Dual Diagnosis

Dual diagnosis is a term used when a person struggles with both addiction and a mental health issue (like depression or bipolar disorder). An individual with a dual diagnosis thus has two conditions: 1) drug or alcohol addiction; and 2) a mental illness.

Someone with a dual diagnosis may also be referred to as having a co-occurring disorders (aka comorbidity), which again simply means that they suffer from two different psychological issues at the same time.

Dual Diagnosis

What does it mean to have a dual diagnosis?

Roughly one third of all those who have a mental illness also suffer from substance abuse. That number that rises to 50% for those with severe mental illness.

Similarly, approximately 30% of alcoholics and over 50% of drug addicts report suffering from a mental health issue in addition to addiction.

Thus, there are a large number of people who struggle with both a mental health disorder as well as alcoholism or drug addiction. In 2014, approximately 7.9 million adults in the U.S. had such a dual diagnosis, also known as having co-occurring disorders.

Either a substance abuse issue or mental disorder can develop first. However, it's widely believed that those with mental health disorders and other emotional and psychological issues often engage in drug or alcohol use in an attempt to self-medicate (thus, it was the mental health condition that existed before the addiction).

Self-medication is an effort to treat one's own psychological or other issues, often without realizing that that's what's happening. For example, someone suffering from a mental health problem could be using drugs and alcohol in order to try to numb the pain they are experiencing due to the mental health issue. In essence, they're trying to make themselves feel better – cope with emotions or pain that feels out of control to them. Problematically, research demonstrates that rather than helping, substance abuse only worsens symptoms of mental health disorders.

An added issue is that alcoholism and drug addiction can actually lead to mental health issues. This is in part because many drugs (and different drug combinations) can alter a person's thoughts, mood, brain chemistry and behavior.

How is a dual diagnosis established?

One of the challenges of establishing a dual diagnosis (or co-occurring disorders) is the fact that certain substances, including drugs and alcohol, affect a person's perceptions and behaviors. For example, if a person is experiencing hallucinations while contending with substance abuse, it can be difficult to determine whether their hallucinations are a result of the drug addiction or a mental health issue like bipolar disorder.

A major advantage in terms of correct diagnosis is attending a drug rehab or alcohol rehab program and undergoing detox. Once a patient has undergone detox in a rehab facility, physicians have a clearer view of what's happening, and it is easier to make a correct diagnosis.

After detox, there are a number of models to help doctors and psychiatrists determine which mental health issues a patient may be suffering from. For clinical assessments, one of most widely used is the PRISM-IV, or Psychiatric Research Interview for Substance and Mental Disorders. Mental health disorders targeted in the evaluation include:

  • Major and manic depression
  • Panic disorder
  • Social and specific phobias
  • Bipolar disorder
  • Post-traumatic stress disorder (PTSD)
  • Obsessive compulsive disorder (OCD)
  • Personality disorders like Borderline Personality Disorder
  • Schizophrenia

How is a dual diagnosis treated?

In the past, those with a dual diagnosis were thought to be best treated by treating each condition separately, meaning leaving one issue to be treated first, before the other. For example, it would be recommended that then under substance abuse treatment, then mental health treatment. However, new research demonstrates that integrated therapy is actually the preferred method of treatment for those with a dual diagnosis, or co-occurring disorders.

Integrated therapy simply means combining strategies from psychology/psychiatry with those of addiction treatment. According to research by the Substance Abuse and Mental Health Services Administration, using combined strategies lowers the rate of relapse rate, diminishes suicide attempts, and is more likely to lead to long-term sobriety.

Treating alcoholism and drug addiction alongside co-occurring mental health disorders helps in a number of ways, including:

  • In the rehab setting, treating those with a mental health disorder as well an addiction helps in terms of identifying their specific triggers, which can include panic attacks, depressive episodes, or mood swings
  • Group therapy specifically for those who have co-occurring disorders is more effective, since it helps individuals struggling with both mental illness as well as addiction the chance to connect, bond, and hear from others like them
  • Quality integrated recovery plans often include prescribing medications that address both the mental health disorder as well as the substance abuse (the medications complement one another, rather than complicate matters)
  • Instead of judgment or stigma, integrated recovery plans take into account the unique needs of those recovering from mental health disorders, such as the fact that they often have a fear of interacting with others, and suffer from lower attention spans and lowered motivation levels

Some rehab centers specialize in dual diagnosis. In rehab facilities that treat those with a dual diagnosis (aka co-occurring disorders), staff members are trained and have qualifications specifically in dual diagnosis treatment. Addiction recovery professionals like these understand that those with co-occurring disorders have specific challenges, and they're able to help.

What does sobriety look like for those with a dual diagnosis?

Those who treat dual diagnosis conditions often assert that the best course of action is to treat both the substance abuse disorder and mental health issue as chronic and often relapsing conditions that necessitate long-term, ongoing support.

Sometimes those with co-occurring disorders who are prescribed medication to help with one or both of their conditions wonder if they're "clean and sober" if they're still on a drug, even if its purpose is to help them.

The answer is yes, the person still "counts" as sober as long as they're using the medication as prescribed. Unlike substance abuse, pharmaceutical medication is overseen by a physician who can help monitor dosage and efficacy. Plus, such medications help manage symptoms, rather than hiding them. The goal of integrated treatment is to help someone become stable and healthy, and this is sometimes aided by prescribed medications.

It's important to understand that both mental health disorders and substance abuse issues (addiction) are both treatable illnesses. They are not a person's "fault", and they do not mean someone is weak or bad.

Both mental health disorders and drug and alcohol addiction affect millions of people of all ages, ethnicities, and economic backgrounds. Those with co-occurring disorders also number in the millions, and with the right help, they can live meaningful, productive, and joyful lives.

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