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Updated on September 27, 2022

Dual Diagnosis: Addiction and Mental Health Treatment

People who struggle with substance abuse are often also diagnosed with mental health disorders. Doctors call co-occurring addiction and mental illness a dual diagnosis.

According to the National Survey on Drug Use and Health (NSDUH), over 45% of people dealing with addiction have also been diagnosed with a mental health disorder.1 Moreover, people with a mental illness have a higher risk of drug addiction than other groups.

Recognizing the existence of a dual diagnosis can help people needing substance abuse treatment and mental health services get the proper care. Unfortunately, mental and substance disorders are often incorrectly diagnosed without the correct treatment program. 

If alcohol use disorder is primarily treated, and the underlying depression or anxiety is not addressed, treatment is much less likely to be successful long-term.

What is a Dual Diagnosis?

A dual diagnosis is when a person has both a mental health disorder and substance abuse. Many people may never recover from either illness if they aren't treated concurrently.

People who struggle with drug abuse often don’t get properly diagnosed when they’re also struggling with an underlying mental illness. Identifying the dual diagnosis may help people get the combined substance abuse and mental health treatment they need.

Common Mental Health Conditions Associated with Addiction

The connection between substance abuse and mental health disorders is complex. Mental illnesses and addiction go hand in hand in almost half of addiction cases.1 

Mental health disorders often lead to substance abuse due to self-medicating. People with severe depression or anxiety drink alcohol to deal with their mental health issues, but often the drinking becomes a problem.

On the other hand, some people’s mental illnesses worsen due to their use of drugs and alcohol.

The most common mental health conditions associated with addiction and substance abuse are:

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Signs and Symptoms of Co-Occurring Disorders

There is often a combination of signs and symptoms to spot in someone dealing with co-occurring disorders: 

Type of Symptom Associated Signs & Symptoms
Physical  -Extreme tiredness or fatigue
-Major weight gain or weight loss
-Elevated blood pressure, erratic alteration in pulse rates, and hyperventilation
Behavioral  -Erratic behavior and acting out
-Inappropriate behaviors and unwarranted reactions to minor issues
-Major changes in personality traits
-Extreme levels of high and low energy
-Using substances to cope with sadness or anger
-Losing interest in activities that were once very important
-Withdrawal from close friends and family - social isolation
-Inappropriate sleeping habits
Psychosocial  -Severe impatience or agitation
-Mood swings
-Suicidal thoughts or attempts
-Emotional detachment from friends and family
-Deep sadness
-Anger and aggressiveness towards others
-Manic behavior, or feeling invincible
-Self-isolation and self-hatred
Cognitive  -Panic
-Bouts of confusion
-Anxiety and paranoia
-Feelings of disorientation
-Loss of memory and blackouts
-Trouble focusing

Who Needs Dual Diagnosis Treatment?

People with co-occurring mental health disorders and substance abuse problems need dual diagnosis treatment. 

Unfortunately, sometimes spotting a dual diagnosis can be difficult. For example, many people don’t know that addiction is often a symptom of an undiagnosed mental illness. Furthermore, addiction can worsen or trigger preexisting mental illness. 

Whether a person started with an addiction or mental health diagnosis, both types of people would benefit from concurrent treatment. 

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Do You Need a Dual Diagnosis from a Doctor to Receive Treatment?

To receive a proper dual diagnosis, a person must visit a dual diagnosis treatment center. Suppose someone is looking to receive treatment from an inpatient treatment facility or needs medicine prescribed. In this case, they’ll need a diagnosis from a doctor. 

However, there are group therapy options, such as 12-step programs, that a person can attend without a medical diagnosis. 

Unfortunately, 12-step programs will likely not address mental illness and addiction to the extent needed for a full recovery. Studies show AA success rates are as low as 5 to 10% for people struggling with a dual diagnosis.2

Treatment Options for Dual Diagnosis

Almost all dual diagnoses require some level of combined treatments. For best results and to increase the probability of a full recovery, dual diagnosis treatment should include:

  • Help from professionals who specialize in substance abuse and mental health treatment to ensure all their needs are taken care of
  • Psychotherapy treatment with the possibility of medication for mental illness when necessary
  • The support of friends, family, or household members to provide guidance

Types of Therapy Used in Dual Diagnosis Treatment

Many dual diagnosis treatment centers are staffed with mental health and substance abuse professionals. 

