Most women recovering from substance addiction also need dual diagnosis treatment, due to the high prevalence of co-occurring disorders. Especially for women with a trauma history, integrated mental health care is key.
Villa Kali Ma is a holistic treatment program dedicated to the service of women’s recovery. We treat women’s addiction, mental illness, and trauma, using a signature combination of Western clinical methods, trauma treatments, and holistic therapies.
At heart, Villa Kali Ma is intended as a healing sanctuary, a place where the complexity of women’s suffering is understood and addressed in full. Seeing each woman as individual, we do our best to meet her in the ways that will serve her best.
In this post, we explore why dual diagnosis deserves extra clinical attention.
What Is Dual Diagnosis and Why Does It Require Specialized Care?
“Dual diagnosis” means that someone qualifying for a substance abuse-related diagnosis also qualifies for a mental health disorder. For example, a person can have alcohol addiction and also borderline personality, or benzodiazepine addiction on top of a mood disorder like depression or anxiety. Frequently, people who have a trauma diagnosis like Post Traumatic Stress Disorder or complex PTSD also abuse substances. Many of the women we treat at Villa Kali Ma fall into this category; they experience mental health symptoms in addition to addiction problems, as a way of coping with significant underlying traumatization.
Dual diagnosis is particularly common among women. While substance use creates many mental health problems, and can be a causal factor for being in situations where a trauma is sustained, it is usually the case that pre-existing mental health problems and trauma are contributing factors to the desire to use substances in the first place. In the end, trauma, mental illness and addiction all feed each other, creating a negative loop of suffering.
Dual diagnosis requires specialized care. The presence of addiction and mental health problems working together in a negative feedback loop means that recovery challenges are greater. Women who genuinely would like to be sober may struggle extraordinarily with their symptoms of anxiety, depression, mood swings, or other symptoms, when they stop using substances. The presence of pre-existing mental health problems is a significant relapse risk, if the mental health condition isn’t addressed in parallel with the substance abuse.
Another complicating factor is that many common prescriptions given to women for mental health problems, especially those designed to assist with symptoms of anxiety and attention deficit, are addictive themselves. The use of an addictive pharmaceutical product is counterproductive for any woman with a tendency towards substance dependence.
Further, it is noteworthy that a connection is believed to exist between mental illness and trauma. People who are given mental health diagnoses, more often than not, may have endured traumatic backgrounds. Many Adverse Childhood Events, or ACEs are relatively common. Mental health symptoms like panic attacks and the intense relational problems associated with borderline personality can also arise as symptoms of trauma, both complex and acute.
All in all, there are many advantages to seeking help not only in a context that will treat dual diagnosis, but one that provide trauma-informed services.
Common Co-Occurring Disorders in Women
Dual Diagnosis is more prevalent among women than men. The reason for a higher incidence of dual diagnosis among women is that women are impacted by cultural gender issues as well as biological sex differences that tend to compound addiction and mental health. They are also more likely to be traumatized in early childhood, to be abused sexually as minors, and to be assaulted sexually as adults. Here are some of the common co-occurring disorders for women in substance abuse treatment.
Anxiety
A very common co-occurring mental health disorder amongst women with substance use disorders is anxiety. Anxiety is a close companion of stress and uncertainty in life. Overwhelm in facing daily life, for example when trying to balance the many responsibilities of parenting with working, is a source of toxic levels of stress for many women. Stress is one of the most common reasons that women cite, for their substance use. It’s important to recognize that anxiety, like depression, is also a residue traumatization. For many women the original source of their constant stress is a history of chronic abuse or neglect.
Depression
Depression is a painful mental health disorder characterized by low energy and dark mood. Depression may or may not be accompanied by suicidal thoughts and feelings. While some amount of mood fluctuation is normal as a response to the ups and downs of life, women with depression may get stuck in feeling down, thinking negative thoughts and unable to access joy. Depression is greatly aggravated by all substance use, and women often use substances as a way to get relief from depression.
