Dual Diagnosis

What is dual diagnosis?

Dual diagnosis means you have both a mental health disorder and a substance use disorder at the same time. Other names for dual diagnosis include co-occurring disorder and co-morbidity. Dual diagnosis isn’t a diagnosis — it’s a combination of diagnoses.

Mental health disorders include depression, anxiety and other mental health conditions. A substance use disorder may involve alcohol, drugs or other addictive substances. When these conditions occur together, the effects of each can be worse. Untreated mental health issues can cause substance use problems to worsen and increase. And when substance use increases, your mental health problems may increase, too. This creates a vicious cycle.

How common is dual diagnosis?

Dual diagnosis conditions frequently occur together. Researchers have found 50% of people who experience a substance use disorder during their lives will also have a mental health disorder and vice versa. In 2020, 17 million U.S. adults had a co-occurring mental health disorder and substance use disorder.

What are the symptoms of dual diagnosis?

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

Symptoms of a substance use disorder may include:

• Withdrawal from your family and friends.
• Difficulty maintaining focus.
• Sudden changes in your behavior.
• Engaging in risky behaviors.
• Developing a high tolerance for the substance and/or having withdrawal symptoms.
• Feeling like you need the substance to function.

Symptoms of a mental health disorder may include:

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

Which disorder comes first in a dual diagnosis?

Like the chicken or the egg, it can be difficult to figure out which came first. Even though dual diagnoses occur together, it doesn’t mean one caused the other.

Substance use disorders may not directly cause mental health disorders (or 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 causes dual diagnosis?

Researchers have a few theories about why substance use and mental health disorders occur together.

Shared common risk factors

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 families. Research shows many genes may contribute to your risk of developing either condition.
• Environmental factors: Environmental factors such as 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.

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. Although these substances may temporarily help symptoms, they can make them worse over time. Mental health disorders may also change the way the “reward” centers of your brain work. This can make it more likely you’ll become addicted.

Substance use disorders may contribute to mental health disorders

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

How is dual diagnosis diagnosed?

Dual diagnosis isn’t a diagnosis — it’s a combination of diagnoses. It can be difficult for your healthcare provider to make an accurate diagnosis because the symptoms of both disorders can overlap.

However, your provider will use wide-ranging screening tools to evaluate you for both disorders. It’s important to be honest when speaking with your healthcare provider. Based on your answers, they can determine which disorders you may have and identify appropriate treatment.

What is dual diagnosis treatment?

Dual diagnosis treatment will include 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 your disorders affects the other. This will help you determine which treatment will be most effective.

For you to achieve a dual diagnosis recovery, you must stop using the addictive substance. For many people, this may start with detoxification. During inpatient detoxification, 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.

Based on several factors, your treatment for dual diagnosis may include behavioral therapy, medication, support groups or in-patient care.

Behavioral therapy

Behavioral therapies that have been shown to treat co-occurring disorders include:

• Cognitive behavioral therapy (CBT): Cognitive behavioral therapy can teach you how to cope with and change ineffective patterns of thinking.
• Dialectical behavioral therapy (DBT): Dialectical behavioral therapy 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 alleviate the symptoms of both of the conditions of a dual diagnosis. For instance, the FDA has approved bupropion for the treatment of depression (Wellbutrin®) and for nicotine dependence (Zyban®).

Support groups

Support groups can be very beneficial by giving you the emotional and social support you need to maintain your sobriety. 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 dual diagnosis treatment center. There, you’ll receive medical and mental health care including medication, therapy and support.

How can I reduce my risk of dual diagnosis?

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

• Learning about your biological family history.
• Limiting the amount of alcohol you consume.
• Talking to your healthcare provider.

What can I expect if I have a dual diagnosis?

With appropriate treatment, your chances for dual diagnosis recovery are very good. You can improve your quality of life and expect a good outcome. You’ll need to continue working with your healthcare providers and/or support groups for 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 very difficult. Your loved one may deny they have a problem and 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, 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.

A note from Cleveland Clinic

If you’re going through a dual diagnosis, it can feel like a double whammy. You may feel you brought it on yourself. But it’s important to remember that mental health disorders and substance use disorders are medical diseases. Just because you can’t “see” them doesn’t mean they’re not real diseases. Don’t be afraid to reach out to your healthcare provider. Be honest and open with them so they can help you find the treatment you need. Asking for help is the first step.