Does Substance Treatment Reduce Violence in People With Dual Diagnosis?
Dual diagnosis is a serious health condition characterized by overlapping symptoms of substance abuse/addiction and at least one other diagnosable mental health problem. Many people in the U.S. dealing with substance issues meet the criteria for this condition, and subsequently have worse mental/physical outcomes than others who do not meet the criteria. In a study published in November-December 2014 in the Journal of Substance Abuse Treatment, researchers from three U.S. universities concluded that effective treatment of substance problems in people with dual diagnosis may lead to a decline in violent/aggressive behavior, a phenomenon linked to several forms of mental illness.
Dual diagnosis can appear in people who have serious problems with any form of substance use, as well as in people affected by any form of non-substance-related mental illness. However, some individuals are more likely to be affected than others. Substances most commonly associated with overlapping mental health issues include marijuana/cannabis, alcohol and the stimulant methamphetamine. Forms of severe mental illness most commonly associated with overlapping substance issues include schizophrenia, major depression, several personality disorders and several conditions categorized as anxiety disorders. Depending on the substance under consideration, roughly 30 percent to 50 percent of all Americans with diagnosable drug or alcohol problems meet the criteria for dual diagnosis. Conversely, depending on the mental illness under consideration, roughly 30 to 50 percent of all Americans with diagnosable mental health problems also meet the dual diagnosis criteria. Generally speaking, people affected by dual diagnosis have a relatively difficult time finding appropriate treatment and following their treatment regimens. They also often experience accelerated health complications and die at an unusually early age.
Violence, Mental Illness and Substance Problems
Aggressive and/or violent behavior only appears in a minority of those individuals dealing with severe mental illness. In addition, affected individuals usually experience aggressive/violent episodes rather than a constantly aggressive or violent pattern of behavior. Forms of mental illness most associated with aggressive or violent acts include schizophrenia, various types of depression and various types of bipolar disorder. The overlapping presence of substance abuse/addiction is known for its ability to increase the odds of violent behavior in a person coping with a severe mental illness. As a rule, odds for violence increase the most in those individuals simultaneously affected by substance abuse/addiction and schizophrenia or some other mental illness capable of triggering the debilitating mental state called psychosis. While roughly 2 percent of the total population only affected by a psychosis-producing illness behaves in criminally violent ways, almost 9 percent of people affected by a psychosis-producing mental illness and substance abuse/addiction engage in criminally violent behavior.
Impact of Substance Treatment
Since active problems with substance use can interfere with mental illness treatment, doctors who treat dual diagnosis patients commonly address issues of substance abuse/addiction before addressing additional issues of mental illness. In the study published in the Journal of Substance Abuse Treatment, researchers from St. John’s University, the State University of New York at Buffalo and Syracuse University used data from 278 adults to determine how successful substance treatment affects the odds for violent behavior in people with dual diagnosis. All of these adults were enrolled in a long-term outpatient program for dual diagnosis patients. Over a period of half a year, the researchers tracked the level of aggressive/violent behavior among the study participants. They used statistical analysis to separate the impact of substance use on aggressive/violent behavior from the impact of severe mental illness.
After completing their analysis, the researchers concluded that changes in the severity of the study participants’ mental illness symptoms had little or nothing to do with the level of involvement in aggressive/behavior. On the other hand, they concluded that the greatest reductions in aggressive/violent behavior occurred in those individuals who significantly reduced their substance intake over the course of the six-month study period. The researchers also concluded that the largest drops in substance intake occurred in those individuals who participated most actively in the dual diagnosis treatment process.
The study’s authors note that violence reduction is not a common reason for prioritizing the treatment of substance issues in people dealing with dual diagnosis. Instead, they believe that their findings point toward an unexpected and previously unrecognized benefit of this prioritization in the form of lowered aggression/violence in people undergoing treatment for this condition.