What is Dual Diagnosis and How is it Treated?

Posted on March 28, 2022

two profiles depicting dual diagnosis

A person with a dual diagnosis struggles with a substance use disorder and one or more mental health disorders at the same time. Substance use disorder is a dependence on alcohol, drugs, or both. Co-occurring disorders or comorbidity are other names for dual diagnosis.

Studies find that more than half of adults aged 18 and older diagnosed with a mental disorder also have a substance use disorder. Although the presence of both disorders is not uncommon, either can mask or worsen the symptoms of the other, making a diagnosis challenging. It is critical that health professionals use assessment tools for both mental illness and substance use issues during examinations to ensure they do not miss either condition.

The 2020 National Survey on Drug Abuse and Health found that 17 million Americans over age 18 struggled with both a mental illness, although not necessarily severe, and a substance use disorder. The report also found approximately 5 million adults experienced a severe mental health issue and a substance use disorder. Preliminary data suggests the number of people with dual diagnoses may now be higher.

Since the onset of the COVID-19 pandemic, mental health professionals report a significant increase in those seeking help with anxiety, depression, and other mental illnesses. Centers for Disease Control and Prevention statistics find an alarming rise in the number of adults who have started using or increased their use of an addictive substance to cope with pandemic-related mental health issues.

Research finds many of those under the age of 18 also struggle with dual diagnosis. The 2020 National Survey found that 644,000 adolescents aged 12 to 17 had co-occurring major depression and substance use disorder in the survey year.

What are Substance Use and Mental Health Disorders?

Doctors may diagnose a substance abuse disorder (SUD) if an individual cannot control or stop their use of legal or illegal drugs or alcohol, even when serious consequences result.

Substance use disorder is the continued use of alcohol or drugs despite significant impairment, including health problems, disability, and failure to meet responsibilities at work, school, or home. The American Society of Addiction Medicine (ASAM) states addiction involves “complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences.” In short, addiction rewires how the brain works.

Mental health disorders impact a person’s mood, emotions, and behavior. As with substance use disorder, a mental illness affects how a person relates to others and may impair their ability to function responsibly in their life.

Doctors may diagnose a mental health disorder if a person struggles with “health conditions involving changes in emotion, thinking or behavior (or a combination of these). Mental illnesses are associated with distress and/or problems functioning in social, work or family activities.”

Both substance use disorder and mental disorders are chronic but treatable medical conditions.

Risk Factors for Dual Diagnosis

Either disorder can start first and may trigger the other. It is not uncommon for a person struggling with a mental illness to turn to drugs or alcohol to relieve anxiety, depression, or other psychological pain. Conversely, individuals abusing drugs or alcohol may develop anxiety, depression, or another mental illness as negative consequences resulting from their use of an addictive substance.

Risk factors that may contribute to dual diagnosis include:

  • Genetics, which may predispose a person to addiction and mental disorders
  • Stress caused by school or work, unemployment, relationship problems, loss of a loved one, or financial or legal problems
  • Trauma such as physical or sexual abuse, exposure to violence, or surviving a natural disaster
  • Environmental factors like living in an unsafe home or community environment, family members with a mental illness, or early exposure to addictive substances
  • Certain personality traits, including impulsivity and difficulty regulating emotions
  • Changes in the brain from drug or alcohol use, which can increase the risk of developing a mental illness

Disorders that Commonly Co-occur

People with either a SUD or a mental illness struggle to function well in their daily lives. Individuals with two or more disorders find it even more challenging. The most common combination is a substance use disorder and a mood or anxiety disorder.

Research has found more than half of those with drug or alcohol dependence also suffer from an emotional, psychological, or psychiatric disorder.

While any mental health or substance abuse issue can co-occur, National Institute of Mental Health statistics find substance use disorders most commonly co-occur with the following mental health issues:

  • Anxiety disorders, including obsessive-compulsive disorder (OCD)
  • Mood disorders, including major depressive and bipolar disorder
  • Attention-deficit disorder (ADHD)
  • Psychotic illness
  • Borderline personality disorder
  • Anti-social personality disorder
  • Schizophrenia

Those struggling with an eating disorder also have a higher rate of comorbidity with substance abuse or other mental illnesses than the general population. A study published in the American Journal of Drug and Alcohol Abuse found between 23 and 37 percent of individuals with an eating disorder also struggled with a SUD. Study findings identified bulimia nervosa and alcohol use disorder as most commonly co-occurring.

Dual Diagnosis and Suicide Risk

Untreated individuals with dual disorders have a high risk of suicide. The National Alliance on Mental Illness (NAMI) warns 90 percent of Americans who take their lives have either clinical depression or bipolar disorder, substance abuse disorder, or, in many cases, a dual diagnosis.

