Simultaneous substance abuse and mental health problem

Antti has been drinking heavily for years. Over the past six months, he has also been very depressed. Antti has not been able to sleep properly and distressing images and thoughts were constantly going through his mind.

The distressing thoughts led him to seek help from a health care centre doctor, who referred him for a talk with the depression nurse. Antti found the first visit to the depression nurse successful: he had not been drinking for two days before the visit and the conversation helped him alleviate his anxiety. He felt he was being listened to and understood. During the second and third visits, Antti was heavily drunk. The depression nurse told him that the conversation was useless if he was drunk. The visits had to stop as this was the second time Antti showed up drunk at the appointment.

Antti was admitted to detoxification, which he had applied for through social services. Antti was very motivated to stop drinking, making the detoxification successful. It also helped Antti stay sober after the treatment. During the treatment, however, Antti suffered from intense anxiety attacks and outbursts of rage, which may have been caused by alcohol withdrawal. Although Antti almost had to abandon the detoxification treatment because of his outbursts of rage, he managed to complete it.

After being sober for two months, Antti still experiences intense anxiety and feelings of hopelessness. In addition, Antti is constantly tired and experiences different kinds of pains and fears. The doctor says that Antti is physically healthy.

What can Antti do?

Antti’s anxiety and fear are not caused solely by excessive use of alcohol. Antti may be suffering from a mental disorder separate from the substance abuse, i.e. dual diagnosis.

The psychological symptoms of substance abusers suffering from dual diagnosis, such as anxiety and depression in Antti's case, do not disappear even after a long period of sobriety. Dual diagnosis patients need treatment both for their substance abuse problem and the mental disorder.

The problem with dual diagnosis patients is that it is often difficult to find a proper place of treatment for them. In order to receive psychiatric treatment, the patient is usually required to have been sober long enough; however, the symptoms caused by the mental disorder may make it more difficult to become sober. In addition, substance use tends to intensify the psychiatric symptoms.

Usually the first goal of the treatment of dual diagnosis patients is to end their dependence on alcohol. Alcoholism can be treated, for instance, at A-Clinics. Once the alcohol use is under sufficient control, the mental disorder can be treated, for example, at the psychiatric polyclinic. In some cases, the mental disorder and the substance abuse can be treated simultaneously and even at the same place. It is likely that in the future both problems will be treated more and more at the same place.

Antti should go, for example, to the health care centre and have his situation examined very carefully. He would probably benefit from some sort of mental disorder treatment.