Addiction and Dual Diagnosis

Studies show that a significant number of individuals with a substance use disorder (SUD) also have another mental health condition, known as a dual diagnosis.1 Dual diagnoses can complicate each other and affect how treatment for the SUD or mental health disorder is approached.

In this article: 

What Is Dual Diagnosis?

A dual diagnosis—also referred to as comorbidity or co-occurring disorders—is defined as having one or more mental health issues simultaneously. One of the most common types of dual diagnosis is the occurrence of a mental health condition at the same time as chemical dependence or a SUD.1

Dual diagnosis varies from person to person. Some individuals have more severe SUD and less severe mental health symptoms, while others have mild SUD and more intense mental health symptoms. This difference in presentation changes the approach to dual diagnosis treatment. Those who have severe SUD but few visible mental health symptoms may have barriers to receiving treatment for their underlying mental health condition.1

Who Develops Dual Diagnosis?

Some people are more at risk of developing comorbid conditions than others based on certain experiences, environmental factors, genetics, and diagnoses.

For some individuals, the mental health condition develops first and they attempt to use a substance to manage their symptoms. In the field of psychology this is known as “self-medicating.”2 The practice of self-medicating can lead to the development of a SUD. The opposite process can also occur where use of a mind-altering substance leads to the development of mental health symptoms. These mental health disorders, when diagnosed, may be classified as “substance-induced.”

You may be more vulnerable to development of dual diagnosis if you have one or more of the following:

  • Trauma history—Unresolved trauma may contribute to the development of mental health symptoms or substance misuse. High-impact trauma often occurs in childhood when a person is physically more vulnerable and dependent on caregivers. However, traumas that affect mental health can occur at any age.3
  • Limited emotional regulation skills—Emotional regulation skills assist with managing stress and recovering from adverse experiences. Substance use can become an unhealthy coping mechanism for individuals struggling with overwhelming mental health symptoms who have not yet developed other skills to regulate their emotions.4
  • Genetic predisposition—Mental health conditions do not always stem from life experiences, but can be passed down genetically. This heredity is present with both SUDs and other mental health disorders. 5
  • Certain mental health conditions—You may be born with a preexisting mental health condition that becomes symptomatic later in life. The presentation of new mental health symptoms can make you more vulnerable to developing substance misuse. 5

Community and social support are often key for dual diagnosis treatment and management of comorbid conditions. Individuals without support from family, friends, or social groups may experience more severe versions of their diagnoses and worsening symptoms over time, which can lead to the development of a secondary condition in a person who has either a SUD or another mental health disorder.6

What Are the Most Common Dual Diagnoses?

Some mental health conditions are more likely to co-occur with a SUD. However, having these diagnoses or addiction does not predict or guarantee development of the other. If you are concerned about the possibility of dual diagnosis, call 800-839-1686Who Answers? to speak to an addiction treatment specialist.

Mental health conditions that have the highest rate of comorbidity with SUDs include:

Studies show that although some individuals practice self-medication to cope with their mental health condition, their symptoms may worsen after the effects of the substance wear off.7 Those with depression may experience a worse depressive episode once sober and those with anxiety may experience more acute levels of anxiety when they are sober. This effect may lead to continued substance use to achieve the same level of calm or excitement, eventually developing into physical dependence or a SUD.8

How Is Dual Diagnosis Treated?

Successful dual diagnosis treatment must not only focus on treating the SUD, but also on treating the co-occurring mental health condition that may have caused, contributed to, obscured, or complicated the addiction in the past.

If a SUD is treated, but not the underlying mental health condition, then you will still be at risk of relapse. Likewise, if a mental health condition is treated successfully, but the SUD is not addressed, then you remain at risk of mental health and physical health complications from substance misuse.

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Inpatient and Outpatient Treatment

Treatment methods available for people with dual diagnosis include inpatient treatment—such as treatment at a hospital or residential addictions treatment facility—and outpatient treatment, which may include sessions at a therapist’s office or treatment facility. Depending on the severity of your mental health condition and addiction, you may begin the recovery process in an inpatient setting and then step down to an outpatient setting.

Inpatient settings allow you to receive medical care and supervision during detox and stabilization, as well as a firm recovery plan for when you are back in the community.

