Dual Diagnosis: Diagnosis and Treatment

With this guide, learn about the details of dual diagnosis, why it occurs, and how it is treated.

Table of Contents

What Is Dual Diagnosis?

It’s no secret that substance use and mental health are interconnected. The good news is that mental health and substance use disorders are treatable. If you or someone you know is struggling with a dual diagnosis, it’s essential to seek help. There are many resources available, and with treatment, people can live healthy and happy lives.



Dual diagnosis is a common term used to describe an individual with both a mental health disorder and substance use disorder. For instance, if a person is diagnosed with post-traumatic stress disorder (PTSD) and alcohol use disorder, they qualify for dual diagnosis treatment.

Learn More About Co-Occurring Disorders

How Common Is a Dual Diagnosis?

According to the National Library of Medicine, about half of all people with a mental illness will also have a substance use disorder (SUD) at some point in their life. About half of all people with an SUD will also have a mental disorder during their lifetime.

What Comes First: Substance Abuse or Mental Health Problems?

Mental health and substance use disorders are often co-occurring; however, just because an individual has a dual diagnosis does not mean that one of the disorders caused the other. If a person developed a mental health disorder first and substance use disorder afterward, the mental health disorder did not necessarily cause the substance use disorder.

Co-Occurring Disorders

Co-occurring disorders are similar to dual diagnoses, but they do not mean the same thing. Co-occurring disorders are defined as when a mental health disorder causes a substance use disorder or when an SUD causes a mental health disorder. Thus, one disorder exists due to the other.

In contrast, dual diagnosis is defined as two disorders co-existing independently, not because of one or the other. Suffering from a mental health and substance use disorder can lead to health issues, impairment of life skills, injuries, loss of life, and legal ramifications. Unfortunately, although treatment is effective, many people do not have access to or receive care for their co-occurring disorders.

Why Do Substance Use Disorders and Mental Disorders Occur Together?

Dual diagnosis mental health and substance use disorders are frequently co-occurring. Many addiction professionals and public health researchers have dedicated their careers to studying the dual diagnosis relationship. Thus far, it appears there are three explanations for dual diagnosis disorders.

Common Risk Factors

Mental health and substance abuse risk factors including trauma, stress, and genetics can potentially contribute to the likelihood of dual diagnosis.

Mental Disorders Can Contribute to Drug Use

If a person has a mental health diagnosis, they may struggle with symptoms, including but not limited to insomnia, extreme mood changes, inability to concentrate, and sadness. Individuals with untreated mental disorders may turn to self-medication for symptom relief. Self-medication typically includes substances like alcohol or drugs. Additionally, mental illnesses can alter the brain and increase the likelihood of addiction following substance use.

Substance Use and Addiction Can Contribute to the Development of a Mental Disorder

Substance use and addiction change the human brain and make people more susceptible to mental health disorders. For this reason, it’s critical for those struggling with substance use to seek out a reputable dual diagnosis treatment center.

Signs of Substance Use Disorder

If a person is experiencing a substance abuse problem and mental illness simultaneously, there are specific symptoms to look for. Symptoms can include sudden changes in behavior, risky behaviors while under the influence, and withdrawal from family and friends. The following section will explore the symptoms of mental health and substance use disorders.

Guilt, shame, and minimizing are significant challenges in addiction. If you or a loved one are struggling with substance and alcohol use disorder, there are physical, behavioral, and psychological warning signs to look for:

Risky Behavior

Risky behaviors associated with substance abuse include driving while under the influence, having unprotected sex, and using dirty needles.

Abrupt Personality Changes or Changes in Behavior

Unusual, secretive, and suspicious behaviors can all be symptoms of substance use. Additionally, if a person neglects their responsibilities at home, school, or work, that may be another symptom of substance use.

Socially Isolating Self from Family, Friends, and Favorite Activities

If someone suddenly stops participating in hobbies or activities they used to enjoy to use alcohol or drugs, that is a symptom of substance use disorder. People struggling with substance use disorder and addiction often fail to maintain regular communication with their loved ones.

Unable to Control Drug or Alcohol Use

When an individual begins using more than they originally intended or cannot stop, this is a symptom of substance use. For instance, someone with an alcohol use disorder may agree only to have two drinks after work each day. Although this could be their genuine intention, the progression of addiction makes it difficult for an individual to control their drug or alcohol use.

Craving Substances

Cravings are a symptom of drug and alcohol use. For example, suppose a person has gone for some time without the substance or is trying to remain abstinent. In that case, they will likely begin experiencing cravings for the substance or substances they are addicted to.

