A dual diagnosis means someone has a mental health condition and a substance use disorder at the same time. Depression with alcohol use disorder is a common example. So are PTSD with opioid addiction, and anxiety with benzodiazepine misuse. Each condition affects the other, which is why treatment works best when it handles both together.
You’ll also hear it called co-occurring disorders. Either way, it comes down to how the two conditions connect, what the signs look like, and what good treatment involves.
What Is a Dual Diagnosis?
MedlinePlus, the National Library of Medicine’s health site, keeps the definition simple: you have both a mental disorder and a substance use disorder, involving alcohol or drugs. It’s common. It’s even more common in teenagers, in people with serious mental illness and in people with certain mental disorders. Either one can come first. Some people develop depression or anxiety and later start drinking or using to cope. Others develop mental health symptoms after years of substance use. Often it’s hard to say which came first, and you don’t need to settle that before treatment starts.Why Mental Illness and Addiction Occur Together
MedlinePlus gives three main reasons the two show up together:- Shared risk factors. Genetics, chronic stress and trauma raise the risk of both mental illness and addiction.
- Self-medication, where people with mental health symptoms use alcohol or drugs to feel better and end up with a substance use disorder. Our post on self-medicating with alcohol and drugs goes into this in more detail.
- Changes caused by the substances themselves: alcohol and drug use can alter the brain in ways that make a mental disorder more likely.
Common Dual Diagnosis Pairings
Any mental health condition can occur alongside any substance use disorder. Some combinations, though, come up again and again in treatment:- Depression with alcohol, cocaine or other stimulants
- Anxiety disorders with alcohol, marijuana or benzodiazepines (see drinking to cope with anxiety)
- PTSD and trauma with alcohol or opioids (see Christian PTSD treatment)
- Bipolar disorder with alcohol or stimulants
- ADHD with stimulants or alcohol
- Eating disorders with alcohol, stimulants or diet pills (see eating disorders and substance abuse)
Signs of a Dual Diagnosis
Each condition can mask or mimic the other, so a dual diagnosis is easy to miss. Signs that both may be present:- Using alcohol or drugs to cope with feelings, memories or symptoms
- Mood changes, anxiety or depression that hang on even during stretches of not using
- Pulling away from family, friends and activities
- Using in risky situations, or losing control over how much
- Needing more of the substance to get the same effect
- Feeling you can’t function without it
- Relapsing again and again after addiction treatment that never touched mental health
How Dual Diagnosis Treatment Works
MedlinePlus notes that it’s usually better to treat both conditions at the same time rather than separately. In practice, you want one team looking at the whole person, not an addiction provider and a mental health provider who never talk to each other.Assessment
Treatment starts with a careful look at substance use, mental health history, trauma, medical needs and current medications. Some symptoms ease once substance use stops, so diagnoses often get refined over the first few weeks.Detox, if needed
Some people need medical detox first. Withdrawal from alcohol or benzodiazepines can be dangerous, and withdrawal can also make anxiety or depression temporarily worse, so medical monitoring matters.Integrated therapy and psychiatric care
Treatment usually pairs individual therapy, group therapy and family involvement with psychiatric care and medication management when needed. Cognitive behavioral therapy helps on both fronts, because it targets the thought patterns behind anxiety or depression and the ones behind cravings. For people whose substance use is tied to past trauma, trauma-informed care is a must; our trauma and substance abuse page covers it.Stepping down over time
Many people move through several levels of care, say residential treatment, then day treatment or intensive outpatient, then aftercare. Mental health care and relapse prevention keep going after formal treatment ends.Questions to Ask a Treatment Program
- Do you screen every client for mental health conditions?
- Is there psychiatric care and medication management on site?
- Are addiction and mental health treated by the same team, at the same time?
- How do you handle trauma?
- What happens after residential treatment ends?
