Dual Diagnosis: Co-morbidity, Society, Steroids, and Health Effects

This essay delves into the concept of dual diagnosis, also known as comorbidity or co-occurring disorders, focusing on the intersection of mental disorders and substance use. It explores the historical and cultural variations in the treatment of mental illness, particularly in Australia, highlighting the stigmatization faced by individuals with such conditions. The paper examines the use and effects of anabolic steroids, discussing their impact on physical and mental health, including eating disorders, cardiovascular issues, and psychotic disorders. Furthermore, the essay addresses the addictive nature of steroids and provides insights into addiction patterns and health complications. It also touches upon the treatment and management of dual diagnosis, emphasizing the need for healthcare practitioners to distinguish between symptoms caused by mental illness and those caused by drug abuse. The essay underscores the importance of understanding the complex relationship between mental health, substance use, and societal attitudes, offering a comprehensive overview of the challenges and consequences associated with dual diagnosis.

Running Head: DUAL DIAGNOSIS CO-MORBIDITY AND SOCIETY 1
Dual Diagnosis Co-Morbidity and Society
Name
Institution

DUAL DIAGNOSIS CO-MORBIDITY AND SOCIETY 2
Introduction
Dual Diagnosis is a term used to describe an individual diagnosed with a mental disorder
or substance use. It can also be interchanged and described as comorbidity disorder or a co-
occurring disorder, which is the existence of more than one disorder in an individual (National
Alliance on Mental Illness 2019). Naturally; it is co-existence of a new disease about an existing
one. Epidemiological study shows that comorbidity infections are common to drug and substance
addicts or psychoactive substances. Drug use may cause a user to experience more than one
mental health disorder which may be short-lived or a long term mental health disorder. Such
mental illness may include bipolar disorder, schizophrenia, major depression, and Psychotic
illness. The drugs commonly abused are alcohol and cannabis (Walter et al. 2009). Overlying
genetic vulnerabilities may cause this disorder. Once the genetic factors are predisposed, the
person is at risk of mental disorder. Proper Medical attention is also required seeing that the
disordered mental patients has more consequences from drug and substance abuse in contrast to
patients with schizophrenia or bipolar illness which is a mental disorder (Hryb, Kirkhart and
Talbert, 2007).
The article elaborates further on Dual diagnosis by discussing performance and image
enhancing drugs which have a high prevalence rate among the young people (NIDA). The report
also explains the causes of drugs addiction and how dependency of the drugs can be reduced.
Most of the duo diagnosed patients are not treated with care and respect, reason because health
practitioners fail to distinguish symptoms due to mental illness and symptoms caused by drug
and substance abuse (Saddichha, Schütz, Sinha & Manjunatha, 2015). The paper focuses on the

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harmful effects of substances such as steroids, how they are treated, and how victims can manage
the infection.
History and Cultural Variations In dual Diagnosis
In Australia, the mental disorder was managed through imprisoning the victims besides
asylum walls; infected people were isolated from the rest in preventing exposure of the health
risks to the community. Isolation was done to punish them for their mental illness taken under
the care of wardens. They were commonly referred to as lunatic and harshly treated. Others were
chained in posts where they were left to stay on their own vomits, excretes with no hope to live a
free life. The unmanageable individuals and those who caused trouble faced a barbaric treatment.
The wealthy Australian people tried to manage their insane relatives by rocking them in dark
rooms. Others were put in private houses and put under the supervision of a doctor or a clergy
since they were viewed as evil possessed (Booth and Burford 2017). Until the 19th century, the
mental disorder was considered as lunacy or possessions in Australia. Today, mental disorders
are one of the common deadly diseases in Australia. One in five 20% Australian with a
significant age between 16 -85 years’ experience mental health illness every year and 45% of the
population in Australian have a common mental illness according to National Survey of Mental
Health 2016. Australian population estimate experiencing mental health disorder is about 8.6
million each year (Australian Government Department of Health 2016) The most prevalent
psychiatric disorder is mental illness, depression and substance disease increasing the rate of
suicide among the youths.
Different cultures have different views of mental illness. Culture refers to how
different people view and altitude towards mental disorders. In Australia, people with mental
illness faced a lot of stigmatization and viewed as an outcast in society. From this stigma, the

