If you’ve been researching 7-OH addiction, kratom addiction, or addiction treatment in Portland, Oregon, you may have also come across the term dual diagnosis.
While it may sound like a complicated medical concept, it describes a phenomenon that we see at Shanti Recovery and Wellness every day: people who struggle with a mental health condition like depression, anxiety, PTSD, or bipolar disorder who also struggle with addiction (aka Substance Use Disorder or SUD).
Contrary to popular belief, most people who struggle with addiction don’t begin using substances simply to “get high.” Instead, they’re often leveraging the resources available to them in an effort to cope with overwhelming emotional pain, chronic stress, trauma, or untreated psychiatric symptoms.
When you struggle with overwhelming problems like these, substance use is a very compelling strategy because it often feels like it’s actually “working” to manage very severe symptoms.
At first, that is.
Now, as novel, highly potent substances like 7-hydroxymitragynine (7-OH) become more widely available, understanding the connection between mental health and addiction has never been more important.
At Shanti Recovery and Wellness, we know that effective treatment for mental health starts by looking at the whole person. Our patients are real, everyday, multidimensional people, not one-dimensional diagnoses on a piece of paper.
That’s why we offer mental health treatment alongside addiction treatment (if appropriate) as a unified, multi-disciplinary, integrated, evidence-based clinical team – all under one roof.
What Is Dual Diagnosis?
“Dual diagnosis” or “co-occurring disorder” are interchangeable terms that both mean the same thing. They indicate that a person is experiencing both a mental health condition and a substance use disorder at the same time.
Common dual diagnosis examples we see at our Portland, OR clinic include:
- Depression and opioid use disorder
- Anxiety and alcohol dependence
- PTSD and stimulant misuse
- Bipolar disorder and polysubstance use
While these dual diagnosis combinations are common themes, any and all combinations can and do happen. When these combinations occur, the conditions almost always influence one another. Someone living with anxiety may begin using substances to calm racing thoughts. Over time, substance use can actually increase anxiety, creating a cycle that’s difficult to break without professional treatment.
Similarly, someone experiencing depression may use substances in an attempt to feel relief or escape emotional pain. While substances may temporarily elevate a patient’s mood, they often worsen depression over time and make recovery more challenging.
In the past, mental health conditions and problematic substance use patterns were treated as totally different issues. Now we know that they’re often two sides of the same coin. Because dual diagnosis patients have conditions that are so closely connected, treating only one while ignoring the other doesn’t tend to be effective. Sometimes, treating just one of these dual diagnosis combinations can make both problems worse. Dual diagnosis treatment is now considered the gold standard treatment approach for patients struggling with co-occurring disorders.
Where Does 7-OH Fit Into This Picture?
7-hydroxymitragynine, commonly called 7-OH, is a powerful compound found naturally in very small amounts in kratom leaves. More recently, highly concentrated 7-OH products have begun appearing in smoke shops, gas station convenience stores, and online retailers throughout the Portland metro area. These products are often marketed as legal wellness products or as a natural alternative to opioids.
Easy access to this “miracle drug” can be especially appealing to patients with legitimate chronic pain problems, which in turn can be exacerbated by untreated mental health issues. As unscrupulous over-prescription of opioids gave way to a full-blown opioid crisis in our country, many physicians became much more conservative when deciding to prescribe opioid pain medications. While this impulse is well-founded, the unintended result of this trend is that patients with legitimate chronic pain issues now frequently struggle to find relief with physician-prescribed medications and over-the-counter options. 7-OH purports to fill this gap.
Unfortunately, the marketing often leaves out important information.
Because 7-OH acts on many of the same opioid receptors as prescription opioids, repeated use can lead to the same tolerance, dependence, withdrawal symptoms, and compulsive use we see with heroin, Oxycontin, and fentanyl. From a clinical perspective, 7-OH addiction is not significantly different from any other opioid addiction. For individuals already living with anxiety, depression, or trauma, these products can become another form of self-medication.
Many people don’t even realize they’ve developed a substance use disorder until they try to stop using 7-OH and find that they cannot. Instead, they’re hit with intense withdrawal symptoms, cravings, and worsening mental health symptoms that lead them right back to using 7-OH to feel “OK.”
Why Mental Health and Addiction Are So Closely Connected
Mental health disorders and substance use disorders share many of the same biological and environmental risk factors.
Brain chemistry plays a significant role. The same neural pathways involved in mood regulation, stress response, reward, and impulse control are also involved in addiction. When someone experiences chronic depression or anxiety, substances may temporarily activate the brain’s reward system, providing short-lived relief while reinforcing continued use.
Life experiences also matter.
Trauma, adverse childhood experiences, chronic stress, grief, social isolation, housing instability, and untreated psychiatric illness all increase the likelihood of developing both mental health and substance use disorders.
This doesn’t mean everyone with depression or anxiety develops an addiction problem, but it helps explain why these conditions so frequently occur together. It also helps explain why patient outcomes can be so severe when dual diagnosis patients suffer over the long-term without access to appropriate treatment designed to address the patient as a whole person who is experiencing multiple conditions simultaneously.