Borderline Personality
Borderline Personality Disorder is a painful, complex condition that is often diagnosed to women who also have substance abuse and trauma histories. Borderline patterning is recognizable in the archetype of a troubled, unstable, intense woman, who suffers especially in the realm of love relationships. Symptoms like very intense fear of abandonment, rage, impulsivity, instability, despair, and self-harm tendencies may go together with this diagnosis.
Women with borderline personality symptoms frequently also struggle with substances. The search for heightened sensation and emotional intensity, alternating with feelings of despair coupled with self-destructive urges, can easily lead to use of substances to modulate.
It’s also important that women are aware that borderline personality disorder is almost certainly created through trauma, at least according to some researchers in the field.
Trauma and Post Traumatic Stress Disorder
Unsurprisingly, PTSD and complex PTSD are also common co-occurring disorders.
Women using substances are more likely than the average woman to come from a background of childhood sexual abuse, sexual assault, and other adverse events. For such women, there is a direct link between traumatization and using substances to cope. Somewhere between two thirds to three fourths of women seeking treatment for addiction have histories of serious victimization, most often sexual and/or sexual abuse in childhood. Childhood trauma of any kind, including neglect and attachment trauma, is correlated with substance addiction.
Bipolar Disorder
Bipolar disorder is distinguished by extreme mood swings, alternating between over-energized, agitated ups and very deep, dark downs. Cycling between “good” mood (mania) and a mood crash (depression), women with bipolar disorder feel at the mercy of their change of state. Bipolar Disorder is exceptionally painful, and there is a strong tendency for people with this disorder to rely on substances to cope. Women with bipolar disorder typically use different substances during each phase, such as depressants like alcohol or benzodiazepines during manic times, and stimulants like cocaine or methamphetamines to alleviate the depressive phase.
Behavioral Disorders: Eating Disorders and Self-Harm
Women presenting for treatment because of a substance use disorder may also have pre-existing problems with their weight, body image, and emotional eating. Self-harm, including cutting, is likewise a common problem for women who are seeking a way to get relief from emotional pain. Again, eating disorders and self-harm are also linked to a history of sexual abuse and other kinds of trauma.
Integrated Treatment for Lasting Recovery
For all women who have addiction, it’s important to carefully assess for dual diagnosis. Many mental health symptoms are both masked and aggravated by addiction. Emotional instability, chronic depression, and severe anxiety are side effects of addiction to substances.
When painful patterns of thinking, feeling, personality and behavior persist long after a substance has been cleared out of a woman’s body, then those symptoms most likely existed before the start of using substances in the first place. In such cases, a woman qualifies for a standalone mental health diagnosis. This situation is often the case for women, but accurate assessment can only take place after detoxification and the completion of withdrawals.
Since trauma is almost always a factor for women who are using substances, it must be likewise assessed whether what presents as a pre-existing mental health condition like depression or anxiety, is itself a symptom of complex trauma. Assessment is important because of the implications for treatment.
The safest approach for women is to receive substance abuse treatment in a facility that is ready and able to address both mental health and traumatization. Treatment for the latter two conditions must proceed closely upon the heels of the first, in tandem and ideally with great sensitivity and careful monitoring. If treatment for mental health conditions and trauma does not take place shortly after detoxification and completion of withdrawals, the chances that a woman can stay sober plummet.
For all these reasons and more, we recommend integrated treatment in a facility such as ours here at Villa Kali Ma, as the best option for lasting recovery.
Comprehensive Dual Diagnosis Care at Villa Kali Ma
Dual diagnosis is difficult to overcome. The pain of mental health imbalances tends to drive people deeper into substances. The many nightmares of substance addiction, on the other hand, make mental health problems worse. Pervasive trauma rooted in the body, brain, and nervous system informs and affects both mental health and substance addiction.
When all three topics – trauma, addiction, and mental health – can be addressed together in an appropriate setting, however, great healing is possible.
Villa Kali Ma represents a unique opportunity to sensitively address substance abuse, trauma, and mental health as one. Our programs offer comprehensive, holistic and trauma-informed dual diagnosis treatment. Throughout all of our offerings, we unite the most effective western clinical interventions together with the natural approaches for gently healing mind, body, and soul.
