Dual Diagnosis

Dual diagnosis means you have a mental health disorder and a substance use disorder (SUD) at the same time. Mental health disorders can include depression, anxiety and ADHD. A substance use disorder may involve alcohol, drugs or other addictive substances.

When these conditions occur together, the effects of each can worsen. Untreated mental health issues can cause substance use problems to get worse. And when substance use increases, your mental health problems may worsen. This can become a tough cycle to break.

Studies suggest that about 50% of people who experience a substance use disorder during their lives will also have a mental health disorder (and vice versa). In 2023, about 20.4 million U.S. adults had a dual diagnosis. Other names for the condition include:

• Co-occurring disorder
• Comorbidity

Which disorder comes first in a dual diagnosis?

Like the chicken or the egg, it can be hard to figure out which came first. Dual diagnoses occur together. But it doesn’t mean one caused the other.

Substance use disorders may not directly cause mental health disorders, and vice versa. But there’s a clear connection between the two. Drugs and alcohol can worsen the symptoms of mental health conditions. And the continued use of these substances can increase your risk of developing a mental health disorder.

What is the best example of a dual diagnosis?

An example of a dual diagnosis is having major depressive disorder and alcohol use disorder at the same time. If you have depression, you may drink alcohol as a coping mechanism. This can make your depression worse. If you have alcoholism, it can worsen your depression. This may lead you to drink more.

Other examples of co-occurring disorders include:

• Post-traumatic stress disorder and opioid use disorder
• Bipolar disorder and stimulant addiction
• Schizophrenia and cannabis use disorder

Dual diagnosis symptoms

Your substance addiction and your mental health issue each have their own symptoms. So, the symptoms of dual diagnosis depend on which substances and mental health disorders are involved. Symptoms may vary widely. There are many different combinations of dual diagnoses. Sometimes, the symptoms overlap.

Symptoms of a substance use disorder may include:

• Withdrawal from your family and friends
• Trouble focusing
• Sudden behavior changes
• Engaging in risky behaviors
• Developing a high tolerance for the substance
• Having withdrawal symptoms
• Feeling like you need the substance to function

Symptoms of a mental health disorder may include:

• Extreme mood changes
• Confusion
• Irritability
• Problems concentrating
• Unable to function at work or school
• Avoiding social activities
• Thoughts of suicide

Dual diagnosis causes

Mental health disorders and substance use disorders are interconnected.

Mental health disorders may contribute to substance use disorders. If you have a mental health disorder, you may self-medicate. This means you use alcohol or drugs to try to feel better or cope. These substances may briefly help your symptoms. But they can make them worse over time. Mental health conditions can affect how your brain handles rewards, making addiction more likely.

Substance use disorders may contribute to mental health disorders. Alcohol, drugs and other substances can trigger changes in your brain’s structure and function. This can make it more likely that you’ll develop a mental health disorder.

Risk factors for co-occurring disorders

Certain risk factors can contribute to both mental health conditions and substance use disorders. These risk factors may include:

• Genetics: Mental health disorders and substance use disorders can both run in biological families. Many different genes may contribute to your risk of developing either condition.
• Environmental factors: Environmental factors like stress and trauma can be passed down through generations. These can contribute to the development of a substance use disorder or a mental health disorder.

How to lower your risk

Mental health disorders and substance use disorders are both brain diseases. You can’t prevent them. But you can reduce your risk by:

• Learning about your biological family history
• Limiting the amount of alcohol you drink
• Talking to a healthcare provider about risk factors

How doctors diagnose co-occurring disorders

Dual diagnosis isn’t a diagnosis — it’s a combination of diagnoses. It can be hard for your healthcare provider to make the right diagnosis. That’s because the symptoms of the disorders can overlap.

But your provider will use a wide range of screening tools to test you for both conditions. It’s important to be honest when speaking with your provider. Based on your answers, they can figure out which disorders you have. Then, they can get you started on the right treatment.

How is dual diagnosis treated?

It’s important that you receive treatment for your mental health condition and your substance use disorder at the same time. You’ll work with your healthcare provider to understand the ways each of the disorders affects the other. This will help you figure out which dual diagnosis treatment will be most effective.

For you to reach recovery, you’ll need to stop using the addictive substance. For many people, this may start with detoxification. During in-patient detox, healthcare providers will monitor you 24 hours a day for up to a week. They’ll help you wean off the substance and provide ways to lessen the effects of withdrawal.

What are the types of dual diagnosis treatment?

Based on several factors, your treatment for dual diagnosis may include:

• Behavioral therapy
• Medication
• Support groups
• In-patient care

Behavioral therapy

Behavioral therapies that can help treat co-occurring disorders include:

• Cognitive behavioral therapy (CBT): CBT can teach you how to cope with and change ineffective patterns of thinking.
• Dialectical behavioral therapy (DBT): DBT can reduce self-harm behaviors. These may include drug use, cutting and suicidal thoughts or actions.

Medication

Your healthcare provider may prescribe medication for one or both of your conditions. Some drugs can help relieve the symptoms of both conditions. For instance, the FDA has approved bupropion for more than one condition. You can use it to treat depression (Wellbutrin®) and for nicotine dependence (Zyban®).

Support groups

Support groups can be very beneficial. They may give you the emotional and social support you need to stay sober. The people in these groups have been in your shoes before. Your peers can share their experiences and answer your questions. They can also offer tips on how to deal with everyday challenges.

In-patient care

If you’re experiencing a dependent pattern of substance use along with a mental health condition, you may benefit from a co-occurring disorders treatment center. There, you’ll receive medical and mental health care. This includes medication, therapy and support.

What is the best treatment for dual diagnosis?

The best dual diagnosis treatment combines care for your mental health condition and your substance use disorder. That means you’ll work with the same healthcare provider(s) to treat both conditions at the same time. Combined care is your best chance for long-term recovery.

But there’s no one-size-fits-all solution. The best treatment is the one you and your provider decide will be most successful.

What are the success rates of dual diagnosis treatment?

With the right treatment, your chances for recovery are very good. About 50% of people with co-occurring disorders respond well to a combined treatment program. But you’ll need to continue working with your healthcare providers. You may also need to work with a support group for your recovery to last. Don’t be afraid to reach out for help.

What can I do to help my loved one with a dual diagnosis?

Helping someone with a co-occurring disorder can be hard. Your loved one may deny they have a problem. They may resist treatment. When they do begin treatment, the road to recovery can be long.

Accept what you can and can’t do. You can’t force your loved one to remain sober. You can’t force them to take their medication or go to counseling. But you can make positive choices for yourself. Encourage your loved one to get help and offer your unconditional support.