Dual Diagnosis

Dual diagnosis is a term for when someone experiences a mental illness and a substance abuse problem simultaneously. Dual diagnosis is a very broad category. It can range from someone developing mild depression because of binge drinking, to someone’s symptoms of bipolar disorder becoming more severe when that person abuses heroin during periods of mania.

Either substance abuse or mental illness can develop first. A person experiencing a mental health condition may turn to drugs and alcohol as a form of self-medication to improve the troubling mental health symptoms they experience. Research shows though that drugs and alcohol only make the symptoms of mental health conditions worse.

Abusing substances can also lead to mental health problems because of the effects drugs have on a person’s moods, thoughts, brain chemistry and behavior.

How Common is a Dual Diagnosis?

About a third of all people experiencing mental illnesses and about half of people living with severe mental illnesses also experience substance abuse. These statistics are mirrored in the substance abuse community, where about a third of all alcohol abusers and more than half of all drug abusers report experiencing a mental illness.

Men are more likely to develop a co-occurring disorder than women. Other people who have a particularly high risk of dual diagnosis include individuals of lower socioeconomic status, military veterans and people with more general medical illnesses.


The defining characteristic of dual diagnosis is that both a mental health and substance abuse disorder occur simultaneously. Because there are many combinations of disorders that can occur, the symptoms of dual diagnosis vary widely. The symptoms of substance abuse may include:

  • Withdrawal from friends and family.
  • Sudden changes in behavior.
  • Using substances under dangerous conditions.
  • Engaging in risky behaviors when drunk or high.
  • Loss of control over use of substances.
  • Doing things you wouldn’t normally do to maintain your habit.
  • Developing tolerance and withdrawal symptoms.
  • Feeling like you need the drug to be able to function.

Some standard alcohol and drug screening tools are used in mental health clinics to identify people at risk for drug and alcohol abuse.

The symptoms of a mental health condition also can vary greatly. Knowing the warnings signs, such as extreme mood changes, confused thinking or problems concentrating, avoiding friends and social activities and thoughts of suicide, can help identify if there is a reason to seek help.

How is a dual diagnosis treated?

The most common method of treatment for dual diagnosis today is integrated intervention, where a person receives care for both a specific mental illness and substance abuse. Because there are many ways in which a dual diagnosis may occur treatment will not be the same for everyone.


The first major hurdle that people with dual diagnosis will have to pass is detoxification. During inpatient detoxification, a person is monitored 24/7 by a trained medical staff for up to 7 days. The staff may administer tapering amounts of the substance or its medical alternative in order to wean a person off and lessen the effects of withdrawal.

Inpatient detoxification is generally more effective than outpatient for initial sobriety. This is because inpatient treatment provides a consistent environment and removes the person battling addiction from exposure to people and places associated with using.

Inpatient Rehabilitation

A person experiencing a serious mental illness and dangerous or dependent patterns of abuse may benefit most from an inpatient rehabilitation center where she can receive concentrated medical and mental health care 24/7. These treatment centers provide her with therapy, support, medication and health services with the goal of treating her addiction and its underlying causes. 

Supportive housing, like group homes or sober houses, is another type of residential treatment center that is most helpful for people who are newly sober or trying to avoid relapse. These treatment centers allow for more freedom while still providing round-the-clock care.


Medication is a useful tool for treating a variety of mental illnesses. Depending on the mental health symptoms a person is experiencing, different mental health medications may play an important role one’s recovery.

Certain medications are also helpful for people experiencing substance abuse. These medications are used to help ease withdrawal symptoms or promote recovery. Medications to ease withdrawal are used during the detoxification process. They produce similar effects in the body as certain addictive drugs.


Psychotherapy is almost always a large part of an effective dual diagnosis treatment plan. Education on a person’s illness and how their beliefs and behaviors influence their thoughts has been shown in countless studies to improve the symptoms of both mental illness and substance abuse.

Cognitive behavioral therapy (CBT) in particular is effective in helping people with dual diagnosis learn how to cope and to change ineffective patterns of thinking.

Self-help and Support Groups

Dealing with a dual diagnosis can feel challenging and isolating. Support groups allow members to share frustrations, successes, referrals for specialists, where to find the best community resources and tips on what works best when trying to recover. They also form friendships and provide encouragement to stay clean. Here are some groups that can offer support: