What Is Dual Diagnosis?

Learn about the details, symptoms, risk factors, and treatment options for dual diagnosis.

Overview of Dual Diagnosis

The rate of dual diagnoses has increased significantly during the past decade. Research shows that approximately half of people struggling with a severe mental illness are also struggling with substance abuse.¹  This statistic is staggering and highlights the current mental health epidemic that is happening across the nation.

There may be several contributing factors to this concerning rise, including a widespread lack of health insurance and access to health care, overwhelming access to social media, and unnaturally high levels of stress that many Americans face on a daily basis.

What Is a Dual Diagnosis?

A dual diagnosis is a condition in which a person simultaneously has a mental health and substance use disorder. The number of people with dual diagnosis disorder has increased significantly over the years, and the numbers are showing no signs of decreasing.

It can be extremely difficult for doctors or therapists to determine which condition came first, as both conditions interact with and worsen the other. Researchers believe one of the most significant reasons that dual diagnosis occurs is because of the number of common risk factors present between the two conditions.

A Discussion on Co-Occurring Disorders

Symptoms of Dual Diagnosis

No two people will display the same signs of a dual diagnosis. The signs and symptoms that are present largely depend on the mental illness and the substance used.

For example, a patient with anxiety who smokes marijuana will have vastly different symptoms than a patient who has schizophrenia and uses methamphetamines.

Because there is such a large disparity between the types of symptoms that a person may exhibit, it can be extremely difficult to diagnose or for their family members to realize that something is wrong.

Nonetheless, more severe dual diagnoses show more prevalent signs and symptoms, becoming increasingly apparent to friends, family, and coworkers. Some of the warning signs to watch out for include the following.¹ 

Withdrawal From Friends and Family

A family member or close friend who suddenly seems withdrawn, secretive, or unwilling to communicate or spend time with their loved ones may be experiencing a mental health crisis or substance abuse disorder.

It is important not to make hasty accusations or automatically assume that the person is doing something harmful, so try communicating with them first. Are they stressed? Are they busy with something important happening in their life? Expecting a significant change in the future?

Sometimes people pull away because they are going through an event that they are having difficulty processing, such as the loss of a job, loved one, or home. However, there is also a very real possibility of substance abuse if they are actively hiding things from those they love or going out of the way to avoid people.

If it appears that their health may be declining or they may be in danger, consult a mental health specialist or an intervention specialist for help in reaching them.

Sudden Changes in Behavior

Is your loved one suddenly acting differently? For example, they might be more secretive, nervous, or withdrawn than they once were, or they might be missing work or school when they were previously very attentive to their responsibilities.


Severe mood swings are another common hallmark of a dual diagnosis. When there are severe chemical imbalances in the brain, it can cause a person to behave in ways that are completely unnatural for them.

Engaging in Risky Behaviors

If your loved one is disappearing in the middle of the night or frequently missing for days on end without contacting anyone, that is a warning sign. More examples include if someone is taking less care of themselves, not eating or sleeping regularly, or associating with unsavory individuals.


In addition, if they suddenly seem to care less about what happens to them or others or they seem to be taking risks that could cause them or others harm, then it is time to try to seek help for them.

Developing High Tolerance and Withdrawal Symptoms

Many people have a drink occasionally when they are out with friends, but a few warning signs may include going out, partying, or drinking significantly more alcohol than they used to. Another warning sign to watch for is withdrawal symptoms. These are important signs to keep note of that may indicate it is time to seek professional help:

• Tremors
• Paranoia
• Insomnia
• Hallucinations
• Severe irritability
• Depression or anxiety
• Aches, pains, or chills
• Nausea and vomiting
• Rapidly changing moods
• Confusion or cognitive difficulties

These symptoms may begin within six hours of a person’s last usage of drugs or alcohol, and they will worsen significantly within the next day.² 

Feeling Like the Substance is Needed to Be Able to Function

One of the most recognizable symptoms of addiction is cravings. If a person feels like they need a specific substance to start their day, attend a meeting, or perform any other tasks, they are likely to have an addiction and should seek help.

Common Risk Factors

The common risk factors of dual diagnosis may include:

• Genetics: People with a family history of depression, anxiety, bipolar disorder, or other mental health conditions are more likely to develop those conditions themselves. Additionally, people who have one or both parents who abused drugs or alcohol are more likely to experience addiction themselves.
• Stress: People who are experiencing high levels of stress in their lives, whether from their jobs, family pressures, illness, etc., are more likely to develop a mental health condition and/or a substance abuse disorder leading to a dual diagnosis than other people. This is often the result of attempting to self-medicate to reduce the symptoms of their mental health condition.
• Trauma: Patients who have experienced one or more adverse childhood experiences are more likely to develop a mental health condition and/or a substance abuse disorder than those who have not.

Research is still being conducted into the phenomenon of dual diagnosis in an attempt to understand it better and help prevent its occurrence in the future.³ 

Link Between Substance Abuse and Mental Health

In some cases, a person may not have an underlying mental health condition prior to their substance abuse. When one occurs only while using substances or during the period of withdrawal, then these are not considered to be true mental health conditions.


Instead, these are known as substance-induced mood disorders. Substance-induced mood disorders are typically temporary and will usually resolve once treatment has been completed. Moreover, substance abuse will typically worsen the underlying mental health condition. This can cause several problems, particularly if the patient is undiagnosed.


Eventually, continued substance use can lead to a vicious cycle of worsening the mental health condition, leading to more substance abuse in an attempt to self-medicate the condition.

A Further Look at Addiction Risk Factors

How to Treat Dual Diagnosis

Dual diagnosis recovery is possible through a dual diagnosis treatment program. When a person has a dual diagnosis, it is important that they are treated at a reputable rehabilitation center that specializes in dual diagnosis recovery.

