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dual diagnosis: symptoms & treatment.

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Dual diagnosis is a common, and frequently misunderstood, condition. The term describes a situation where a person has a mental health condition and a substance use disorder. As more research is available, medical professionals are gaining a much deeper understanding of dual diagnosis and the best ways to help patients.

However, many people outside of the medical field may not be aware of what dual diagnosis is or how it affects them—despite the fact that a significant number of people deal with co-occurring disorders.

According to SAMHSA, in 2020 in the U.S. 17 million people (18 and over) had a mental illness and a substance use disorder. It is likely that many more suffer from co-occurring disorders, but they have not participated in any kind of treatment or studies to gather this data.

what is dual diagnosis?

Dual diagnosis, also known as a diagnosis of co-occurring disorders, is when someone is suffering from both substance abuse disorder and a mental health disorder. When it comes to mental health, people overlook or misunderstand the impact of mental health. This includes the individuals suffering from addiction themselves.

Another term that frequently refers to dual diagnosis is comorbidity. Comorbid is defined by Merriam-Webster as “existing simultaneously with and usually independently of another medical condition”. For example, someone dealing with alcoholism and depression is dealing with comorbidity.

As noted above, in 2020 17 million adults, 18 and over, had co-occurring disorders. For adolescents, aged 12 to 17, around 644,000 experienced both. For many youth and young adults, it’s common to experiment with substances and even to see the experience as fun despite clear harm. For this reason, and many others, it may be more difficult to recognize co-occurring disorders in younger people.

why substance abuse & mental health are connected

When someone is experiencing co-existing disorders, it is not always apparent which came first —substance abuse disorder or mental health disorder. Whether it is known or not, it is clear that substance abuse and mental health are closely connected.

The National Institutes of Health (NIH) defines a substance use disorder (SUD) as “...a mental disorder that affects a person’s brain and behavior, leading to a person’s inability to control their use of substances such as legal or illegal drugs, alcohol, or medications.” Quite often with substance abuse, a person is attempting to cope with mental health disorders. It is potentially a conscious decision as well as unconscious.

When someone is dealing with untreated mental health disorders, they may find themselves overwhelmed to the point that they feel the only relief they get is through substances.

Depending on the length and amount of use, it is possible for someone abusing a substance to develop a mental health disorder as a result.

Self-medication is dangerous for a number of reasons. Part of the danger is using substances without medical supervision, like prescription drugs, that are easy to become dependent on. Without medical supervision, dependence and addiction is very difficult to overcome in order to achieve and maintain sobriety.

Whether a psychoactive substance is legal or illegal, eventually anyone can develop physical and/or psychological dependence. With continual abuse, a person must increase consumption to feel the same effects. This significantly increases the risk of lifelong health complications, overdose, and death. These include severe mental health risks.

types of dual diagnosis

SAMHSA explains that dual diagnosis can include any combination of two or more substance use disorders and mental disorders. They also note that this does not include any specific combination. There are many different types of mental health disorders and different kinds of substances that one can abuse.

Some of the most common mental disorders include:

  • Anxiety
  • Mood disorders
  • Schizophrenia
  • Bipolar disorder
  • Major depressive disorder
  • PTSD

And some of the most common types of substances misused include:

  • Alcohol
  • Tobacco
  • Opioids
  • Stimulants (amphetamines, cocaine, methamphetamine)
  • Marijuana
  • Hallucinogens (LSD, psilocybin, peyote)
  • Prescription Drugs

It is of course possible for someone to abuse multiple substances at the same time or over a period. Moreover, it is also of course possible that they are experiencing more than one mental health disorder at any given time.

common co-occurring disorders


Anxiety is a disorder with symptoms of intense unease, fear, or worry. It is not always a severe issue. Sometimes someone can experience anxiety in social situations, like public speaking or in a job interview but ultimately be okay or find healthy ways to manage it.

There are different types of anxiety with varying ranges of severity and people are affected differently. When it is more severe, it is important for individuals to seek professional help, but due to many circumstances this is not always possible.

More severe types of anxiety include:

  • Generalized anxiety disorder
  • Panic disorder
  • Phobia-related disorders

People dealing with anxiety frequently turn to substances as a means to cope. Alcohol is one of the most widely abused substances in the world. It is widely socially acceptable and one of the more easily obtained substances. Many people use it to help calm their nerves and it is easy for this to quickly get out of hand.