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mentally affected internalize the altitude and fail to seek medical attention. Additionally, Stigma
lowers their access to employment opportunities; proper housing and socialization, which make
them reduce their self-esteem increasing hopelessness in their lives (Putul et al. 2019). Among
Asian cultures, stigma is more such that they consider mental illness is brought by poverty within
the family lineage.
Androgenic Anabolic Steroids
Anabolic steroids are a group of hormones that has male sex hormone testosterone along
with synthetic versions which allow the production of polypeptide within the in the human cells.
The steroid increases testosterone concentration, electrifying protein synthesis, which increases
body size, muscles, and strength. Testosterone hormone stimulates the development of masculine
characteristics such as body baldness, sperm production, and also animate more physique among
males (Ganesan and Zito 2019). Moreover, testosterone is good for nitrogen balance, which
allows effective blood concentration that leads to androgen receptor allowing desirable anabolic
and androgenic changes. Therefore administration of testosterone may increase body
performance. Anabolic steroids can be taken orally, used as an ointment or injected to the body.
Athletes in sports mostly use anabolic steroids since it helps in tissue growth and reduces muscle
damage enabling the athlete to have a quick recovery in the sessions. In case of any injury, they
also able to heal quickly since anabolic steroids allow anabolic and catabolic balance through
protein synthesis. (Demling, 2005)
Anabolic steroid taking appears to be shared among the athletes seeing that they use the
drugs for several months where the quantity used increase gradually using various consumption

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patterns. These patterns may include cyclic pattern, staking pattern, pyramiding pattern, and
plateauing pattern. The cyclic pattern involves taking more than one dose of steroid for a certain
period of time. The user may stop consumption for days then continue. Periodically stopping and
starting is done to reduce the adverse effects caused by the steroids. The static pattern occurs
when the user takes two different types of anabolic steroids, mixing both oral and injectable.
Some users also consume anabolic steroids meant for animal use in the augment that, various
steroids interact with each other to give a combine muscle size that may be greater than each
steroid used individually. Pyramid pattern involves the gradual taking of anabolic steroids in the
cycle of six to twelve weeks. In the beginning, the user may mix several different doses of
smaller quantities and later progressively increase the dosage. In the second half, there might be
no dosage since they are decreased to zero. The second cycle, there may be no drug use to allow
the body to adjust to the drugs earlier used (National Institute of Drug Abuse). Drug free cycle
enables the collection to ameliorate. Plateauing pattern, the steroids are interchanged with other
types to avoid body fortitude.
Study shows that males use anabolic steroids more compared to females. According to the
research done Williamson (1993), anabolic steroid users were males under seventeen years of
age purposely for body structuring, muscle build, and sports performance. Most steroid users are
adolescent with prevalence ranging between 1%-5%. In the Middle East, the number of steroid
users is increasing mostly by male bodybuilders who use the gym. According to research done
by Addict (2015), lifetime prevalence among the youths in America is between 19-28 years.
About 2.9-4.0 million use anabolic steroids with a high dependency ratio. Anabolic steroid
addicts are mainly youths who participate in sports.
Anabolic Steroids Disorders

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Long term use of anabolic steroids may lead to health complication among users. Anabolic
steroids are related to most of the health disorders such as eating disorders, body health
disorders, and mental disorders. Research shows that men are more affected by an eating
disorder to females. The reason is that they are more anabolic steroids prevalent to females.
Since steroids are subject to metabolism and fat storage in the body, it may lead to weight
increase. Corticosteroids prompt the user to eat more, seeing that it increases the appetite.
Corticosteroids alter body electrolyte and water retention. The steroid forces the body to retain
excess water than required. Considering there is unbalanced hydration level in the body, the body
tends to dangle on the retained water leading to more weight to the user. Therefore asteroid user
should exercise regularly to burn calories and prevent excess weight increase.
Steroid use may impede the absorption and regular utilization of certain nutrients in the body
such as sodium, protein, calcium, and vitamin C because of nutrients depletion by prednisone.
Consequently, deficiency of the nutrients may lead to bone loss since steroids decrease the
ability to make new bones and high susceptibility to bones weakness and fracturing. Steroid
users are advised to include food rich in potassium in their dietary or potassium supplements to
prevent bones infections (World Health Organization 2019). High sodium consumption boosts
water retention in the body, causing weight increase. Relatively sodium leads to calcium loss
through the urine. In the view of sodium complications, proper health measures should be taken,
such as limiting the amount of sodium usage in the diet, avoiding smoked meat of fish and
bacon. Steroid users should also seek other sodium alternatives like herbs, garlic, or onion
powder.
Use of corticosteroids to treat inflammation may façade increase of glucose levels. Continuous
use of corticosteroids leads to insulin resistance making the blood sugar increase above normal.

