Substance Use

What is Dual Diagnosis? Signs, Symptoms & Treatment

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The term dual diagnosis means the diagnosis of two mental health disorders or substance abuse problems. People who suffer from dual diagnoses often experience symptoms of both conditions simultaneously.

People dealing with dual diagnosis disorders face unique challenges. On top of addiction, they are also likely to struggle with depression, anxiety, and other mental health concerns. This opens them up to relapse and poor treatment outcomes.

This, of course, makes it important to find the best treatment providers possible. These providers should be well-informed about dual diagnosis disorders to make sure that they provide the best possible results. 

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What is a Dual Diagnosis Disorder?

A dual diagnosis disorder occurs when someone has both a mental health condition and a substance abuse problem. (1) Essentially, a dual diagnosis means that someone is struggling with not only substance abuse but also with a mental health issue.

These other mental health disorders can include:

  • Anxiety disorders
  • Depression
  • Attention-deficit hyperactivity disorder (ADHD)
  • Bipolar disorder
  • Post-traumatic stress disorder
  • Borderline personality disorder
  • Schizophrenia (2)

Dual diagnosis was first identified in the 1980s. (3) Also referred to as co-occurring disorders, it is increasingly recognized within the fields of addiction treatment and mental health care due to its prevalence and significant impact on individuals’ lives. 

Over 24 million Americans reported severe psychological distress and 21.3 percent of this population had active substance abuse/dependence disorders. (3) Substance use disorders include alcohol addiction, drug addiction, and opioid addiction.

Why Do Substance Use Disorders and Mental Disorders Occur Together?

Although these problems often occur together, they don’t always happen simultaneously. Sometimes, one appears first, while the other follows later. People with substance use disorders are at particular risk for developing one or more primary conditions or chronic diseases.

Research suggests three possibilities that could explain why SUDs and other mental disorders may occur together:

  • Common risk factors can contribute to both SUDs and other mental disorders. It is estimated that 40–60 percent of an individual’s vulnerability to substance use disorders is attributable to genetics. Environmental factors, such as stress or trauma, can cause genetic changes that are passed down through generations. (2) (4)
  • Mental disorders can contribute to substance use and SUDs. Studies found that people with a mental disorder may use drugs or alcohol as a form of self-medication. However, although some drugs may temporarily help with some symptoms of mental disorders, they may make the symptoms worse over time. (2)
  • Substance use and SUDs can contribute to the development of other mental disorders. Substance use may trigger changes in brain structure and function that make a person more likely to develop a mental disorder. (2)

Throughout adolescence, the brain undergoes significant development. Particularly, the circuits responsible for executive functions such as decision-making and impulse control are among the final to mature, making adolescents more vulnerable to drug use and the onset of substance use disorders. (4)

Having a mental disorder during childhood or adolescence can make it more likely for someone to start using drugs later on and develop a substance use disorder. Studies have shown that mental illness might come before a substance use disorder, which means if we can identify and treat mental health issues early on in young people, it could help lower the chances of having both mental illness and drug problems at the same time. (4)

One study found that adolescent-onset bipolar disorder confers a greater risk of subsequent substance use disorder compared to adult-onset bipolar disorder. Similarly, other research suggests that youth develop internalizing disorders, including depression and anxiety, prior to developing substance use disorders. (4)

Common Mental Health Issues and Addiction

Several common mental health issues often coexist with addiction. People suffering from depression, anxiety, bipolar disorder, PTSD, ADHD, and schizophrenia are more likely to develop addictions, such as alcohol abuse, later in life.

The presence of co-occurring mental health disorders and substance use disorders can make recovery from an addiction more difficult because the brain changes associated with each disorder can affect how we think, feel, and behave.

Various regions of the brain are impacted by both substance use disorders and other mental illnesses. 

Addictive substances can influence the circuits responsible for:

  • Reward processing
  • Decision-making
  • Impulse control
  • Emotional regulation (leads to disruptions observed in conditions like depression, schizophrenia, and other psychiatric disorders)

In addition, multiple neurotransmitter systems have been implicated in both substance use disorders and other mental disorders including, but not limited to:

  • Dopamine
  • Serotonin
  • Glutamate
  • GABA
  • Norepinephrine (5)

Certain mental disorders are established risk factors for developing a substance use disorder. It is commonly hypothesized that individuals with severe, mild, or even subclinical mental disorders may use drugs as a form of self-medication.

Although some drugs may temporarily reduce symptoms of a mental illness, they can also exacerbate symptoms, both acutely and in the long run. For example, evidence suggests that periods of cocaine use may worsen the symptoms of bipolar disorder and contribute to the progression of this illness. (5)

The Dangers of Self-Medication

Self-medication can be extremely dangerous. Some believe that using illegal drugs will relieve their emotional pain. However, research shows that this isn’t true.

Using substances as a coping mechanism can create a cycle of dependency, making it increasingly challenging to address both the mental health issue and the substance abuse problem.

