I. The Basics of Dual Diagnosis

What Is Dual Diagnosis?

The term dual diagnosis can have several meanings depending upon the situation. When mentioned in the context of substance abuse, it refers to individuals who simultaneously have a substance use disorder and any other type of mental illness. Other phrases commonly used to refer to this situation are comorbidity and co-occurring disorder.

Substance abuse can include prescription drug misuse or the use of illicit drugs and/or alcohol. Some common mental illnesses often associated with addiction include depression, PTSD, generalized anxiety disorder, and schizophrenia.

What Causes Dual Diagnosis?

Addiction is considered a mental illness in itself due to the brain’s desire to repeat detrimental behaviors regardless of the negative consequences. It can be difficult to determine why many individuals with a substance use disorder also have another type of mental illness, but there are three common scenarios.

  • Some people with mental illnesses attempt self-medication by misusing substances. Examples include an individual with generalized anxiety disorder taking sedatives to relax or a bipolar individual using stimulants during a depressive state.
  • Substance abuse causes chemical changes in the brain, which can create new problems within the individual, contributing to the likelihood of developing a mental illness.
  • Certain environmental risk factors can influence a person’s chances of trying illicit drugs. These same contributors, such as excess stress or trauma, are often associated with mental illnesses as well.
  • There are genetic markers that may help create an enhanced response to the pleasures of certain drugs. Persons with those markers may be at an increased risk for addiction and/or mental health conditions.

Dual Diagnosis by the Numbers

The Substance Abuse and Mental Health Services Administration (SAMHSA) has included mental illness statistics in many of their drug use surveys. The 2015 data tables show that the percentage of persons aged 18 and older who used illicit drugs and/or misused prescription drugs was much higher in individuals with a diagnosed mental illness.

Drug Used/MisusedAny Mental IllnessNo Mental Illness
Marijuana23.2%11.5%
Cocaine4.2%1.4%
Methamphetamine2.2%0.4%
Psychotherapeutics*15.8%5.3%

*includes pain relievers, tranquilizers, stimulants, and sedatives

II. Signs and Symptoms of Dual Diagnosis

It may be difficult to separate the symptoms of a particular mental illness from those of drug addiction. However, if you notice any of the following, you should seek out a medical professional or licensed therapist to discuss the possibilities of a substance abuse issue, alone or with a co-occurring mental health disorder.

Escalation of mental illness:

  • More frequent episodes
  • Longer lasting episodes
  • More intense episodes

Substance abuse indications:

  • Enhanced craving for the addictive substance
  • Increased need for more of the substance to achieve the same effect
  • Time management issues as more time is spent under the influence of the substance or in obtaining the substance
  • Continuing to use the substance even in the face of negative consequences
  • Withdrawal symptoms when trying to reduce the amount or frequency of the abused substance

III. Treatment Options for Dual Diagnosis

For individuals with co-occurring disorders, the road ahead may seem a bit tough. However, there are many treatment options available to help overcome substance abuse and keep mental illnesses under control.

Inpatient and Outpatient Rehab

Many addiction centers have specific programs for individuals with a dual diagnosis. The Dual Diagnosis Capability in Addiction Treatment (DDCAT) and the Dual Diagnosis Capability in Mental Health Treatment (DDCMHT) assess treatment programs nationwide to determine their ability to serve people with dual diagnosis issues. These programs are assigned scores that place them in the following categories:

  • Addiction Only Services
  • Mental Health Only Services
  • Dual Diagnosis Capable
  • Dual Diagnosis Enhanced

Support Groups

Support group meetings provide patients with co-occurring disorders a safe place to discuss problems and learn coping techniques from other members. In addition to the substance abuse programs offered by AA, NA, and Smart Recovery, Double Trouble in Recovery is aimed specifically at addicts with a co-occurring mental illness. The program follows the 12-Step recovery process, but members can enjoy a unique shared experience with other members dealing with the same struggle of simultaneous addiction and mental illness.

Prescribed Medications

Many mental illnesses are treated with medication to lessen the severity and frequency of episodes. The medication is dependent upon your specific illness, other health issues, and lifestyle factors. Proper medication adherence can play a large role in managing mental illness.

Additionally, medications are often used during the withdrawal phase of addiction recovery. It is vital that your physician or therapist be aware of both of your disorders to properly prescribe medications. Do not stop taking any medication for your mental illness without the advice of a trained medical professional.

Therapy Options

  • Cognitive behavioral therapy (CBT) can be very effective in treating many mental illnesses, including substance abuse. Its core principles involve learning how unhealthy thought patterns lead to negative behaviors. By changing these thought patterns and improving coping skills, individuals can create positive outcomes in their lives. One type of CBT called dialectical behavioral therapy centers on persons with suicidal thoughts, but it’s also applicable for persons with destructive behaviors, such as substance abuse.
  • Contingency management therapy focuses on rewarding individuals for appropriate behavioral changes. It has shown promise in the treatment for substance abuse and can provide benefits for patients who show poor adherence to their mental illness treatment regimen, whether it be attending regular appointments or taking medication as prescribed.

IV. How to Get Help & Additional Resources

  • The National Institute on Drug Abuse explains comorbidity and identifies connections between certain commonly abused substances and mental health conditions.
  • SAMHSA’s Treatment Locator makes it easier to find rehab facilities that specialize in or treat patients with a dual diagnosis.
  • Youth are often at risk for co-occurring disorders, and Mental Health America lists the signs of adolescent alcohol and drug use among teens with depression or other mental health conditions.
  • The National Alliance on Mental Illness lists support groups and discusses treatment solutions for individuals with a dual diagnosis.

This guide is intended to give general information on dual diagnosis with regard to mental illness and substance abuse. It’s not offering any specific treatment or giving any medical advice. Always seek out a medical professional before starting any treatment regimen or discontinuing any addictive substance.

V. Sources