In addition to alcohol, there are obviously a number of legal and illegal drugs a person can turn to. Frequently people tend to misuse prescription drugs like Xanax, Klonopin, Lexapro, and Zoloft among others. They may abuse their own prescription or drugs they acquire from a friend, family member, or even a stranger.


Depression is a common and serious mood disorder. It is also referred to as major depressive disorder or clinical depression. As with anxiety, there are several types of depression.

Common depression types include:

  • Persistent depressive disorder (lasts for at least two years)
  • Postpartum depression
  • Psychotic depression
  • Seasonal affective disorder
  • Bipolar disorder

Potential symptoms include:

  • Persistent sad, anxious, or “empty” mood
  • Irritability
  • Decreased energy or fatigue
  • Appetite and/or weight changes
  • Thoughts of death or suicide, including suicide attempts
  • Difficulty concentrating, rememberin, or making decisions
  • Difficulty sleeping

The types of depression and symptoms listed above are not all-encompassing. Moreover, someone experiencing depression is not going to necessarily experience all symptoms at the same time. NIH explains that if someone experiences any of the possible symptoms for at least two weeks they are potentially suffering from depression.

For many people, the severity and length of depression often make their circumstances seem dire. There are many potential causes including genetics, social situations, and physical health issues among many others. Without proper care, and the longer one experiences depression, it is common for people to turn to substances to cope with depression.

Again, alcohol is one of the most common substances people turn to due to social acceptance and easy access. With depression, someone may also turn to substances that provide a “euphoric high” to attempt to counteract feeling badly all of the time. Because side effects vary widely from person to person, the substances one feels work best will also vary.

Commonly though people use drugs like alcohol, cocaine, LSD, and Xanax. Xanax is frequently associated with a “Xanax high” that leaves one feeling euphoric. It is dangerous to abuse as people quickly become dependent and addicted and need higher doses to feel the same effects.

bipolar disorder

NIH defines Bipolar Disorder as “...a mental disorder that causes unusual shifts in mood, energy, activity levels, concentration, and the ability to carry out day-to-day tasks.” It lists three types: Bipolar I Disorder, Bipolar II Disorder, and Cyclothymic Disorder.

All three have clear changes in energy, activity levels, and mood. The symptoms vary and not everyone will experience the same symptoms or at the same level of severity. With bipolar disorder, people may experience a period of time known as a “mood period” where their emotions and behavior fluctuate wildly.

Symptoms of a manic episode may include:

  • Feeling very “up,” “high,” elated, or irritable and touchy
  • Feeling “jumpy” or “wired”
  • Have a decreased need for sleep
  • Loss of appetite
  • Risky behavior: spending a lot of money, drinking a lot, engaging in reckless sex, etc.

Symptoms of a depressive episode may include:

  • Feeling very sad, “down”, empty, worried or hopeless
  • Increased appetite and weight gain
  • Difficulty sleeping - falling asleep, staying asleep, or sleeping too much
  • Feeling hopeless or worthless
  • Thinking about death or suicide

With proper medical treatment, it is possible for people with bipolar disorder to manage their symptoms and live healthy, active lives. Unfortunately, many people either do not seek help or are unable to for a number of reasons. As with many other mental health disorders, people with bipolar disorder frequently turn to substances to cope. There is significant potential for this to be worsened during a manic or depressive episode.

borderline personality disorder

According to NIH, borderline personality disorder (BPD) is “ illness marked by an ongoing pattern of varying moods, self-image and behavior. These symptoms often result in impulsive actions and problems in relationships. People with borderline personality disorder may experience intense episodes of anger, depression, and anxiety that can last from a few hours to days.”

Potential symptoms include:

  • Extreme views - things are totally good or totally bad
  • Quick changes in how they view others - liking them one day and hating them the next
  • Feelings of dissociation
  • Difficulty trusting others
  • A pattern of intense and unstable relationships with family, friends, and loved ones
  • Impulsive and often dangerous behaviors - spending sprees, unsafe sex, substance abuse, reckless driving
  • Efforts to avoid real or imagined abandonment

The symptoms experienced will vary from person to person as well as how frequently they experience them and for how long.