Potential risks of self-medication practices include: 

  • Incorrect self-diagnosis
  • Delays in seeking medical advice when needed
  • Infrequent but severe adverse reactions
  • Dangerous drug interactions
  • Incorrect manner of administration
  • Incorrect dosage
  • Incorrect choice of therapy
  • Masking of a severe disease
  • Risk of dependence and abuse (6)

Self-medication often masks the root causes of mental health symptoms, delaying proper diagnosis and treatment. This can result in worsening mental health conditions and increased risk of complications, including overdose and other serious health consequences.

Recognizing the dangers of self-medication is crucial for individuals with dual diagnosis disorders, highlighting the importance of seeking professional help and integrated treatment approaches that address both mental health and substance use issues concurrently.

Without medical care, you will not receive the diagnosis and guidance you need to move forward. 

What are the Treatments for Dual Diagnosis?

Patients with dual disorders may be misdiagnosed and improperly treated, often “falling through the cracks” in the healthcare system. (7) This leads to a cycle of relapse and failure, which usually begins when someone tries to manage one problem without addressing the other.

The best way to treat co-occurring disorders is to address each condition individually in a customized treatment plan, but most people don’t know how to do that. Instead, they tend to approach either addiction or mental illness separately, treating one condition without considering whether it might worsen another.

A dual diagnosis can require the help of both mental and physical health specialists. Addiction therapists can provide patients with support during detoxification, ensuring that they also have strategies that help them reduce cravings and ease symptoms.

Mental health experts can additionally explain what causes the patient’s behavior and offer advice.

There are several ways to help people with dual diagnoses,  including medication, therapy, and support groups

Dual Diagnosis Treatment Programs

Dual diagnosis treatment programs are specialized facilities that cater to those struggling with both substance abuse and mental health disorders simultaneously.

This is particularly important because recent findings from a national study conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA) suggest individuals with co-occurring substance use and psychiatric disorders continue to receive disparate care that targets either the psychiatric or substance use disorder. (8) So it is crucial to find treatment programs that address both for successful recovery.

By making use of both rehab centers and mental health treatment facilities, dual diagnosis programs can provide individuals with tailored treatment services that address just their needs. The goal of dual diagnosis treatment programs is to enable comprehensive recovery, helping people overcome both substance abuse and mental health challenges. 

Dual Diagnosis Rehab

Dual diagnosis rehab is a facility that offers specialized care for people with dual diagnosis disorder. It has programs that usually start with a detox phase to safely manage withdrawal symptoms from drugs or alcohol.

After that, individuals then get to participate in addiction recovery therapies through substance abuse treatment and mental health treatment. This all takes place within a supportive environment.

Dual diagnosis rehab centers provide a range of services focusing on integrated treatment. Programs within both the psychiatric and substance abuse systems have some of the key services of integrated treatment. 

Those can include:

  • Assessment and diagnosis
  • Crisis intervention
  • Counseling targeted at psychiatric and substance use problems
  • Medications
  • Patient education
  • HIV screening and counseling
  • Family counseling
  • Education (9)

Additionally, some programs in dual diagnosis treatment centers may offer aftercare in the form of sober living accommodations to support individuals in transitioning to independent, substance-free lifestyles after completing treatment.

Research has demonstrated that recovery housing is associated with a variety of positive outcomes for residents including:

  • Decreased substance use
  • Reduced likelihood of return to use
  • Lower rates of incarceration
  • High income
  • Increased employment
  • Improved family relationships (10)

Medication Therapy for Dual Diagnosis

The medications available to treat a dual diagnosis depend on a patient’s condition. People with coexisting mental illnesses may need more than one medication to control their symptoms. Medication choices depend on the specific condition being treated.

Some common medications may include:

  • Antidepressants: Antidepressant medications work by increasing levels of serotonin and norepinephrine in the brain. Examples include selective serotonin reuptake inhibitors (SSRIs). Practitioners are however advised to know the following before prescribing antidepressants for patients with co-occurring substance use disorders (11):
    • Treatment recommendations for patients with co-occurring depression and substance use disorders
    • Potential antidepressant interactions with alcohol and drugs of abuse
    • Whether antidepressants have a risk of misuse
  • Antipsychotics: People who suffer from schizophrenia, bipolar disorder, or schizoaffective disorder may benefit from taking antipsychotic medications. (12) These medications can stabilize moods and control psychotic episodes.
  • Anxiolytics: Anxiolytic medications are used to treat anxiety disorders. Anxiety disorders and substance use disorders are highly comorbid (between 18% and 37%). SSRIs are considered first-line therapy in the treatment of dual anxiety while benzodiazepines should be avoided. (13)

Dual Diagnosis Behavioral Therapy

Psychotherapy can be effective for people with dual diagnoses. It helps them understand their mental illness and learn how to manage symptoms. Therapists also help clients develop coping skills so they don’t fall back into old habits.