Disturbing statistics include:

Most researchers find COVID-19 has caused increases in mental illness and substance abuse. While suicide rates have continued to climb in most age groups, especially adolescents, over the past decade, experts disagree on whether the pandemic has caused a spike in the number of suicides in the last two years.

However, many suicide and crisis hotlines across the country report huge increases in call volumes since the onset of COVID. The call volume to the NAMI HelpLine has increased by 40 percent, with most callers saying they are experiencing more mental health and substance use issues since the start of the pandemic.

If you are struggling with thoughts of suicide, contact the National Suicide Prevention Lifeline at 800-273-8255.

How are Dual Diagnoses Diagnosed?

Those with a dual diagnosis must receive treatment for both disorders simultaneously. Unfortunately, the 2020 National Survey on Drug Use and Health found only about 5.7 percent of adults with a co-occurring mental illness and substance use disorder received treatment for both in the surveyed year.

Because symptoms of one disorder may overlap symptoms of the other, it can be challenging for a health professional to diagnose both. Treatment is also more challenging. A Psychology Today article on co-occurring disorders notes that “compared to individuals who have a single disorder, those with a combination of disorders may experience more severe medical and mental health challenges and may also require longer periods of treatment.”

Dual Diagnosis Symptoms

Symptoms vary according to the specific disorders, but NAMI lists certain symptoms often present in substance use disorders and many mental illnesses.

Symptoms of substance use disorder may include:

  • Withdrawal from friends and family
  • Sudden changes in behavior
  • Engaging in risky behaviors
  • Developing a high tolerance
  • Experiencing withdrawal symptoms
  • Feeling like you need an addictive drug to be able to function

Symptoms of a mental health condition may include:

  • Extreme mood changes
  • Confused thinking or trouble concentrating
  • Avoiding friends
  • Loss of interest in social activities
  • Talk of suicide

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) provides clinicians with diagnostic guidelines for substance use disorders and mental disorders. These guidelines also help practitioners understand the severity of each issue, which allows them to plan the best treatment approach.

Treatment of Dual Diagnosis

For their best chance at long-term recovery, those diagnosed with dual disorders need an integrated treatment approach that focuses on all co-occurring conditions. Not all treatment centers are qualified to treat both substance use disorders and mental health conditions. It is crucial to find a licensed facility with the necessary credentials and experience and a medical director on staff.

A combination of psychotherapy, including behavioral therapies, medication therapy (if appropriate), holistic practices, family counseling, support groups, and attendance at after-care programs increases the chances for long-term recovery.

Behavioral Therapies For Dual Diagnosis

  • Cognitive Behavioral Therapy (CBT) is talk therapy that focuses on identifying problems and solutions and exploring how beliefs, thoughts, feelings, and behaviors are related. It teaches individuals how to recognize damaging thought and behavior patterns and change how they react to situations.
  • Dialectical Behavior Therapy (DBT) is a form of CBT that helps people who have extreme emotional reactions to situations learn to respond less emotionally and more positively. DBT teaches coping skills such as mindfulness, acceptance, and emotional regulation to overcome self-destructive behaviors.
  • Yoga Cognitive Behavioral Therapy (Y-CBT) is a mind-body approach blending CBT with yogic principles and psychotherapy techniques. Y-CBT gives individuals a greater sense of well-being and improves their stress management skills.
  • Motivational Interviewing helps clients resolve ambivalent feelings and find the motivation to make positive behavioral changes.
  • Accelerated Resolution Therapy (ART) builds upon Eye Movement Desensitization and Reprocessing (EMDR), which uses rapid eye movement to help individuals process trauma. ART combines EMDR, CBT, Gestalt, and psychodynamic therapy elements to produce fast results, often within two weeks.
  • Contingency Management is a behavioral approach that provides or withholds a reward depending on whether the patient achieves or fails to achieve a treatment goal. This therapy is effective in motivating clients to attend treatment sessions. Rewards may include a voucher, cash, or another prize.

Holistic approaches encourage healing of the mind, body, and spirit. Yoga, equine-assisted therapy, hypnotherapy, massage, acupuncture, positive thinking, journaling, regular exercise, healthy nutrition, and more, when integrated with psychotherapy, can enhance the recovery process. Lifelong practices of holistic healing methods increase the chances of long-term health.


Medication-assisted treatment (MAT) combines prescribed medications with talk and behavioral therapies to treat substance use disorders, especially those involving opioids. The Food and Drug Administration has approved several drugs to treat drug and alcohol use disorders to ease withdrawal symptoms and cravings, lessen anxiety, and help manage physical and mental health issues after withdrawal.

Depending on the mental illness, mental health professionals may prescribe certain medications to improve symptoms during the recovery process and after completion of the treatment program. Studies have found psychiatric drugs can enhance the effectiveness of the psychotherapeutic process.