Self-Medication Isn’t a Character Flaw
One of the most harmful misconceptions surrounding addiction is that people simply lack willpower.
In reality, many individuals are trying to manage overwhelming emotional distress with the tools they have available at the time.
Someone experiencing panic attacks may discover that a substance temporarily reduces anxiety and allows them to function somewhat normally.
Someone living with PTSD may find temporary relief from intrusive memories with alcohol use, which allows them to pursue social connections and interests they actually enjoy in the present.
Someone with untreated depression may experience a brief improvement in mood with methamphetamines, which allows them to access basic daily living skills that otherwise feel out of reach.
Are the substances being used here actually “problems” or are they just rational solutions to difficult daily realities that far too many people in Portland (and throughout the world) experience?
From a short-term perspective, substance use can actually be a reasonable fix to overwhelming problems.
But the problem is long term.
And the brain adapts.
Over time, substances become less effective, larger amounts are needed to achieve the same effect, and the underlying mental health condition often becomes worse. Symptoms associated with substance use disorder ramp up and the patient’s disease begins to restructure the patient’s life in distorted ways that place continued substance use above all other priorities. At this point, patients often feel trapped, out of control, and unable to reverse course.
It goes without saying that finding oneself in this position is very distressing and can trigger a cascade of negative thoughts and events, all of which also contribute to worsening mental health.
This creates a negative feedback loop, where both conditions magnify one another.
Recognizing this cycle is not about making excuses or avoiding personal responsibility where personal responsibility is called for.
It’s about understanding why comprehensive treatment for dual diagnosis patients – like people who struggle with 7-OH use as well as an underlying mental health condition – is so important.
Why Treating Both Conditions Together Matters
Historically, addiction treatment and mental health treatment were often delivered separately. Someone might be told they needed to become sober before addressing depression, or that they should stabilize their mental health before receiving addiction treatment.
Today, research consistently supports a different approach.
Integrated treatment recognizes that addiction and mental health influence one another continuously. Addressing both conditions simultaneously often leads to better engagement, better symptom management, and more sustainable recovery.
At Shanti Recovery and Wellness, we offer a broad range of addiction and mental health services for patients who are interested in a patient-centered, holistic and rigorously evidence-based approach. Treatment begins with a comprehensive psychiatric evaluation designed to understand the full picture of a patient’s health. Rather than focusing only on substance use, our providers evaluate mood, anxiety, trauma history, medication needs, physical health, and recovery goals to create an individualized treatment plan. At Shanti Recovery and Wellness, we do not have a “cookie cutter” plan. We create each bespoke plan around our patients’ lifestyles, goals, health profile, and preferences.
Signs That Someone May Be Living With a Dual Diagnosis
Sometimes it’s difficult to know whether mental health symptoms are causing substance use or whether substance use is contributing to emotional distress. Often, both are true.
Some common signs include:
- Using alcohol or drugs to manage anxiety, depression, or emotional pain
- Mental health symptoms that worsen after using substances
- Difficulty maintaining recovery despite strong motivation to quit
- Mood changes, sleep disruption, or increased isolation
- Repeated cycles of stopping and returning to substance use
If these patterns sound familiar, it’s worth seeking an evaluation from clinicians experienced in co-occurring disorders. We can help you determine if Shanti Recovery and Wellness is a good fit for you, and if it isn’t, we will try to point you in the right direction.
Recovery Looks Different for Everyone
No two recovery journeys are identical.
Some individuals benefit from medication-assisted treatment.
Others need psychiatric medication management alongside therapy.
Some may require trauma-focused treatment.
Others benefit from family involvement, behavioral therapies, or structured outpatient care.
At Shanti Recovery and Wellness, we don’t focus on simply helping our dual diagnosis patients discontinue their substance use.
Our clinical focus is on helping real people build healthier, more stable lives by addressing all of the complex factors that contributed to substance use disorder in the first place.
We’re finding that this approach is particularly important for people in Portland who are struggling with emerging substances like 7-OH, where dependence can easily develop in people with no previous history of addiction, often before patients fully recognize what’s even happening.
Hope Starts With Understanding
Living with both mental health challenges and addiction can feel very, very overwhelming, but effective treatment for dual diagnosis patients is gaining in popularity and becoming easier to access.
Recovery isn’t about perfection. It’s about gaining a more nuanced understanding of what you’re experiencing, receiving compassionate care from people who understand, and gradually developing the tools you need to move forward.
At Shanti Recovery and Wellness, we’ve been helping individuals throughout the Portland community since 2014 with personalized treatment for addiction, mental health conditions, and dual diagnosis. Whether you’re concerned about your use of 7-OH, kratom, opioids, alcohol, or another substance, we’re here to help.
If you or someone you love is struggling with both substance use and mental health symptoms, you don’t have to figure it out alone.
Contact us today for a confidential evaluation can help determine what support may be most appropriate and provide a path toward recovery that addresses both mental health and addiction together.