There are many different types of behavioral therapies that psychotherapists utilize for patients with a dual diagnosis.

The most common therapies include:

  • Cognitive Behavioral Therapy (CBT): CBT teaches patients new behaviors and thought processes to cope with their problems. This type of therapy works best when combined with other treatments. (14)
  • Dialectical Behavioral Therapy (DBT): DBT helps patients to identify negative emotions and unhealthy behaviors before acting on them. By identifying triggers, patients can avoid falling back into negative patterns. Studies indicate that DBT may provide a useful therapeutic approach to managing co-occurring symptoms. (15)
  • Interpersonal Psychotherapy (IPT): IPT helps patients improve relationships with family members and friends. It teaches them to recognize and change destructive interactions. (16)
  • Mindfulness BasedCognitive Therapy (MBCT): MBCT teaches patients to focus on the present moment and accept things as they are. They learn to notice thoughts without judging themselves or others. (17)
  • Motivational Interviewing (MI): MI is an intervention technique that encourages people to make positive changes in their lives. It’s based on the idea that people will only change if they want to do so. (18)
  • Problem-Solving Skills Training (PSST): PSST teaches patients problem-solving techniques to deal with life stressors. It helps them develop strategies for dealing with difficult situations.
  • Self-Management Skills Training (SMST): SMST teaches patients to monitor their own behavior and adjust it accordingly. For example, if you have difficulty controlling impulsive behaviors, you learn to plan and set limits.
  • Social Skills Training (SST): SST teaches patients to interact appropriately with others. It teaches them to communicate effectively and express feelings.

Support Groups for Dual Diagnosis

Support groups for dual diagnosis are important for those dealing with both substance abuse disorder and mental health challenges. They provide a safe and supportive environment where people are able to talk about their experiences and struggles with others. It is also a space where one can celebrate their wins as well – no matter how big or small.

Social support can help individuals live a better life. A pilot study conducted among dually-diagnosed clients reported that combining peer social support with intensive case management was associated with positive outcomes including fewer crisis events and hospitalizations, perceived improvements in quality of life, and physical and emotional well-being. (19)

Support groups offer helpful peer support and encouragement for relapse prevention and holistic wellness. They complement the services of addiction treatment centers and mental health facilities.

These groups create a sense of community and camaraderie, empowering individuals to navigate dual diagnosis challenges and maintain sobriety while focusing on overall well-being.


Different types of counseling might be involved in your dual diagnosis treatment, including:

  • Individual Counseling: If you’re having difficulty managing your symptoms, individual counseling might be helpful. Individual counselors usually specialize in one area of psychology, such as addiction treatment, eating disorders, or depression.
  • Group Counseling: Group counseling involves two or more patients struggling with similar disorders. These group therapies are often led by trained professionals with experience helping people with dual diagnoses.
  • Family Counseling: Sometimes families struggle with a dual diagnosis. In these cases, family therapy can provide support and guidance. Young adults can specifically benefit from substance abuse and mental health family counseling.

Helping a Loved One with a Dual Diagnosis

The road to recovery is often a bumpy ride. For those struggling with addiction and another mental illness, it can feel like being stuck in a rut. But there are ways to navigate the obstacles and make progress toward lasting sobriety.

In many cases, people with dual diagnoses struggle with resistance to treatment — refusing to seek help for either addiction or mental illness. They may think changing their lives is impossible, not being ready to recover, believe that they’re too ill to recover, or think that seeking help will hurt others around them.

First, try to understand why your loved one isn’t ready to change. Accept that he or she may not agree to seek treatment. If your loved one continues to resist treatment, consider talking to a doctor or therapist about options for managing his or her symptoms.

A psychiatrist might prescribe medications to treat depression or anxiety, or a psychologist could recommend cognitive behavioral therapy

Continue to speak with them and advocate for their care. Sometimes taking a step back and allowing their consequences to catch up to them can assist in creating a “rock bottom.”

Once your loved one is ready to seek help, you can have options ready for them. There are different levels of treatment available, including inpatient, outpatient, and partial hospitalization for their mental health problems and drug or alcohol use.

Get Help for A Dual Diagnosis

If you’re struggling with addiction, finding the right treatment program can seem like a daunting task. But it doesn’t have to be difficult. Find one that offers evidence-based treatments. This includes cognitive behavioral therapy (CBT), motivational interviewing, family counseling, and contingency management. These types of therapies have been proven to help people overcome mental health diagnoses and addictions.

Look into the facility’s history. The most reputable facilities have had success helping others successfully address their issues. If possible, find out how long the facility has been around, what kinds of clients they treat, and whether they work with other organizations.

If you’re struggling with a dual diagnosis, there are several resources available to help you get better. Zinnia Health can help you get the treatment you need. Call our helpline at (855) 430-9439 or fill out our online contact form to learn more about dual-diagnosis treatment options. We utilize an evidence-based approach to treating a wide range of mental health disorders and substance use disorders.


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