Financial or Legal Problems

An unexplained need for money, asking to borrow money, or stealing money are warning signs of substance use disorder. In addition, legal problems, including arrests, child custody, and marital issues, can stem from substance use.

Building a Tolerance So More Is Needed to Achieve the Desired Effect

When a person needs more of a substance to experience the same effect or high, they are building a tolerance. Tolerance is a clear sign of substance use disorder.

Experiencing Withdrawal Symptoms if Substance Is Not Used

Using drugs or alcohol to relieve withdrawal symptoms is a sign of substance use disorder. If a person experiences nausea, insomnia, depression, sweating, anxiety, restlessness, or shaking due to lack of use, they are most likely withdrawing from their drug of choice.

Signs of a Mental Health Disorder

When it comes to mental illness, behaviors, signs, and symptoms vary by individual—each mental health diagnosis has its own symptomology. With this in mind, there are signs of mental health disorders that one can be aware of:

Recognize the Signs

Confusion

Learning difficulties and confused thinking can both be signs of a mental health disorder.

Inability to Concentrate

For children and adults, trouble concentrating could be a symptom of an undiagnosed mental illness.

Eating and/or Sleep Problems

Lack of energy, feeling tired, changes in sleeping patterns, fear of weight gain, increased hunger, and lack of appetite can all be symptoms of a mental health disorder.

Inability to Function in Daily Life

Although many of us have a bad day occasionally, it is concerning if an individual regularly struggles to function in their daily life. Symptoms can include excessive fear, constant worrying, difficulty perceiving reality, suicidal thoughts, and difficulty getting out of bed each day.

Changes in Sex Drive

An unusual increase or decrease in libido could be a symptom of mental illness.

Unexplained Physical Pain

Unexplained physical or chronic pain can be a symptom of mental illness. For example, headaches and stomach aches could result from untreated trauma or an undiagnosed mental health disorder.

Fluctuating Mood, Bouncing Between Highs and Lows

Extreme mood changes and feelings of euphoria can be associated with mental illness. Some individuals report experiencing uncontrollable highs followed by low periods filled with depression.

Social Isolation

When a person struggles with mental illness, it is common to avoid friends, isolate socially, and stop participating in activities. Unfortunately, social isolation only worsens mental health.

It is important to remember that seeking help from a mental health professional when experiencing any of these symptoms can be very beneficial. They are equipped with the tools needed to treat and guide patients to recovery and a better life.

Why Co-Occurring Disorders and Dual Diagnosis Are Treated Differently

Dual diagnosis
Unlike stand-alone mental health and substance disorders, integrated treatment is paramount for co-occurring disorders and dual diagnosis. When a person has a dual diagnosis, they are at an increased risk of morbidity and poor treatment outcomes. Treatment that simultaneously addresses both disorders or integrated treatment improves treatment outcomes. For individuals with co-occurring disorders, it’s also crucial for their providers to be licensed to provide care for substance use and mental health disorders. As with any other illness or disease, all care team members need to be aware of all diagnoses to provide appropriate treatment.

Mental health and addiction treatment centers offer various levels of care and therapies to treat individuals with co-occurring disorders and dual diagnoses. The following section will discuss standard therapies available at dual diagnosis and integrated treatment centers.

Common Therapies Offered at a Dual Diagnosis Treatment Center

Therapies at a dual diagnosis treatment center can include detoxification, inpatient rehabilitation, medication management, psychotherapy, peer support, and self-help groups. Dual diagnosis treatment typically comprises multiple forms of treatment and therapy.

Evaluation and Diagnosis of Mental Health Disorders
An individual must visit a dual diagnosis treatment center to complete a mental health assessment to receive proper treatment. A trained and licensed mental health professional accurately diagnoses existing mental health disorders.

Family Therapy
Individuals with a substance use disorder and mental illness can significantly benefit from family therapy. Interpersonal conflict and the challenge of caring for someone with a dual diagnosis are excellent reasons for patients and their loved ones to participate in family therapy. Many dual diagnosis rehab facilities offer family therapy to their clients.

Individual Therapy
Individual therapy or psychotherapy is a critical component of any effective co-occurring disorders and dual diagnosis treatment plan. During individual therapy sessions, clients process events, learn coping skills, address maladaptive thinking patterns, and create treatment plans.

Cognitive Behavioral Therapy
Cognitive-behavioral therapy (CBT) is an effective talk therapy for dual diagnosis clients. During CBT, the client and therapist work together to identify and work through ineffective thought patterns.

Medication-Assisted Treatment
Mental health medications play a critical role in treating co-occurring disorders and dual diagnoses. Various drugs can treat mental illness, alleviate withdrawal symptoms, and promote sustained substance recovery. Medication management is also used during medical withdrawal and detoxification processes.