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When the blood sugar rises above average, one may be infected with diabetes 2. To avoid
diabetes infections, one should avoid sugar-containing drinks and fruit juice. Steroid usage
increases Osteoporosis rate of infection due to calcium deficiency and bone loss. To improve the
situation, users are required to take multivitamin supplements which boost calcium absorption in
the body. Bodybuilders and athletes are advised to shun from smoking since it contributes to
Osteoporosis (World Health Organization 2019). Besides, Prednisone can irritate the lining of
the stomach; hence, when taken; it should be taken with a meal.
The use of anabolic steroids is related to the development of psychotic disorders, which are
due to testosterone abuse. Users become more aggressive; they have mood labiality and show the
signs of depression. They may also be faced with irritability and mood swings. Psychotic
manifestation may vary from one user to another according to the duration of usage, type of
substance used, and amount of the content (Papazisis, 2006). There are more suicidal reported
cases as a result of steroid consumption. Steroid anabolic steroid addicts are unable to control
their temper due to their aggressiveness and anxiety. Children in adolescent stages are more
prone to suffer from steroid psychosis due to a high increase of corticosteroid where the
symptoms appear in four days after consumption. Steroid consumption may tamper the normal
production hormone in the body due to low sperm production due to hypogonadism infections
that shrink testicles. These may also lead to testicular cancer when steroids are used in
combination with insulin (NIDA 2019).
Females who use steroids tend to develop Masculinization in that the size of the breast
decreases, the skin becomes coarse, and the voice depends and in more hair grows in their bodies
like males. Continuous consumption of the steroid by the females leads to enlargement of the
clitoris and fat decrease in their bodies. Steroids are also associated with liver infections and

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peliosis where the cysts are formed in the liver, which severely bleeds, causing death. Due to
damage of the liver, there may be signs of jaundice where the skin and the eyes turn pale yellow.
Additionally, steroid misuse causes acne and abscess in their bodies as a result of injections
(NIDA 2019). Anabolic steroids contribute to the development of cardiovascular infections,
leading to fatty substance deposition in the arteries hence blocking blood flow in the body.
Blocking off the blood vessels damages the heart since there is insufficient blood in the center. In
consequence, the user suffers from a stroke or heart attack.
Steroids Addiction
Steroids abuse is very addictive despite its harmful social and mental effects on the users.
According to the study, addiction is common with young people in the age gap between 17-34
years. Prevalence of substance use is greater to young people because they are involved in sports
activities such as athletics and bodybuilding (Zafar et al. 2013) They may as well use the drugs
for body appearance Evidence for a steroid is not as common as cocaine or heroin though users
may develop prevalence and tolerance through experiencing a lot of side effects. The commonly
abused steroids include Anadrol, ox and in, Winstrol and Dianabol. However, steroid addicts
may prompt to stop steroid use. Research shows that addicts may experience Steroid withdraw
syndrome while attempting to prevent drug use. Steroid withdraw syndrome refers to relapse of
disease after glucocorticoid therapy withdrawal. This is due to the lack of adrenaline when
glucocorticoids are reduced. Some of the withdrawal symptoms seen among the addicts are
mood swings, depressions, restless, and insomnia (NIDA 2019). Furthermore, joint pain and
elevation of calcium may be noted. Steroid withdrawal treatment is tailored to the user, which
involves steroids administration that is decreased over a short period.

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Prednisone in the body may be used as cortisol hormone. Cortisol hormone is used to regulate
blood pressure and respond to stress. When the prednisone user uses it more than three weeks,
the body adapts prednisone and may substitute cortisol to prednisone leading to lowering the
level of cortisol. When the user stops using prednisone, it may lead to prednisone withdrawal
since the body may not produce cortisol at once. Some of the prednisone withdrawal symptoms
are severe fatigue, body ache, and general weakness. The withdrawal symptoms may last for
more than eleven months depending on consumption period of prednisone. To reduce withdrawal
symptoms; one is required to eat food rich in saturated fat and vitamin B-6.
Policy Documents That Report Contemporary Practice
Australia Anti-Doping Authority (ASADA) has greatly contributed in regulation of doping
behavior in Australia. It is a government organization that relies with World Anti-doping Code in
order to protect integrity of the athletes. (WHO, 2019) Doping is becoming a hazard to the health
safety of athletes and is a form of unhealthy completion and cheating. With the collaboration of
World anti-Doping Agency (WADA), the efforts have been intensified to eradicate doping in
sports activities and medical professionals. In the essence of Olympism, WADA intends to
preservation sports value by developing and implementing prevention anti-doping programs.
According to WADA, it is the responsibility of each athlete to ensure no illegal, prohibited
substance enters in the body or any forbidden method used in the course of performance (Kayser,
Mauron and Miah 2007).
The Anabolic Steroids Control Act of 1990 possession or sale of illegal anabolic steroids drug
substance shall attract a penalty of $ 1000 or one-year imprisonment. By this penalty, the act
regulates the excessive consumption of steroids.