The reason for this is that treating a dual diagnosis is significantly different than treating a mental health condition or an addiction alone. With a dual diagnosis, both conditions must be treated in tandem in order for a patient to have their best chance at recovery.

Detoxification

The first step in any treatment program that manages addiction is to help the patient detox. Recovery is not possible while a patient still has drugs or alcohol in their system, and it can be extremely difficult while they are dealing with withdrawal symptoms and cravings.

Rehabilitation centers first help patients fully detox from the chemicals and toxins in their bodies before they begin any other treatment.

Inpatient Rehabilitation

A patient who is undergoing detox will be admitted to an inpatient rehabilitation program so they can be monitored as their bodies rid themselves of the drugs or alcohol. They will be constantly monitored to ensure that they are detoxing as safely as possible and as comfortable as possible.

Once the detox is finished, patients will begin treatment for their mental health condition before being released to an outpatient facility. Treatment is not complete until all underlying conditions have been diagnosed and a treatment plan has been initiated. This may include therapy or medication.

Medications

Depending on how long a person has been struggling with an addiction, they may need medication to help them manage their withdrawal symptoms. A person who is going through severe withdrawal may experience life-threatening withdrawal symptoms if they are left untreated.

This is why it is highly recommended that a person does a medically-assisted detox. Certain medications, such as methadone, naltrexone, or buprenorphine, can help protect the body from the most severe symptoms.

Self-Help and Support Groups

One of the most helpful tools in dual diagnosis recovery is group therapy. With a dual diagnosis, it can be very easy to feel alone in the world or to feel like they don’t have anyone to rely on.

A support group can help immensely. These groups exist to help people see that they are not alone and not the only ones struggling with their situation. In addition, it can be helpful and cathartic to hear the experiences of others and to share their own with people who understand these experiences without judgment.

Most reputable dual diagnosis programs understand the importance of a support group and the importance of a sponsor. While many mental health conditions can be managed through individual therapy or medication, it can be much more difficult for those who are also struggling with addiction to recover.

Why Dual Disorders Are Treated Differently

When a patient has a dual diagnosis, rehabilitation and treatment become more complex. This is because a doctor or specialist must treat two or more conditions simultaneously rather than focusing on one at a time.

A person with a dual diagnosis is fighting a war on two fronts, and each of their conditions feeds back on the other in a continuous loop. These conditions will continue to worsen and hinder treatment attempts if they are not treated together. If a person who has a dual diagnosis is only treated for their substance abuse disorder, then the underlying problem has not been addressed, and they are more likely to relapse.

Similarly, when a person is treated for a mental health condition, but their substance abuse isn’t addressed, the likelihood of stopping substance use on their own increases. This could also lead them to discontinue their mental health treatment.

What Mental Health and Substance Abuse Issues Commonly Occur Together?

Virtually any mental health condition can be comorbid with a substance abuse disorder, but there are some that are more common than others. Some conditions that are frequently found together are:

• Anxiety and alcohol addiction
• Panic disorder and alcohol addiction
• Bipolar disorder and alcohol addiction
• Major depression and cocaine addiction
• Schizophrenia and any drug in addition to alcohol addiction

As stated, these are not the only conditions that are frequently comorbid together, but they are the most common.

Helping a Loved One with a Dual Diagnosis

Dual diagnosis help can take place in the form of therapy, drug rehab, and other forms of dual diagnosis treatment programs. It is important for loved ones to understand that when someone they care about receives a dual diagnosis, it is not the end of the world.


Although it may not seem like it at the time, dual diagnosis of mental health and substance abuse is a positive first step in a person’s recovery journey. Support can go a long way during treatment, but it is important to remember that those supporting should take care of themselves as well.

Seek Support

The first thing people should do is seek professional support. Reach out to a therapist, addiction center, or intervention specialist to better understand what the options are.

There are many rehab centers that accept insurance, and many insurance providers will pay for some, if not all, of the cost of treatment for alcohol or other substance abuse.

It may also be helpful for people to look into information regarding helping their loved one return to life after recovery. This can look different for everyone, but most people will need help finding a place to live, gainful employment, a therapist, and a support group to help them maintain their sobriety.

Set Boundaries

While offering support, it is important to set boundaries. People must remember that they cannot make a person choose sobriety.

Ensure that there is a line, or a boundary, that will not be crossed. Boundaries often include not letting the person live in one’s home while they are struggling with addiction or not lending them any money until they have gone to a rehabilitation center.

Setting firm boundaries with a loved one can be extremely difficult, but it is essential in helping them realize that they must seek professional help. Additionally, these boundaries are there for protection in case the individual tries to lie, cheat, or to continue their addiction during a time of weakness.

A person living with an addiction has a brain disease, and while they are in the middle of their addiction, it can be very difficult to control their actions and impulses. This does not mean that they are a bad person or trying to hurt their loved ones. They simply need professional help to treat the dual diagnosis first-hand.

Educate Oneself

When someone discovers that their loved one has a mental health condition, a substance use disorder, or both in a dual diagnosis, one of the most important things they can do is understand what the person is going through.


Researching the condition provides a better understanding of what they are going through. These conditions manifest as a chemical imbalance in the brain that the person has no direct control of.


In many cases, the person suffering from one or more disorders may need therapy, treatment, or medications to help correct these chemical imbalances. Mental health and addiction are complicated, incredibly intricate conditions that are often misunderstood.

Be Patient

Addiction recovery and improved mental health are not things that happen overnight. Instead, recovery and treatment are slow, methodical processes that can take weeks, months, and even years of effort.

It is important to understand that the person may slip, relapse, and struggle while they are recovering and that all of this is completely normal. Be there to support and encourage them during their recovery but be sure to not directly or indirectly enable them to go back to their old ways.