Dual Diagnosis & Addiction

By The Fix staff 01/21/15

Dual diagnosis is when you have substance-abuse and mental health issues at the same time.

Dual Diagnosis

The term dual diagnosis, also called co-occurring disorders, refers specifically to when a person is dealing with both mental health and addiction issues at the same time. For some individuals, there is more than one mental health issue, like depression and anxiety, to deal with. For others, there is more than one addiction, like both alcohol and an illegal drug, to deal with. For still others, they're having to sort out multiple mental illnesses, for example, bipolar disorder and anxiety, and more than one addiction, like alcohol and gambling.

There are as many kinds of dual diagnosis as there are mental health issues and addictions. The most common combinations seem to be depression and alcohol, anxiety and alcohol and/or tobacco, and bipolar disorder and alcohol and/or tobacco. These are the combinations with legal substances. A large number of people add illegal substances - marijuana, cocaine, prescription painkillers, ADHD meds, and even heroin.

Then there is the issue of addictive behaviors – gambling, sex, pornography, shopping, to name the more well-known process addictions. Combine any of these with any mental illness, with any substance, and you now have a diagnostic and treatment quagmire.

Dual Diagnosis Statistics

According to the National Association of Mental Illness (NAMI), approximately 37 percent of individuals with alcoholism and 53 percent of individuals with drug addictions have at least one serious mental illness. That means dual diagnosis, or co-occurring disorders, happens more often than was first thought.

A person with a mental health issue can turn to substances like alcohol or drugs – sometimes both – to try to get relief from the symptoms of the mental condition they are feeling. In mental health parlance, it's called self-medicating. Getting drunk or high at least temporarily drowns out the other chaos there may be in that person's mind.

The problem is, although alcohol, drugs, and other addictive behaviors distract a person from their other mental issues, they can develop addictions to the substances or behaviors. If addictions develop, this complicates the situation enormously.

Sometimes, it's a chicken-or-the-egg kind of situation. Did the mental illness lead to getting addicted or did the addiction trigger the mental illness? The bottom line is, it's not so much which came first, but now that we know about both issues, what are we going to do about it?

Signs and Symptoms

The first step in dealing with a person who may have both mental health and addiction issues is determining if a mental illness and an addiction issue do indeed co-exist in this individual. According to the National Institute on Drug Abuse (NIDA), drug addiction is in itself a mental illness. Separating mental health from addiction issues in order to effectively treat them both is a highly complex issue. This in itself can be a challenge if the substance the person is abusing is masking the mental illness signs, or if using the substance itself is creating a mental illness just by being used. Dual diagnosis? Maybe. Maybe not.

It is not possible to accurately determine if an individual is dealing with a dual diagnosis situation unless and until the addiction has been addressed. For example, according to NIDA, the most common illegal drug that people admit to using is marijuana. Controversy abounds as to whether marijuana is addictive in and of itself, if it's a gateway drug to harder substances, whether it should be legalized, if it's truly effective for pain and nausea following chemotherapy, and so on. What there is no argument on is that marijuana is a mind-altering substance. This affects how the brain works and affects how an individual presents. The marijuana has to be out of a person's system before a mental health professional can make a determination of dual diagnosis.


Dual diagnosis issues call for more complex, and possibly more time-consuming, processes and procedures in order to accurately diagnose what's really going on with a person. Accurate diagnosis of both the addiction and the mental illness are crucial to prescribing the right treatment, especially if the treatment involves any kind of medication, no matter how short- or long-term the course of medication is.

Diagnostic Process:

1. The person must become aware of the effects their addiction are having on their life. Sometimes a full-blown intervention is needed to accomplish this.

2. Detox from the substance, if that is the addiction. This can take up to a week, depending on the substance.

3. Undergo a thorough physical exam by a competent physician. This may include a battery of diagnostic tests to rule out any physical condition that could cause the symptoms. Physicians use medical tests like bloodwork, MRIs, CT scans, EKGs, EEGs, x-rays, and other diagnostic tools to rule out physical causes of mental illnesses.

4. If a physical condition is contributing to an emotional condition (other than normal concern about maybe having an illness) like central nervous system tumors, head trauma, multiple sclerosis, stroke, syphilis, and various cancers (pancreas, prostate, breast), the physical condition must be treated before anyone spends time and attention on mental health diagnoses.

5. Participate fully in a psychological (or psychiatric) evaluation by an appropriate mental health professional. This may include interviews and psychological tests for both the client/patient and family members who are in close proximity to the person.

Dual Diagnosis Treatment and Dual Diagnosis Treatment Centers

Once a dual diagnosis is established, an individual can receive treatment for both conditions at the same time in the same place. To do this safely, it is important to select a treatment facility that is licensed to treat both addiction and mental illness. This means that both psychiatric and addiction specialists need to be part of the treatment team. In order to avoid any kind of substance interaction, the treating professionals must know about every substance the person is taking in, by whatever means (and food/medication interactions can occur, too).

Two types of treatment programs are available:

Inpatient Dual Diagnosis Treatment

The client/patient goes to a residential-type dual-diagnosis facility for treatment. This can be short-term, for example, only to detox from a substance, or longer-term, which may include detox (if needed), psychiatric evaluation and treatment for stabilization, psychotherapy, and introduction to a sober lifestyle. The treating professionals can exert greater control over creating and maintaining a therapeutic environment. The client/patient is also able to focus on recovery without any distractions from the outside world. The hope is that the skills the client/patients learn, and the habits they form will be strong enough to maintain sobriety when they return to their regular environments.

Outpatient Dual Diagnosis Treatment

The client/patient goes to a facility that does not have living accommodations. This is usually after detox has been accomplished, or the detox is not severe enough to need medical supervision. Other aspects of treatment are the same as an inpatient program. Sometimes after diagnosis, a mental health professional will prescribe an Intensive Outpatient Program (IOP), which includes both group and individual therapy. Several sessions a week are conducted over a period of six weeks to two months, although the timespan may be longer or shorter.

IOP usually addresses addiction issues. The mental illness component, also addressed in an outpatient setting, usually involves visiting a mental health professional for psychiatric stabilization. This may or may not involve medication.


It's important to have support when undergoing recovery from any sort of illness, and support for both the mental illness and the addiction components is crucial. Support that starts as close to the beginning of treatment as possible is the most helpful. The client/patient is also more likely to continue attending meetings and check-in/tune-up sessions if they become a habit and their benefits are experienced and discussed during the course of treatment.

Finding one support group that satisfies both needs may not be possible, or even practical. When a person has reached the outpatient phase of their recovery, they may need to focus on one issue at a time. Some client/patients attend one of the 12-Step support groups for their addiction aftercare (more than one type of group if they are recovering from more than one type of addiction), and a therapist-facilitated support group for their mental health issues.

Unconditional positive regard goes a long way in helping a person improve self-esteem and build a sense of community and belonging, but there is no substitute for feedback from a trained therapist when it comes to mental health issues. As a person becomes healthier and stronger, the need for support becomes less urgent, but it is always there.

In fact, part of recovery from addiction is to provide support to someone who isn't as far along in their recovery. This is best done in the aftercare phase of treatment. Doing this helps keep recovery concepts in the forefront of a person's mind and helps prevent relapsing into unhealthy ways of thinking and doing. Providing support also helps a person become even stronger in their recovery, although it is always good to ask for help for yourself when you need it. No matter how long a person is in recovery (from any kind of illness), help is always available.

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