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The Institute of Medicine has put in place performance measures that will regulate the quality
and aspects of all health care facilities. Measures are addressed to control and treat all substance
use disorders by providing quality health care facilities.
Policy and Legislation of Steroid Use
The performance image-enhancing drugs have been recently used by athletes in international
sports to boost their speed and strength. However, the United Nation viewed this as fair
competition and amended the Pure Food and Drug Act 1988, which inhibits possession of
anabolic steroids other than the ones advised by the physician (Latiner, 2005).Pure food and drug
act 1988 makes illegal procession or selling of any anabolic steroids, except in doctor's
prescription cases which must be lawfully recognized. Australia Anti-doping Authority
(ASADA) has set anti-doping programs which are to regulate the use of certain steroids in
gaming activities. In collaboration with (WADA), they perform quality tests to the athletes to
bring consistency in the organization. Drugs such as insulin Injections are highly prohibited since
they contain anabolic effects. Some of the banned substances include anabolic drugs, exogenous
substances, erythropoietin and tibolone (WHO 2019)
Patterns and Prevalence of Harm
In the 1940s, the performance-enhancing drugs in Australia were used to treat severe
malnutrition illness, and individuals who participated in prison wars. Today the drugs in
Australia are used to treat anemic and gynecological infections. However, steroids drugs have
been negatively abused. Recent years several studies have shown that the use of steroid in
Australia through injection has increased rapidly, mainly caused by sports activities and

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bodybuilders. After the performance of the Olympic Games in 1988, which were held in Seoul,
the steroid use has risen with more than 50% among Australian athletes.
The prevalent steroid abuse is more than 18 % among the young people who participate in
sporting activities. This is to increase their body muscles and strength for their competitions
(Fard et, al 2009); consequently, users increase the rate of cancer infections in their bodies seeing
that steroids such as Corticosteroids causes’ adrenal suspension, therefore adrenalin may not get
typically respond to physiological stress caused by steroids.
Steroid use is more prevalent to bodybuilders for their muscles building, increasing the risk
of impotence and Infertility. Steroids are known to disrupt the production of hormones, causing
testes malfunctions. By this, testis reduces sperm production leading to infertility (Hubert et al.
2016).
Promotion Strategies Dual Diagnosis Disorders
Health Care
Many substance use disorder people may lack knowledge of whether they need medical
attention or others may not know where to get health facilities. Therefore the first step for the
infected individuals is to undergo screening for substance use and to involve the patients with the
appropriate health care and long term management on severe substance disorder. These help the
individual in quick recovery (Abuse, 2016).
Integrated Treatment
The integrated treatment has proved positive results in controlling mental health disorders.
This allows the infected to receive spiritual healing simultaneously under a comprehensive
program. Health care providers work as a team with the infected and set objects of improvement.

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Family members may be included in enhancing the system. The system may also be useful when
treating substance use disorder and mental disorder since the conditions interact with one
another.
Conclusion
According to (NIDA 2019), 50% of mental disorders are caused by drug and substance use.
Abuse of harmful drugs such as cocaine and marijuana is known to cause mental illness. People
who already have mental illness are likely to abuse drugs which are said they make them feel
better and control their disease. Due to the effects of, the drugs should be avoided highly avoided
to manage the mental illness. Since most of the steroid users are young people between 17-50
years, Counseling should be done to educate the users on control measures to adapt to steroid
usage. Steroid users should seek other medical alternatives to build their bodies rather than using
steroids. Those infected by steroid disorders should seek proper medication or treatment like
psychological therapies for muscle disorder, psychosocial treatment for opioids users.