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Dual Diagnosis

People rebuilding their lives while undergoing addiction recovery face the challenges of fighting substance use and living with a mental health disorder at the same time.

What’s more, there is an inextricable link between substance use disorders and mental health issues. The National Alliance on Mental Health (NAMI) reports, “Among the 20.2 million adults in the U.S. who experienced a substance use disorder, 50.5 percent—10.2 million adults—had a co-occurring mental illness.”

Government data available today stresses this point.

In a 2017 survey published by the Substance Abuse and Mental Health Services Administration (SAMHSA), an estimated 8.5 million adults had a substance use disorder (SUD) and any mental illness (AMI). The connection between specific mental health disorders and substance use is noted by the National Institute on Drug Abuse (NIDA).

NIDA goes on to say, “Both substance use disorders and other mental illnesses are caused by overlapping factors such as genetic and epigenetic vulnerabilities, issues with similar areas of the brain, and environmental influences such as early exposure to stress or trauma.”

Those who struggle with depression and anxiety are more likely to misuse substances to deal with their conditions. Twenty percent of people with mood disorder or anxiety had a substance use disorder, according to the Anxiety and Depression Association of America (ADAA).

Dual diagnosis is a specialized form of treatment for people with a co-occurring mental health disorder and a substance use problem.

The Link Between Substance Abuse and Mental Illness

The National Institute on Drug Abuse (NIDA) lists reasons why substance abuse and mental illness are inextricably linked.  

People with mental health disorders will use substances as a way to self-medicate. The possibility to indulge too much in self-medication is great, which can exacerbate the mental health issue. Relapse from the substance(s) is also a strong possibility.

Some types of common mental health disorders are:

  • Depression
  • Post-traumatic stress disorder (PTSD)
  • Bipolar disorder
  • Generalized anxiety disorder
  • Eating disorders (anorexia, bulimia, binge eating)
  • Personality disorders
  • Obsessive-compulsive disorder (OCD)
  • Borderline personality disorder
  • Schizophrenia
  • Panic disorder

Common Mental Health Disorder Symptoms

People with co-occurring conditions will abuse drugs or alcohol to cope with negative situations or to address symptoms of depression or anxiety. Sometimes their substance of choice may lead to sudden changes in mood and bouts of anger, which could result in strained interpersonal relationships and other negative outcomes.

Below are the symptoms of common mental illnesses such as depression, bipolar disorder, or anxiety:

  • Restlessness
  • Trouble concentrating
  • Irritability
  • Excessive tension or worrying
  • Sharp increases in energy
  •  Mood swings
  • Sleep disorders, such as insomnia
  • Strong feelings of guilt or worthlessness
  • Loss of interest in activities
  •  Appetite or weight changes
  • Feelings of helplessness
  • Inability to experience pleasure
  • Racing thoughts or rapid speech
  • Impaired judgment or impulsivity
  •  Numbness

Severe substance use can mask the symptoms of mental illness. It can also be a precursor to mental health problems as several drugs can alter the chemistry in the brain, noted by NIDA. This, in turn, can make it difficult to diagnose someone accurately.

As mental illness and substance abuse usually go together, a dual diagnosis is the best option for treatment. It will simultaneously treat both conditions and facilitate stability.

Commonly Abused Substances and Mental Health Disorders

The ADAA lists the following mental health disorders which correlate with likely substances abused:

Post-traumatic stress disorder (PTSD): It is not uncommon for someone with PTSD to use substances to ease their symptoms. Alcohol, marijuana, opioids, and benzodiazepines are usual substances abused to diminish the intensity of symptoms.

Due to the most intense symptoms of PTSD, (intrusive thoughts, sleep interruption), relapsing back to using the substance is common for people with this disorder.

Social anxiety disorders: Anxiety affects most of us at some point, but those with social anxiety disorder feel it more strongly. People who are diagnosed with this might abuse alcohol to lessen the anxiety they feel when in social functions. However, alcohol, when heavily drunk, can heighten anxiety. Thus, alcohol use disorder is a possible diagnosis.

Panic disorder: Panic disorder symptoms and alcohol abuse can start at the same time, according to the ADAA. Specific drugs and alcohol can trigger a panic attack. Someone with panic disorder can also relapse back into substance abuse when they feel their symptoms coming on.

Why Dual Diagnosis Treatment Differs From Drug Rehab

Dual diagnosis treatment addresses the person’s mental health condition first and then addresses the substance use disorder. A combined therapeutic and clinical approach is beneficial for the treatment of both disorders.

This valuable and nuanced form of treatment is necessary for the person with a dual diagnosis. Substance use treatment centers that offer this form of treatment provide professionals who are licensed to work with people with dual diagnosis.

Dual Diagnosis Treatment

People who enter substance abuse treatment centers that specialize in dual diagnosis therapy are taught certain types of therapies that can change their thinking and behavior regarding drug or alcohol abuse. Counseling is given, and if necessary, approved medications are provided.

Some of the benefits of dual diagnosis treatment are:

  • An accurate mental health diagnosis is given after an assessment of the client’s underlying problems, which led to substance abuse. Once the right diagnosis is known, there is no more wondering or stressing about what is wrong and how to fix it.
  • Dual diagnosis treatment gives the client the time and space to learn to handle triggers to the substance of abuse and learn how to live with the mental health disorder in a healthy manner.
  • Specific behavior therapies are involved with the aim of teaching the client how to handle certain situations in their life. For instance, cognitive behavioral therapy (CBT) helps the person with dual diagnosis learn how to change ineffective patterns of thinking to effective ones, thus, reducing the risk of substance use.
  •  Along with that, comes mental health education. The client is educated about their disorder and how substance use affects it. Information is shared about coping skills, life skills, and how to prevent relapse going forward. All of this will help the client with a dual diagnosis learn how to live a more stable and better life.
  • A support network. Everyone involved in the client’s care becomes part of a large community of people who support the client. From clinical staff to the psychiatric professionals, everyone is there to ensure the client’s needs are addressed. They join the family and friends and colleagues that support the client as well.

A mental health professional will need to evaluate the person’s situation before an accurate determination of dual diagnosis is given. Professionals in the mental health field use the Diagnostic and Statistical Manual of Mental Disorders to determine if a diagnosis present, and if so, what treatment will be most beneficial.


Substance Abuse and Mental Health Services Administration. 2017 NSDUH Annual National Report. from

National Institute on Drug Abuse. Common Comorbidities with Substance Use Disorders. Part 1: The Connection Between Substance Use Disorders and Mental Illness from

National Institute on Drug Abuse. Common Comorbidities with Substance Use Disorders. Why is there comorbidity between substance use disorders and mental illnesses? from

Anxiety and Depression Association of America. (n.d.). Substance Use Disorders. from

National Alliance on Mental Illness. Mental Health By the Numbers. from

Substance Abuse and Mental Health Services Administration. 2017 NSDUH Annual National Report. Mental Illness among Adults with a Substance Use Disorder from

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