Dual Diagnosis

Addiction is a difficult battle in the best of circumstances, but the road to recovery can be made more challenging when you have a co-occurring mental health disorder. Fortunately, help is available. Trained experts specializing in dual diagnosis care can help you achieve the healthy and happy life you deserve.

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What Is Dual Diagnosis?

Dual diagnosis is a medical concept describing the co-existence of a substance use disorder (SUD) and a psychiatric condition in the same individual. 

Mental health disorders affect a person’s mood, thoughts and behaviors. They can disrupt how individuals interact with others, make decisions and function in everyday life. SUDs are characterized by the recurrent use of drugs or alcohol despite harm to health and the capacity to lead a productive life. 

In a dual diagnosis, these conditions interact with each other and often reinforce and compound their effects. This makes symptoms more severe and results in worse outcomes.

In the United States, an estimated 46 million adults have a SUD and 44% of them (over 20 million) also have a mental health condition.

There are multiple combinations of dual diagnoses. For instance,

• 30% of individuals with anxiety or mood disorders also have SUD.
• 50% of patients with bipolar disorder or schizophrenia have a co-occurring SUD.
• 80% of individuals diagnosed with antisocial personality disorders also have SUD.

Combinations vary. One person with depression may abuse alcohol (a co-occurring disorder) while another with anxiety struggles with opioid addiction and smokes (a co-occurring disorder and a dual addiction).

Why are dual diagnoses so common? Many of the same risk factors that can predispose to developing SUD such as trauma, adverse childhood experiences and genetic or neurobiological characteristics are also associated with mental health conditions.

A person with depression, for instance, has an elevated risk of developing a SUD while an individual who abuses alcohol is also in danger of experiencing future mental health challenges.

Co-occurring disorders are associated with more severe symptoms, a higher risk of unemployment, greater relapse rates, poor quality of life, lower social functioning, elevated levels of hospitalization and higher rates of suicide and mortality. 

Common Dual Diagnosis Combinations

Bipolar and Cocaine Abuse

BD and cocaine abuse commonly co-occur because many individuals may cope with BD’s symptoms, like depressive lows or manic highs, with drugs. Bipolar and substance abuse may exacerbate symptoms, increase mood instability and lead to addiction.

ADHD and Substance Abuse

ADHD and SUD that co-occur as shared brain vulnerabilities may result in self-control challenges. Their dual diagnosis can result in elevated levels of social, professional and personal problems.

ADHD and Alcohol Abuse

About 40% of individuals with ADHD battle an alcohol use disorder (AUD). Shared symptoms (impulsivity, poor decision-making, and emotional dysregulation) can increase alcohol misuse risk. ADHD symptoms (such as impaired focus) can be aggravated by alcohol.

Marijuana and ADHD

Around 27% of individuals with ADHD develop a cannabis use disorder (CUD) likely as a result of shared neurobiological factors like dopamine imbalance. People with ADHD may also seek cannabis for symptom relief but long-term use can worsen memory and inattention.

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PTSD and Alcoholism

An estimated 36% to 52% of individuals with PTSD battle alcohol addiction. Risk factors like impulsivity and emotional distress are common in both conditions. Individuals may cope with PTSD symptoms with alcohol which can end up making PTSD worse.

PTSD and Substance Abuse

PTSD and SUDs are common dual diagnoses as each condition increases the risk of the other. PTSD symptoms like intrusive thoughts, hyperarousal, and avoidance can drive individuals to misuse substances as a form of coping, aggravating both disorders.

Schizophrenia and Drug Abuse

Schizophrenia and SUDs frequently coexist because interconnected disruptions in brain circuits may increase the desire to seek drugs. Also, substance abuse can augment the risk of psychotic episodes in individuals with genetic predispositions.

Trauma and Substance Abuse

Trauma and SUDs may co-occur because adverse experiences may predispose to psychiatric conditions like PTSD. Some individuals use substances to cope with trauma symptoms. SUDs can intensify trauma symptoms. 

What Causes Dual Diagnosis?

SUDs and mental illness have a bidirectional relationship. Mental health conditions can act as disease accelerators for addictive behaviors while substance abuse can make psychiatric disorder symptoms and consequences more severe.

The environment where a person grows up or lives as an adult impacts their mental well-being and their risk of developing SUD. Adverse childhood experiences such as parental neglect, living with adults battling SUDs, or emotional, physical, and sexual abuse can increase the risk of co-occurring disorders.

Traumatic experiences like domestic violence, physical and sexual assault, poverty, and other socioeconomic stresses that many people endure also elevate the risk of developing SUD and experiencing mental health disorders.

Negative life experiences and environmental influences can change how the brain functions. This affects how a person makes choices, regulates their emotions and controls their behavior.