Assertive Community Therapy
Assertive community treatment (ACT) is a type of therapy commonly used to help people with mental health and substance use disorders. ACT services can include psychiatry, nursing, social work, vocal rehabilitation, and substance use treatment. The principle behind ACT is that patients will receive around-the-clock care and support while residing at home. Improved quality of life, independent functioning, and lessening the burden of care on loved ones are three primary goals of ACT.

Integrated Treatment

Integrated intervention or treatment is a method in which a person receives care for substance use and mental illness at the same time. This form of treatment is the most common delivery method for individuals in dual diagnosis therapy.



What is Integrated Treatment?

What You Should Know About Dual Diagnosis

Dual diagnosis or co-occurring disorders are used to describe people with substance use and mental health disorders. The following sections will explore the adverse physical, emotional, and social effects of co-occurring disorders.

Dual Diagnoses Are Very Common

The National Survey on Drug Use and Health estimates that about 2.7 million adults have reported dual diagnosis major depressive disorder and alcohol use disorder. Unfortunately, out of these 2.7 million adults, approximately forty percent did not receive any form of rehab for mental health and addiction.

Dual Diagnosis Has Adverse Physical Effects

Comorbid physical health conditions are expected for individuals with dual diagnosis substance use and mental disorders. Examples of adverse physical effects include increased risk of cancer, heart disease, chronic pain, and infectious disease transmission.10 

Dual Diagnoses Can Worsen Emotional Health

Having a mental health and substance use disorder can have detrimental effects on a person’s emotional health. Isolation, mood changes, depression, anxiety, difficulty concentrating, and suicidal thoughts can all be worsened by a dual diagnosis.11

Dual Diagnosis Has Social Effects

The social effects alone can be debilitating for people battling and overcoming multiple disorders. Withdrawal from loved ones, lack of participation in social activities, disinterest in hobbies, and not fitting inside of social norms are challenges of dual diagnoses.11

Dual Diagnosis Treatment Is Complicated

There is a wide range of dual diagnosis-specific challenges in drug and mental health rehab. Dual diagnosis rehab facilities face the unique challenge of treating multiple disorders without aggravating any courses of treatment. For example, a patient with stimulant use and bipolar disorder may need detoxification, inpatient rehabilitation, sober support, psychiatric treatment, and medication management. Dual diagnosis treatment programs have the infrastructure to coordinate this complex level of care.12

The Dangers of Self-Medication

There are many risks associated with self-medicating using drugs or alcohol. Possible risks include adverse reactions, dangerous drug interactions, risk of abuse, incorrect self-diagnosis, and more. Taking control of one’s health responsibly can be accomplished by working alongside a trained psychiatrist to avoid the dangers of self-medication.13 

Many people attempt to treat or mask their mental illness by using drugs or alcohol. The following sections will discuss common examples of self-medication.

Drinking Alcohol to Feel Less Anxious

People commonly use alcohol to reduce anxiety, specifically social anxiety. Approximately fifteen million adults in the United States have a social anxiety disorder. In addition, it’s estimated that about 20% of these individuals struggle with alcohol abuse or dependence. Although alcohol may temporarily relieve anxiety symptoms, it can increase a person’s irritability, depression, and anxiety in the long term. Dual diagnosis treatment programs are an excellent resource to address social anxiety and alcohol abuse.14 

Taking Excessive Amounts of Benzodiazepines to Ebb an Oncoming Panic Attack

Benzodiazepines are the leading medication used to treat panic disorder in the United States. If used as prescribed, research shows high patient acceptance, favorable tolerability, and rapid onset of action. On the contrary, benzodiazepines, especially taken excessively, pose a significant risk of dependence and withdrawal symptoms.15 

Using Marijuana to Numb the Emotional Pain

In the long term, marijuana use can worsen mental health problems and result in cannabis addiction. Self-medicating with marijuana can also interfere with prescribed medications, harm a person’s memory, and result in learning deficits.16 

Smoking or Injecting Cocaine to Increase Energy

When the body is continually exposed to cocaine, the brain adapts and reward pathways shift. Adverse effects of self-medicating with cocaine include addiction, irritability, anxiety, panic attacks, paranoia, and psychosis.17

Recovery With J. Flowers Health Institute

If you or someone you know is suspected of struggling with multiple disorders simultaneously, drug and mental health rehab can provide the necessary resources for recovery.



J. Flowers Health Institute is a treatment center that provides a wide array of services for individuals with co-occurring disorders and dual diagnoses. Contact J. Flowers Health Institute to learn more about our world-class evaluation, detoxification, continuing care, and wellness programs.