Commonly prescribed psychiatric medications include:

  • Antidepressants, which treat depression, anxiety disorders, obsessive-compulsive disorder (OCD), eating disorders, post-traumatic stress disorder (PTSD), panic disorder, and more. While antidepressants are not addictive, patients can become physically dependent and experience unpleasant side effects when medication use stops.
  • Anti-anxiety medications, which treat conditions that occur with generalized anxiety disorder, including panic disorders, phobias, PTSD, OCD, suicidal thoughts, substance abuse, and depression. These are usually prescribed short-term as they can cause dependency and addiction.
  • Mood-stabilizing medications, which treat acute manic episodes, worsening depression, or bipolar episodes of alternating mania and depression. These medications are not addictive, but if the body becomes physically accustomed to the drug, the user may experience side effects when they stop taking the medication.
  • Antipsychotic medications, which treat severe depression or anxiety, schizophrenia, or bipolar disorders. Antipsychotics are not addictive.

Do You Struggle with Dual Disorders?

No matter how severe, substance use disorders and mental illnesses are highly treatable. The combination of medically supervised detox, psychotherapy, prescribed medications, and lifestyle changes can get you firmly on the road to healing. However, recovery is a life-long journey. There are specific steps you can take to ensure you remain healthy long-term.

  • Ongoing counseling once you complete your treatment program is invaluable for preventing relapse. As you and your therapist work to reinforce the skills you learned during your initial treatment, those skills become more deeply embedded.
  • Family therapy educates family members about your disorders and why it is challenging to stop using addictive substances and control certain behaviors without professional help.
  • Support group participation provides an environment where you feel safe, accepted, and understood. Studies have found that participation in a support group reinforces coping skills, motivation, and a sense of well-being and reduces the risk of relapse.
  • Sober housing or group homes are transitional living situations that provide a drug and alcohol-free environment with other people who have recovery goals like your own. The setting is semi-structured to help you stay on track as you work toward independent living.

Support and Crisis Resources

  • Double Trouble in Recovery is a 12-step group for people managing both mental illness and substance use disorders. Group members share their experiences and provide hope and encouragement to one another.
  • Smart recovery is a science-based rather than faith-based self-empowered addiction support group for people with various addictions, including addiction to drugs or alcohol or addictive behaviors like eating disorders.
  • Dual Recovery Anonymous is a 12-step program for those with an emotional or psychiatric illness and chemical dependency.
  • Alcoholics Anonymous and Narcotics Anonymous are 12-step groups for people recovering from alcohol or drug addiction. Al-Anon and Alateen are programs for families of those struggling with alcohol use disorder. Nar-Anon provides support for families impacted by drug abuse.
  • The National Eating Disorders Association (NEDA) offers virtual support resources for eating disorders.
  • The Substance Abuse and Mental Health Services Administration (SAMHSA) provides the Behavioral Health Treatment Services Locator to find substance abuse and mental health treatment facilities and programs.
  • The National Institute of Mental Illnesses provides resources for anyone struggling with an emotional or mental health issue or suicidal thoughts.
  • If you are considering suicide or suspect someone else is considering suicide, contact 911 or the National Suicide Prevention Lifeline immediately. Call 1-800-273-TALK (8255), 1-888-628-9454 (Spanish) or use Lifeline Chat to connect you to the crisis center nearest you for crisis counseling and mental health referrals.
  • For any crisis, use the Crisis Text Line. Text “HELLO” to 741741 to connect with a counselor who can provide support and resources.

The key takeaway is this: If you have a substance use disorder, mental health disorder, or a combination of conditions, treatment is available. Finding a treatment program with professionals skilled in treating dual diagnoses is crucial. No matter how long you have struggled or how severe your illness is, it is not too late to reach out for help.

Rising Phoenix Wellness Services

Our skilled staff at Rising Phoenix, including doctorate and master’s level clinicians, excels in treating dual diagnoses. Utilizing a scientifically proven approach to treating dual disorders, our model includes intensive outpatient (IOP) and outpatient programs (OP) and ongoing alumni and peer support.

Once our patients complete their initial treatment program, they continue with alumni services, including individual and group therapy, ongoing psychiatric and medication oversight, and peer support.

Recognizing that disharmony in one part of the body negatively impacts the entire body, the Rising Phoenix model embraces healing of the whole person, including mind, body, and spirit. Our wide range of treatment approaches includes holistic practices like yoga, meditation, and equine therapy to help heal the entire being.

We are proud of our success in treating complex disorders like dual diagnosis, bringing hope and a renewed purpose to the lives of our patients.

Contact Rising Phoenix to begin your recovery.

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