Most qualified treatment centers have people who are cross-trained in addiction and mental health treatment. They can provide care for both illnesses. This way, a person can receive both types of treatment to increase the likelihood of a full recovery.

Sadly, only about half of people struggling with a dual diagnosis receive treatment. When people do get professional help, it’s often only for one of their diagnoses. One study showed that only 12% of people with multiple conditions get the proper dual diagnosis treatment.1

Common therapies used at a dual diagnosis treatment center include:

  • Psychotherapy
  • Self-help groups
  • Group therapy
  • Rehabilitation
  • Detoxification
  • Medication prescription and management

In addition, therapy used at a dual diagnosis treatment center combines a handful of different treatments:

Family Therapy 

People with substance use disorders and mental illnesses often struggle with interpersonal conflicts. Additionally, caring for someone with a dual diagnosis can be challenging. Family therapy can help both sides cope with a dual diagnosis.3

Cognitive Behavioral Therapy

Cognitive-behavioral therapy (CBT) is talk therapy for people struggling with dual diagnoses. CBT allows therapists and clients to work through patterns and triggers to increase the chances of a full recovery.

Assertive Community Therapy

Assertive community treatment (ACT) is an immersive type of dual diagnosis therapy that offers people 24/7 support from their own homes. Services provided with ACT are often nurse care, psychiatry, talk therapy, and addiction treatment.4

ACT can effectively help with a person’s independence and overall quality of life. It can also help family members care for their loved one with a dual diagnosis.

Medication-Assisted Treatment

Medications to treat mental health disorders are common when treating a dual diagnosis. Some medicines can help treat mental illness, lessen withdrawal symptoms, and promote recovery.

Medication management is also incorporated. This helps a person during withdrawals and detoxing.

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How is Dual Diagnosis Treatment Different from Traditional Treatment?

For many years, dual diagnosis treatment was unpopular and unavailable. Until the 1990s, many healthcare professionals believed addiction and mental illness needed to be treated separately.5

Additionally, people with psychiatric disorders were often rejected by mental health and addiction programs. The lack of proper care allowed many people to fall between the cracks of the healthcare system. 

Recognition and treatment of people with a dual diagnosis is a modern feat. Dual diagnosis treatment uses an integrative approach or both mental health and addiction services.

In the past, medical professionals and therapists relied on two approaches before using integrative treatment:

  • Sequential treatment: Addiction treatment that separates substance abuse and mental health treatment. The idea was that each person needs to stabilize one illness or disorder before addressing the other. This was the predominant way of creating a dual diagnosis before the 1990s.
  • Parallel treatment: A treatment where a person’s mental health disorder and substance use disorder is managed at the same time, but without their doctors or therapists communicating or working together. 

Dual diagnosis treatment combines traditional therapies to help people treat addiction and mental illness. This combination has been proven to be the most effective for dealing with a dual diagnosis. 

Using cross-trained therapists who are familiar with treatments for common mental illnesses, along with treatment for AUD/SUD, is the ideal way to address a dual diagnosis.

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  1. Substance Abuse and Mental Health Services Administration. “2019-2020 National Surveys On Drug Use And Health: Model-Based Estimated Totals (In Thousands).” January 5, 2022.
  2. WBUR Radio Boston. “Harvard Doctor Debunks 'Bad Science' Behind 12-Step Programs.” March 31, 2014.
  3. Mueser KT, Glynn SM, Cather C, Zarate R, Fox L, Feldman J, Wolfe R, Clark RE. “Family intervention for co-occurring substance use and severe psychiatric disorders: participant characteristics and correlates of initial engagement and more extended exposure in a randomized controlled trial.” Addict Behav. 2009 Oct.
  4. Susan D. Phillips, M.S.W., Barbara J. Burns, Ph.D., Elizabeth R. Edgar, M.S.S.W., Kim T. Mueser, Ph.D., Karen W. Linkins, Ph.D., Robert A. Rosenheck, M.D., Robert E. Drake, M.D., Ph.D., and Elizabeth C. McDonel Herr, Ph.D. “Moving Assertive Community Treatment Into Standard Practice”. 1 Jun 2001.
  5. Woody G. “The Challenge of Dual Diagnosis.” Alcohol Health Res World. 1996.

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