Understanding Dual Diagnosis: Treating Co-occurring Mental Health and Substance Use Disorders

Dual diagnosis refers to a condition where an individual has a mental illness and substance use disorder at the same time.

For example, a person may have an opioid addiction and anxiety disorder simultaneously.

Another example might be when someone has an alcohol addiction and mood disorder together.

When this happens, an individual might be diagnosed as having a dual diagnosis.

In this article, we’ll explore dual diagnosis in more detail, including the symptoms, and effective treatments that can help.

Other terms used to describe dual diagnosis

Mental health professionals use various terms to describe dual diagnosis, including the following:

• Concurrent disorders
• Co-existing mental health and substance use disorders
• Comorbidity
• Co-occurring mental illness and substance use disorder

These terms can be confusing but do all point to the same diagnosis.

If you or someone you know has any of the symptoms mentioned in this article, you should speak to a mental health professional who can advise you further. 

Early diagnosis and treatment can help prevent symptoms from worsening and will improve treatment outcomes for many. 

Understanding dual diagnosis

Although you may not have heard of dual diagnosis, it is a common mental health condition affecting millions worldwide.

For example, one study showed that dual diagnosis impacted over seventeen million US adults in 2020.

Many people with alcohol or drug use disorders will suffer from mental health conditions such as depression, anxiety, and mood disorder. However, knowing which condition came first or caused the other can be challenging.

Dually diagnosed patients experience various complications due to their condition, including diagnostic and treatment challenges, and as mentioned, it can also be difficult to tell which disorder came first. 

For example, does addiction come before the mental health problem, or is it the other way around?

Which came first

Much like the chicken and the egg discussion, researchers have long pondered whether a substance use disorder or mental health condition comes first, and the answer still remains inconclusive today.

However, a few key points have been deduced from decades of research on dual diagnosis, which many might find helpful:

• Mental health disorders can lead to substance abuse. For example, mental health conditions such as depression, anxiety, schizophrenia, and personality disorders can change the brain’s chemistry, making people more prone to the rewarding or pleasurable effects of drugs or alcohol. So, someone may begin using substances as a form of self-medication, but then find the rewarding effects make them want to use more and more of a substance, putting them at a higher risk of addiction.

• Other research suggests that drug and alcohol misuse can contribute to the development of mental health issues since some substances can trigger changes in brain structure and function over time, making people more prone to specific mental illnesses. For example, when someone uses drugs or alcohol, particularly over long periods, they are at higher risk of developing mental health problems, particularly anxiety and depression.

What are the most common co-occurring disorders?

According to the National Institute of Mental Health, the following mental health disorders commonly co-occur with substance abuse:

• Depressive disorders
• Bipolar disorder
• Schizophrenia
• Personality disorders
• ADHD (Attention Deficit Hyperactivity Disorder)
• Anxiety disorders

Is dual diagnosis a common condition?

As mentioned, dual diagnosis is a prevalent condition affecting millions globally. 

People with mental health disorders such as depression or anxiety are more likely to suffer from substance addiction than those without these conditions.

Data from the National Institute on Drug Abuse states that approximately half of those with a substance use disorder or mental illness will also have the other at some point in their lives. (Co-Occurring Disorders, Psychology Today.)

What causes dual diagnosis?

Much like any mental health condition, it can be hard to pinpoint the exact cause of dual diagnosis.

However, researchers have noted some factors that may put you at higher risk of developing co-occurring disorders, including the following:

• Genetics – those with a family history of mental illness and/or substance addiction may be more susceptible to dual diagnosis.

• Environment – mental health professionals believe our environment plays a significant role in our mental health and well-being. For example, if someone has experienced a high degree of trauma or grew up in a chaotic or unstable environment, they are more prone to mental illness and substance addiction than those without these experiences.

