Substance Abuse Disorder and Mental Illness – Dual Diagnosis: By Jonathan Dunn

There is a an unfortunate increase in the number of individuals who suffer both from a mental illness and a substance abuse disorder, more commonly known as a dual diagnosis. In fact, families who have a loved one with a “co-occurring addiction and mental health disorder constitute the expectation, not the exception.”

Substance abuse takes many forms. One substance which has been gaining statewide as well as national attention are opioids (prescription pain medications). In March of 2014 the MA Department of Health and Human Services declared a public health emergency due the rise in opioid abuse in the Commonwealth. The mortality rate of opioid overdoses in MA had risen from 383 in 2000 to 863 in 2013, an increase of 225%. MA is not alone in its struggle with dramatic increase in substance abuse. The National Institute on Drug Abuse reports that there has been a nationwide rise in overdoses from opioids close to 250% (from 9,197 in 2001 to 22,767 in 2013). While the increased mortality rate for opioid abuse is alarming there is even more concern for the mentally ill population who at a much higher risk of substance abuse disorders.

Those with a mental illness are almost twice as likely to have used illicit drugs. The Substance Abuse and Mental Health Services Administration (SAMSHA) has been studying the rates of drug use among the mentally ill. As of 2012 nearly 20% of United States adults (over eighteen) experienced a diagnosable mental illness. Within that population 26.7% of adults with a diagnosable mental illness admitted to using illicit drugs as compared with only 13.2% of adults without a diagnosable mental illness. SAMSHA also found that of the 20.7 million adults with a substance abuse disorder, 8.4 million (40.7%) also suffer from a mental illness. It is increasingly apparent that there is a strong connection between substance abuse and mental illness.

There is help for those with a dual diagnosis. In seeking medical treatment for a dual diagnosis it is important to keep in mind that, “It is often difficult to disentangle the overlapping symptoms of drug addiction and other mental illnesses, making diagnosis and treatment complex. Correct diagnosis is critical to ensuring appropriate and effective treatment.” Legally, a family with a loved one suffering from either a dual diagnosis is able to get help from the Courts as well. Either or both a guardianship or conservatorship may be an appropriate way for concerned loved ones to seek much needed treatment for their loved one with a dual diagnosis or substance abuse disorder.

Under the Uniform Probate Code in MA the standards for seeking a guardianship can include substance abuse disorders and dual diagnosis, depending upon the severity of the addiction. The criteria the courts look at to determine if someone lacks capacity are 1) a clinically diagnosed condition, 2) that results in an inability to receive and evaluate information or make and communicate decisions, 3) to such an extent that the person lacks the ability to meet essential requirements for physical health, safety, or self-care, 4) even with appropriate technological assistance. In many cases a person suffering from a substance abuse disorder or a dual diagnosis may meet the above criteria and the Courts may appoint a guardian to protect that person during this time of great vulnerability. The most important concern about the legal standard is to focus on the severity of the substance abuse or dual diagnosis and if the symptoms of the addiction are enough.

The problems with substance abuse are on the rise nationwide but there is help available in the form of appropriate treatment and legal intervention where appropriate. The most important factor to keep in mind throughout is that recovery is possible.

[1]New Partnership Seeks Evidence-Based Care for Co-occurring disorders – Gary A. Enos, Editor, Addiction Professionals.
 
[1]A Comprehensive Strategy to End Opioid Abuse in Massachusetts. Massachusetts Executive Office of Health and Human Services. Available at http://www.mass.gov/eohhs/feature-story/end-opioid-abuse-in-mass.html . Last viewed October 15, 2015.
 
[1] Fatal Opioid-related overdoses Among MA Residents 2000-2013. Massachusetts Department of Public Health. December 2014. Available at http://www.mass.gov/eohhs/docs/dph/injury-surveillance/overdose/fatal-opioid-overdoses-brief-2013.pdf . Last viewed October 15, 2015. 
 
[1] Overdose Death Rates. National Institute on Drug Abuse. Available at https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates Last viewed October 15, 2015.
 
[1] Substance Abuse and Mental Health Services Administration, Results from the 2012 National Survey on Drug Use and Health: Mental Health Findings, NSDUH Series H-47, HHS Publication No. (SMA) 13-4805. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013. Available at http://archive.samhsa.gov/data/NSDUH/2k12MH_FindingsandDetTables/2K12MHF/NSDUHmhfr2012.htm#sec1-1  Last viewed October 16, 2015.
 
[1] Id.
 
[1] Id.
 

 

[1] Id. 

 

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The Boston law practice of Blake Law is the result of more than 40 years of passionate advocacy for our clients and their families to ensure that those who are charged with the responsibility of caring for the mentally ill, aging parents, spouses, and disabled children receive the legal services that they need. Blake Law works with clinicians and treatment facilities for substance abuse and dual diagnosis. Located in Boston's Old City Hall, Blake Law is committed to providing much needed legal services for families in crisis who have a loved one suffering from diminished capacity. We understand the services available and the systems you must work through. Call and talk to our experienced attorneys to discuss your specific individual/family needs today at (617) 723-3224.