Dual Diagnosis

What is a Dual Diagnosis?

Depressed manMany people diagnosed with a substance use disorder (SUD) also suffer from a co-occurring mental health or behavioral disorder. This is known as a dual diagnosis. Individuals with a dual diagnosis require an integrated treatment plan that addresses both disorders as interconnected mental health issues.

"According to the National Survey on Drug Use and Health (NSDUH), 45 percent of people with addiction have a co-occurring mental health disorder."

By seeking treatment for addiction and a co-occurring behavioral or mental health disorder, you will stand the best chances of successfully attaining the fulfilling, healthy life you deserve.

Common Mental Health Issues and Addiction

There are a few mental health and behavioral disorders that repeatedly present themselves alongside addiction. Oftentimes, these disorders are the underlying cause of an addiction. That’s why it’s important to never ignore the symptoms of a mental health or behavioral disorder when it comes to a person’s long-term addiction recovery plan.

Common mental health disorders linked to substance abuse include the following:

  • Attention-deficit hyperactive disorder (ADHD)

    People with attention deficit hyperactivity disorder (ADHD) may be more inclined to abuse substances as a way to cope with their symptoms. Many people are prescribed stimulants to treat their ADHD, which can be habit-forming and lead to a toxic pattern of substance abuse.

  • Bipolar Disorder

    About half of people with bipolar disorder also struggle with addiction. As with any other disorder, it can be tempting to self-medicate. Drugs and alcohol provide a source of temporary relief from emotional situations and manic episodes for people with bipolar.

  • Borderline Personality Disorder

    Studies have shown that addiction and borderline personality disorder (BPD) often occur together. Over two-thirds of people with BPD have turned toward substance abuse at some point in their lives.

  • Depression

    An estimated one in 10 adults in the United States have reported suffering from depression. Many people diagnosed with depression try to self-medicate with drugs or alcohol. This often makes the problem worse. The crash after the high can be devastating for those with a pre-existing depressive condition.

  • Eating Disorders

    Eating disorders often stem from strong feelings of inferiority. Drugs that suppress appetite are especially common among people with these disorders.

  • Generalized Anxiety Disorder (GAD)

    The most common mental condition in the U.S., generalized anxiety disorder (GAD) affects 18 percent of the adult population. People who suffer from GAD may be more likely to abuse drugs and alcohol to manage their symptoms. People may also abuse benzodiazepines, which are highly addictive prescription medications used to treat anxiety disorders.

  • Obsessive Compulsive Disorder

    Obsessive Compulsive Disorder (OCD) causes a number of unwanted obsessions and compulsions, such as an irrational fear of germs and the need to constantly clean. There are many variations of this illness. People with OCD often suffer from anxiety and depression as a result of their involuntary behavior, which can lead substance abuse.

  • Post-traumatic stress disorder

    When a person develops post-traumatic stress disorder (PTSD) their brain produces less endorphins than a healthy brain, making them more likely to turn toward alcohol or drugs to feel happy. According to the U.S. Department of Veteran Affairs, nearly 75 percent of soldiers and veterans who experience a traumatic or violent event during combat report repetitive alcohol abuse.

  • Schizophrenia

    Schizophrenia is characterized by hallucinations and delusional thinking. Diagnosing schizophrenia alongside an addiction can be difficult because both conditions share the same effects. When a person has schizophrenia and uses substances as a way to self-medicate their condition, they risk putting their health further at risk.

Why Co-Occurring Disorders Are Treated Differently

According to the National Survey on Drug Use and Health (NSDUH), 45 percent of people in the United States struggle with a dual diagnosis. People diagnosed with a mental health condition are about twice as likely as the general population to suffer from a substance use disorder. Similarly, individuals who frequently abuse drugs or alcohol are likely to develop a co-occurring behavioral or mental health disorder.

While it is widely accepted that a mental health disorder can induce a substance addiction – and vice versa – researchers are uncovering what causes both conditions to occur simultaneously.

A number of overlapping factors can aggravate a mental health or a substance abuse disorder:

  • Brain responses

    Abusing drugs can elicit symptoms that mimic a mental illness. For example, excessive marijuana use can give rise to psychosis in some individuals, which is a severe mental disorder that causes people to lose touch with reality.