• The type of substance used – researchers identified another causal factor in dual diagnosis, noting that those with mental health conditions such as antisocial personality disorder, schizophrenia, and bipolar disorder are more likely to develop alcohol use disorder than other addictions. Alcohol use disorder is also frequently linked to certain depressive and anxiety disorders. (Co-Occurring Disorders, Psychology Today.) 

Recognising the signs

In dual diagnosis, both drug or alcohol addiction and mental health issues have unique symptoms that can affect your ability to function at school, at home, at work, and socially.

As if all that’s not enough, concurrent disorders can often affect each other. 

For example, if your alcohol use disorder remains untreated, your mental health condition may worsen.

On the other hand, if you suffer from depression or bipolar disorder, you may misuse alcohol or drugs to cope with the unpleasant symptoms of whichever mental health condition you have.

Dual diagnosis can present various challenges for those with the condition; however, knowing the signs and symptoms can help you recognise when you might have a problem, allowing you to seek proper treatment and support from a mental health professional.

Key questions to ask yourself 

Researchers noted that asking yourself the following questions may help you identify a mental health and substance use disorder in yourself or someone you know:

• When drinking or taking drugs, do you notice that you get depressed or anxious? Or do you drink or take drugs to cope with unpleasant feelings and emotions?

• Do you use alcohol or drugs to feel more confident in social settings or when confronting situations that scare or frighten you? In addition, do you abuse substances to help you focus on tasks? 

• Are you anxious, depressed, or out of sorts, even when sober? 

• Does a close relative or family member struggle with a substance use disorder or mental illness (or both)?

• Have you ever been treated for a mental health condition or substance use disorder? If so, was the substance addiction treatment ineffective due to complications from your mental health issue or vice versa?

Symptoms of dual diagnosis or co-occurring disorders

As mentioned, the mental health conditions that frequently co-occur with substance addiction are bipolar disorder, anxiety disorders, and depression.

Therefore, knowing the signs and symptoms of these conditions can be profoundly helpful and may help you recognise a co-occurring disorder or dual diagnosis in yourself or someone you know.

Anxiety disorder signs and symptoms

Anxiety is one of the most common mental health disorders to co-occur with substance addiction; the symptoms of an anxiety disorder can vary but typically include the following:

• Racing heart or shortness of breath
• Feeling on edge, jumpy or nervous
• Excessive worrying or ruminating over what could go wrong
• Severe irritation or agitation
• Trouble focusing or concentrating on daily tasks such as school or work projects
• Bodily aches and pains, including headaches and muscle tension
• Dizziness and nausea
• Trembling or shaking
• Insomnia
• Loss of appetite or overeating

Depressive disorder signs and symptoms

Each person experiences depression symptoms differently. However, some common symptoms of depression include:

• Loss of interest in daily activities or hobbies you previously enjoyed
• Feelings of helplessness and hopelessness
• Sleep changes; for example, you may sleep too much or not enough
• Profound feelings of guilt or worthlessness
• Problems focusing or concentrating
• Inability to experience joy or pleasure
• Appetite or weight changes
• Lack of energy and/or motivation
• Anger and aggression
• Physical aches and pains
• Reckless or destructive behaviour 

Mania symptoms in bipolar disorder

Individuals with bipolar disorder often experience mania symptoms as part of their condition. These symptoms can include:

• Increased energy and decreased need for sleep
• Racing thoughts
• Rapid speech
• Extreme agitation 
• Profound feelings of euphoria and excitement
• Grandiose or unrealistic beliefs and ideas
• High impulsivity and impaired judgement
• Anger, aggression, or rage
• Hyperactivity

Treating co-occurring mental health and substance use disorders 

Despite the complexities of treating co-occurring disorders, dual diagnosis is a treatable condition, provided people seek professional help and support.

Treating co-occurring disorders requires an integrated approach, meaning that various therapeutic techniques and modalities are necessary to achieve lasting successful treatment outcomes for clients with these conditions.

There is always a reason to be hopeful. 

