness may be a trigger but not necessarily a cause.

As such, where alcoholism is determined in the presence of a mental illness, clinicians will most likely treat the mental illness as the primary disorder.

The alcoholism on the other hand is treated secondarily instead of taking prominence as a primary disease.

It is easy to see that treating the mental illness first and expecting the addiction to go away on its own is a contraindication, which brings us back to the drawing board.

Depending on which side of the debate they are on, professionals choose to handle dual diagnosis in different ways.

Which Side Are Professionals On

Some professionals will choose to diagnose mentally ill substance abusers as addicts or alcoholics.The downside of this is that often times it results in wastage of time and effort. And the chances of relapse after the untreated mental illness recurs are high.

Which then begs the question whether mental illness should take precedence over substance abuse as far as dual diagnosis is concerned.

It is safe to assume that the debate on which came first, between mental illness and substance abuse, is not going to come to and end any time soon.

What is clear though is that clients who have been dually diagnosed need a lot of help to overcome their COD.

It is dual diagnosis treatment centers like The Recovery Way that go the extra mile to ensure clients get their life back after battling with mental health disorders and substance abuse, irrespective of which came first.

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