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Dual Diagnosis | Co-Occurring Substance Use & Mental Health Disorders

Drug addiction, also called substance use disorder (SUD), is a serious mental health condition. It makes you feel unable to stop using drugs (such as alcohol, opioids, or stimulants) despite negative consequences.

Many people with SUD have co-occurring disorders, also known as dual diagnoses. 

What Is A Dual Diagnosis?

A dual diagnosis occurs when someone suffers from a SUD along with another mental illness. Mental illnesses that often co-occur with a SUD include:

According to the National Institute on Drug Abuse, about half of people with a mental illness also have an SUD, and vice versa. 

In addition, about 1 in 4 people with a serious mental illness (SMI) have an SUD. 

The Substance Abuse and Mental Health Services Administration (SAMHSA) defines serious mental illness as a condition that causes serious impairment and routinely interferes with major life activities. 

Signs Of Dual Diagnosis

If you’re not sure whether you or someone you love has a dual diagnosis, look for these signs:

  • mood changes
  • trouble concentrating 
  • loss of interest in activities once enjoyed
  • changes in sleep patterns
  • changes in appetite or weight
  • withdrawing from friends and family members
  • using drugs to ease mental illness symptoms
  • feeling unable to stop using drugs despite wanting to

If you experience these symptoms, talk to your health care provider about getting an official dual diagnosis. 

What Causes A Dual Diagnosis?

Researchers haven’t determined what exactly causes a dual diagnosis. However, they’ve proposed several theories for why dual diagnoses are so common:

SUD & Other Mental Illnesses Share Risk Factors

Many factors that contribute to SUD also contribute to other mental health issues. These factors include:

  • genetic predispositions
  • stress
  • trauma

Thus, someone who experiences one or more of these factors has a high chance of developing both SUD and another mental health problem. 

SUD & Other Mental Illnesses Change The Brain

SUD and other mental illnesses can change the structure and function of certain parts of the brain. 

SUD can make your brain more vulnerable to mental illness, particularly if you already have a genetic predisposition to it. 

Likewise, mental illness can make your brain more vulnerable to SUD, usually by increasing the positive effects of a drug or decreasing your awareness of a drug’s negative effects.

Many People With Mental Illness Use Drugs To Self-Medicate 

A person with mental illness may use alcohol or other drugs to numb unpleasant symptoms. 

For instance, many people with PTSD use alcohol to ease flashbacks, anxiety, and other symptoms. According to the United States Department of Veterans Affairs, 60% to 80% of Vietnam Veterans have alcohol use problems.

Learn more about PTSD & Substance Abuse In Military Veterans

Similarly, people with schizophrenia often use nicotine to ease psychosis (a feeling of disconnection from reality that’s common in people with schizophrenia), reduce the side effects of medications they take for schizophrenia, and cope with stigma and discrimination. 

Self-medication may temporarily ease the above problems. However, it often leads to SUD. It can also worsen the original mental illness. For example, if you abuse alcohol to ease depression, you’ll usually end up with even more intense symptoms. That’s because alcohol is a depressant.

Learn more about The Link Between Depression & Addiction

Early Drug Abuse May Contribute To Mental Illness 

If you abuse drugs before age 18, you may have a higher chance of developing mental illness, especially if you’re genetically predisposed to it. 

For example, an adolescent with a genetic predisposition to schizophrenia has a higher chance of developing the disease if they regularly use marijuana. 

People With Mental Illness & Chronic Pain May Become Addicted To Opioids

People with chronic pain often have depression and anxiety, and people with depression and anxiety often have chronic pain. 

Health care providers sometimes treat chronic pain with pain relief medications called opioids. Since opioids are highly addictive, a person who suffers from chronic pain and mental illness can easily develop an SUD as well. 

Learn more about Chronic Pain & Opiate Abuse

Dual Diagnosis Treatment Options

All mental health disorders, including substance use disorder, are treatable. However, if you get treatment for your SUD but not your other mental health problem(s), you’ll likely start using drugs again. 

In addition, if you get treatment for your other mental health problem(s) but not your SUD, your mental health will likely worsen. 

That’s why it’s important to find a treatment program that addresses SUD as well as other mental illnesses (also called an integrated treatment program). These programs offer services such as:


In therapy, a mental health care professional will help you treat both your SUD and your other mental health issue(s). Common types of therapy for a dual diagnosis include:

  • cognitive behavioral therapy (CBT), which can help you change unhealthy behaviors and develop healthy coping skills
  • integrated group therapy (IGT), which is designed for people who suffer from both SUD and bipolar disorder 
  • exposure therapy, which is designed for people who suffer from PTSD and other anxiety disorders 
  • motivational enhancement therapy (MET), which can help you become more motivated to recover from your SUD and other mental health disorder(s)

Support Groups

Many people with dual diagnoses feel judged and alone. In a support group, you can share your experiences with others who are facing similar challenges. 

One popular support group, Dual Diagnosis Anonymous (DDA), is based on the 12-step program Alcoholics Anonymous (AA) but includes an additional five steps that focus on other mental health problems. 

Medication Management

For some people, medication is an important part of mental illness treatment. At a dual diagnosis program, health professionals can help you choose the right medications, manage side effects, and avoid addictive drugs that could hinder your recovery from SUD. 

Aftercare Planning

Your treatment team can help you design a personalized aftercare plan so you can maintain recovery from all of your mental health issues. Depending on your needs, your plan may include services such as:

  • ongoing therapy and support groups
  • wellness activities like meditation, yoga, and exercise
  • assistance with employment and housing

If you or a loved one struggles with dual diagnosis, please contact a Recovering Champions specialist to learn about our comprehensive treatment options.

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Recovering Champions Is an accredited drug and alcohol rehabilitation program, that believes addiction treatment should not just address “how to stay sober” but needs to transform the life of the addict and empower him or her to create a more meaningful and positive life. We are dedicated to transforming the despair of addiction into a purposeful life of confidence, self-respect and happiness. We want to give recovering addicts the tools to return to the outside world completely substance-free and successful.

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