Although it does take some time, recovering from a substance use disorder and mental health condition is possible. Those with co-occurring disorders can achieve sobriety and wellness with enough time, commitment, support, and encouragement.

When it comes to treating dual diagnosis, addiction specialist Doctor Cavello stated the following:

“Dual diagnosis treatment must address both mental illness and substance use simultaneously since both together have such an impact on a person’s life. Therefore, treatment involves integrating the two disorders rather than focusing on each one separately.” (What Is a Dual Diagnosis? Verywell mind, Sanjana Gupta, August 25, 2022.)

Effective treatments for dual diagnosis

In our experience, various treatment options can effectively treat dual-diagnosis clients.

The most effective treatment programs for dual diagnosis include the following:

• Medical detoxification – medical detox is often the first step in any addiction treatment program. This treatment includes the guidance and management of moderate to severe, often painful symptoms that individuals frequently experience when undergoing substance withdrawal. For your safety and that of your loved ones, those experiencing detoxification must receive medically monitored supervision.

• Inpatient treatment in a rehab facility – studies show those with dual diagnosis greatly benefit from residential treatment in an inpatient rehab facility. People with co-occurring disorders benefit from continuous support, monitoring, and specialised mental health care throughout their recovery, which most inpatient treatment programs provide.

• Behavioural therapy – psychotherapy is an integral part of dual diagnosis treatment. For example, cognitive behavioural therapy (CBT) can help individuals change unhelpful thoughts and behavioural patterns that may contribute to substance use. CBT aims to help individuals identify and manage unhealthy coping patterns that may have led to destructive behaviours such as drinking or drug-taking, instilling healthier alternative coping methods while reinforcing relapse prevention strategies.

• Individualised treatment – involves creating a personalised treatment plan that addresses a person’s unique needs, requirements, and treatment goals rather than adopting a ‘one-size-fits-all approach’. Individual therapy considers all the parts that need to be unpacked and worked through to achieve lasting sobriety and recovery, such as addressing an individual’s past trauma, underlying mental health issues, and any other challenges they may face. Each person’s experience with mental health and addiction will be as unique as they are. Therefore, treatment must address these individual differences compassionately and from a trauma-informed perspective.

• Group therapy – is a highly effective and valuable form of psychotherapy. This treatment is usually facilitated by one or more trained professionals who treat multiple clients simultaneously. Group therapy provides people with a safe, supportive environment where they feel seen, heard, and acknowledged by others. Group therapy is particularly beneficial for those who want to make significant life changes or manage a mental health condition.

• Aftercare and support – help clients stay on track with their recovery after completing a treatment program. The supportive measures provide continuous care and treatment to clients after leaving rehab. Aftercare and support programs can help reinforce vital principles learned during treatment, such as managing urges and cravings to use a substance and practising healthy coping skills and relapse prevention techniques.

Dual diagnosis treatment at Centres for Health and Healing

Centres for Health and Healing provide personalised addiction and mental health treatment to clients in Toronto and surrounding regions.

We know each client has had unique life experiences that brought them to our centre. This is why our holistic programs are designed around each individual’s specific needs, goals, and preferences, and treatment at our centre is client focused.

Our experienced, professional staff are always here to offer a warm, welcoming ambience, ensuring a perfect foundation for recovery.

Our multidisciplinary team of professionals includes nurses, counsellors, psychotherapists, and healthcare staff to help you get the most out of your treatment.

At Centres for Health and Healing we know that no one thing causes addiction, and no single treatment cures it. This is why we use integrated treatment approaches that blend multiple therapeutic modalities and methods to create a lasting, effective addiction recovery plan. 

To learn more about our addiction and mental health treatment programs, contact our recovery centre in Toronto for further advice and support.

We are here and ready to help!

Additional resources

1. What Is a Dual Diagnosis? Verywell mind, Sanjana Gupta, August 25, 2022
2. Co-Occurring Disorders, Psychology Today, July 22, 2021