As with many other disorders, people are often overwhelmed by what they are experiencing. They either do not seek help or are unable to for many reasons. Like with bipolar disorder, someone with BPD might use substances as a coping mechanism.

obsessive-compulsive disorder (OCD)

According to NIH, obsessive-compulsive disorder, OCD, “ a common, chronic, and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts (obsessions) and/or behaviors (compulsions) that he or she feels the urge to repeat over and over.”

For people struggling with OCD they are aware that their behaviors are not beneficial to them but find it difficult to stop without help. It is possible for their behavior to cause serious disruption in their lives whether with friends, family, or colleagues. Many people with OCD also struggle with mental disorders like anxiety or depression. In an attempt to cope, they often turn to substances like alcohol or drugs.

pTSD & trauma

Trauma is common to see with addiction. Someone may experience a traumatic event and then turn substances as a way to cope. They may find their addiction is worsened by a traumatic event while they are already struggling with substance abuse.

With some cases, trauma leads to post-traumatic stress disorder (PTSD). This does not always happen, but it is something that makes sobriety and recovery more difficult. PTSD is often associated with war, but anyone can experience it. It is common in violent situations like physical or sexual abuse.

Traumatic events may include:

  • War
  • Natural disasters: Tornadoes, hurricanes, tsunamis, etc.
  • Physical abuse
  • Sexual assault
  • Emotional abuse
  • Community violence (riots, shootings, etc.)
  • A major loss - death of a family member or friend

Symptoms of Trauma and PTSD include:

  • Persistent anxiety and fear
  • Dreams and flashbacks related to the event
  • Difficulty sleeping and relaxing
  • Withdrawing emotionally and socially
  • Acting in reckless, dangerous, or self-destructive ways

Whether it results in PTSD or not, trauma is a difficult thing for people to deal with. Sometimes without proper help people turn to substances to manage or suppress how they feel. Many feel shame and either do not know how to ask for help or lack the resources.

treatment for dual diagnosis

It is important for people to receive care as soon as possible. Understandably this is not always the case. Many lack the resources to seek help whether that is a lack of social support in friends or family, financial resources, or even a lack of understanding of what they are dealing with.

Even if someone does not seek help early on, it is always better to seek help at any point than to try to manage on one’s own or ignore the problem entirely.

why proper dual diagnosis treatment matters

When someone is suffering from a mental health disorder and a substance use disorder the interaction between them can worsen both conditions. If someone seeks treatment but is only helped with one or the other, they may be more likely to relapse.

At NACA, we believe that it is important to treat a person as a whole. This means treating all of the factors behind addiction. Someone may be experiencing untreated physical issues that they are using substances to cope with. They might also have mental health disorders that could cause them to end up right where they started without proper treatment.

Our facility works with individuals in ways that are unique to them. Treating all patients as the same will not help them long-term. The same medications and types of therapies are not going to work for everyone. With a comprehensive understanding of an individual's genetic makeup, mental health, and other unique factors we can tailor a plan best suited to them.

what does recovery look like with dual diagnosis?

Certain mental health disorders, like bipolar disorder or BPD, are chronic diagnoses that require lifelong efforts to manage. It is the same with addiction. In fact, per the National Institutes of Health, relapse rates between substance abuse disorders and other chronic illnesses are similar. One of the most important things they note is that “relapse doesn’t mean treatment has failed.”

Someone may need to seek treatment or medical help more than just one time. In fact, that may be likely for a good number of people. This should not be discouraging. With unique treatment plans, like at NACA, people are set up with tools to provide a better chance at continued recovery. But again, relapse doesn’t mean they failed. Addiction is a complicated process and dual diagnosis does add to that. That is why it is important to seek treatment at a facility like NACA that works to understand all of the causes and treat each one.

For anyone struggling with mental health disorders, especially those that are lifelong, they should continue to seek out professional help even after treatment. There are many types of therapy and it may take time to find what works best for oneself. Similarly, many do require medication to help manage. Whether someone needs therapy or medication, or both, this is never something they should be ashamed of. It is what many people need to live a healthy, happy, and active life. It is always worth it to invest in one’s health. If you or a loved one is struggling with co-occurring disorders please contact us today.

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