Mental health conditions and addictions can be chronic and often relapsing conditions. Those looking for a long-term recovery should be prepared to commit themselves to long-term mental health care. Once discharged from inpatient treatment, continued treatment may include outpatient care with psychiatric oversight, psychotherapy sessions, and 12-step meetings.9

The necessity of psychiatric care is emphasized in most recovery plans, as studies show that the use of appropriate medication—such as mood-stabilizing medications, antidepressants, and antipsychotic medications—prove beneficial for long-term sobriety and stabilization of mental health conditions.10

Psychosocial Interventions

The addition of psychosocial interventions—such as social skills training—can also be an important part of dual diagnosis treatment. With these psychosocial interventions, a therapist will help you, your family, and other support members to re-engage in society through healthy outlets, such as clubs, organizations, and personal hobbies.5

This aspect of a recovery plan has proven highly beneficial for increasing the longevity of sobriety and management of mental health symptoms. Healthy social skills and outlets allow you the opportunity to outwardly engage with others rather than inwardly engage with your mental health symptoms and substance misuse.5

With a combination of professional treatment, continued psychiatric and psychological care, and 12-step meetings and social skills training, someone with a dual diagnosis can achieve long-term sobriety and wellness.

If you have any questions or concerns about dual diagnosis or what the recovery process may be, please call 800-839-1686Who Answers? for more guidance.

Resources

  1. Buckley, P. F. (2006). Prevalence and consequences of the dual diagnosis of substance abuse and severe mental illness. The Journal of Clinical Psychiatry, 67, 5-9.
  2. Vorspan, F., Mehtelli, W., Dupuy, G., Bloch, V., & Lépine, J.P. (2015). Anxiety and substance use disorders: co-occurrence and clinical issues. Current Psychiatry Reports. 17(2),
  3. Oral, R., Ramirez, M., Coohey, C., Nakada, S., Walz, A., Kuntz, A., Benoit, J., Peek-Asa, C. (2016). Adverse childhood experiences and trauma informed care: the future of health care. Pediatric Research. 79(1-2), 227-233.
  4. Moggi, F., Ouimette, P. C., Moos, R. H., & Finney, J. W. (1999). Dual diagnosis patients in substance abuse treatment: Relationship of general coping and substance‐specific coping to 1‐year outcomes. Society for Study of Addiction, 94(12), 1805-1816.
  5. Kessler, R. C. (2004). The epidemiology of dual diagnosis. Biological psychiatry, 56(10), 730-737.
  6. Meister, K., Rietschel, L., Burlon, M., Gouzoulis-Mayfrank, E., Bock, T., & Lambert, M. (2010). Psychose und Sucht bei Jugendlichen und Jungerwachsenen [nl]Teil 2: Verlauf und Behandlung [Dual diagnosis psychosis and substance use disorders in adolescents–part 2]. Fortschritte der Neurologie Psychiatrie, 78(2),90-100. German.
  7. Tirado Muñoz J., Farré, A., Mestre-Pintó, J., Szerman, N., & Torrens, M. (2018). Dual diagnosis in Depression: treatment recommendations. Adicciones. 2018 30(1), 66-76. English, Spanish.
  8. Davis L, Uezato A, Newell JM, & Frazier, E. (2008). Major depression and comorbid substance use disorders. Current Opinion Psychiatry, 21(1),14-18.
  9. Young, J.T., Heffernan, E., Borschmann, R., Ogloff, J.R.P., Spittal, M.J., Kouyoumdjian, F.G., Preen, D.B., Butler, A., Brophy, L., Crilly, J., & Kinner, S.A. (2018). Dual diagnosis of mental illness and substance use disorder and injury in adults recently released from prison: a prospective cohort study. Lancet Public Health, 3(5), e237-e248.
  10. Ivanets, N.N., Lavrinenko, O.V., & Maximova, T.N. (2017). Osobennosti terapii depressivnykh sostoianiĭ, oslozhnennykh zloupotrebleniem i zavisimost’iu ot alkogolia [Treatment of depression complicated by abuse and dependence on alcohol]. Zh Nevrol Psikhiatr Im S S Korsakova, 117(7), 53-58.

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