  • Genetics

    A person’s genetic predisposition can make them more likely to develop an addiction or a mental disorder. Research shows that genes make up 40 to 60 percent of a person’s susceptibility to addiction.

  • Triggers in the environment

    Chronic stress, persistent anxiety or a traumatic event can kickstart an addiction or mental disorder.

  • Exposure at an early age

    People who experiment with drugs or alcohol at a young age may develop a substance abuse problem and/or mental health disorder later on. This is because adolescents and young adults are more prone to brain damage from substance use than older adults.

Warning Signs of a Co-Occurring Disorder

The signs of a dual diagnosis vary greatly between individuals. Generally, symptoms will depend on the type of substance abused, as well as the severity of their co-occurring condition.

Symptoms of a dual diagnosis include:

  • Sudden change in general behavior
  • Difficulty managing daily tasks and responsibilities
  • Avoiding events or social activities that were once enjoyed
  • Neglecting health and hygiene
  • Disillusioned thinking or cognitive impairments
  • Refusal to seek or comply with treatment
  • Mentions of thoughts of suicide or suicidal behaviors
  • Erratic and impulsive behaviors
  • Issues managing finances
  • Poor performance at school or work

The Dangers of Self-Medication

One of the most common issues surrounding dual diagnosis is self-medication. Self-medication involves using drugs or alcohol to mask the symptoms of a mental health illness. However, using substances as a coping mechanism for mental or behavioral illness can induce an addiction – and make the underlying mental condition even worse.

The following scenarios demonstrate how some people attempt to self-medicate a mental illness.

  • Drinking alcohol to feel less anxious in social situations
  • Taking excessive amounts of benzodiazepines (like Xanax or Valium) to ebb an oncoming panic attack
  • Using marijuana to numb the emotional pain from trauma or grief
  • Smoking or injecting cocaine to increase energy and motivation to complete daily tasks

Sadly, resorting to substances as a way to escape a mental health condition can be a damaging decision. People struggling with a mental or behavioral illness who start abusing drugs or alcohol will consume as much as it takes to achieve the effects they want. Over time, the person will build a tolerance and need to consume more of the drug each time to achieve the same high. This negative, self-feeding cycle is what spawns a co-occurring substance addiction and mental health disorder.

Statistics on Co-Occurring Disorders


more likely

People addicted to drugs are twice as likely to suffer from mood and anxiety disorders, according to the National Institute on Drug Abuse (NIDA).




Nearly 8.4 million adults in the U.S. have both a mental and substance use disorder, according to the 2012 NSDUH.



more likely

People with severe mental illness are about 4 times more likely to be heavy alcohol users. They are also over 5 times more likely to be daily tobacco smokers, according to a study by NIDA.


Get Help for a Dual Diagnosis

While some individuals develop an addiction to drugs or alcohol before being diagnosed with a mental disorder, others become addicted after acquiring a mental disorder. Whichever happened first, it’s paramount to find a tailored treatment plan that targets both disorders simultaneously – rather than a plan that treats them separately. In the case of a dual diagnosis, the best form of treatment is in the structured, safe environment of an inpatient rehab center.

Going to inpatient rehab for a co-occurring disorder is ideal because of the high level of attention and care that patients receive. Oftentimes, people with co-occurring disorders arrive at rehab in various states of distress and poor general health. The combination of extensive substance abuse and a neglected mental condition generally requires the help of both mental health and addiction professionals.

When deciding on a rehab center, choose one that specializes in you or your loved one’s type of addiction and co-occurring disorder. Doing so will ensure the most effective care, as well as the greatest potential for a full recovery.

Ask the following questions to help you make an easier and more informed decision:

  • Do you offer individualized treatment plans for all residents?
  • Is therapy structured to treat a dual diagnosis?
  • Will I or my loved one be evaluated by a licensed psychiatric professional or physician before admission?
  • Are both of my disorders viewed as interconnected health issues, or as separate illnesses?
  • If I or my loved one relapses during rehab, how would that be handled?
  • Does your facility offer aftercare referral services?

Once you or your loved one is settled into rehab, the treatment process begins. Your chosen rehab will incorporate a number of therapies, medications, and activities that will take place throughout the course of the program. Counselors may hold group and individual therapy sessions, while residents can take advantage of any of the center’s offered activities and amenities.

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