Personality traits like impulsivity and a desire to seek novel experiences are also associated with many SUDs and mental health conditions. Genetics may also predispose some individuals to mental and addictive disorders.

The self-medication hypothesis proposes that individuals with mental illnesses use drugs or alcohol to alleviate their symptoms. People may use substances to try to cope with distressing symptoms but they make them worse in the long run while putting themselves at risk of addiction.

Signs and Symptoms of Dual Diagnosis

Substance abuse and mental health conditions can have overlapping symptoms. Also, drinking and using drugs may mask or mimic psychiatric symptoms so an expert assessment is necessary to adequately evaluate a person’s case and offer them appropriate care.

Dual diagnosis symptoms include:

Emotional 

• Extreme mood swings and personality changes
• Fear and anxiety
• Low mood 
• Loss of interest in activities 

Cognitive 

• Difficulty concentrating
• Acting impulsively 
• Low work or academic performance 
• Not being able to stop substance use

Behavioral 

• Avoiding social activities
• Withdrawing from close ones
• Erratic, secretive or risky behaviors
• Persistent drug or alcohol use despite damaging consequences
• Tolerance or withdrawal symptoms 
• Changes in sleeping and eating habits
• Inadequate personal hygiene
• Money or legal problems
• Using substances to cope with mental health symptoms 

Why Early Diagnosis Is So Difficult

Early diagnosis of a dual diagnosis is challenging. Disentangling common symptoms requires expertise that only trained professionals have.

Is the low mood a person experiences a consequence of excessive drinking or do they drink because they are depressed? These are not easy questions to answer which explains why misdiagnosis is so prevalent.

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The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) separates mental health conditions like depression from substance-induced depression. The latter is a disorder that emerges from substance abuse and is expected to resolve with abstinence.

Without careful integrated screening, a dual diagnosis may remain untreated if one of the disorders is seen as primary (the reason for mental health symptoms) when actually the two may coexist, make each other worse and need simultaneous treatment.

If a person’s depression is treated but their alcoholism is ignored or dismissed as merely a symptom of depression and not a condition worthy of concentrated focus then mental health improvement may not be possible. 

How Dual Diagnosis Is Diagnosed

The combination of a substance use disorder and at least one other recognized mental health disorder determines a dual diagnosis.

Professionals evaluating dual diagnoses use several biopsychosocial screening and assessment tools. Tools like the Mental Health Screening Form-III (MHSF-III), Modified Mini Screen (MMS), AUDIT, CAGE-AID, DAST-10 and NIDA-Modified ASSIST can be used to identify potential mental health or substance use disorders.

The assessment process relies on a person’s history including past diagnoses, trauma exposure, environment, psychological well-being and substance use patterns.

Ultimately, a definitive diagnosis of two or more co-occurring disorders will be established by a licensed professional in the United States adhering to DSM-5 criteria.

An accurate diagnosis is essential to offer a person the highest chance of recovery. SUDs and mental illnesses can aggravate each other. Ignoring one while addressing the other may result in incomplete care that undermines treatment success. 

Treatment for Dual Diagnosis

Integrated Treatment for Co-Occurring Disorders

Research shows that integrated treatment that addresses mental health issues and addiction is more effective than treating a SUD alone.

Why is dual diagnosis treatment more effective than treating mental disorders and addiction separately? The simple answer is that co-occurring conditions can reinforce and exacerbate each other.

A person with anxiety may use drugs to numb themselves which can make their anxiety worse. A SUD can undermine mental health treatment if not addressed. Conversely, an individual whose depression is ignored may start a recovery program for alcoholism but their chances of relapse may be greater if their depressive symptoms are uncontrolled.

Dual diagnosis rehab addresses these challenges. Integrated treatment considers every circumstance behind a patient’s psychiatric symptoms and substance habits.

A comprehensive protocol tackles both disorders with medication and detox (if necessary) as well as behavioral therapies and peer support. This minimizes their reinforcing qualities, prevents complications, and increases the chances of long-term mental well-being and sobriety.

Detox and Medical Stabilization

Substances like alcohol, opioids and benzos can change how a person’s brain works. If these substances are suddenly stopped then the individual may be at risk of severe symptoms and complications of withdrawal (like seizures).

In dual diagnosis cases, a clinical team may consider thatdetoxingis the ideal first step to begin the healing journey. They will manage withdrawal symptoms and cravings with medication if necessary while offering emotional support.

Inpatient vs. Outpatient Dual Diagnosis Treatment Centers

Recovery from dual diagnoses is possible, and several alternatives exist. Inpatient and outpatient programs offer evidence-based therapies for overcoming SUDs and mental health challenges yet their unique characteristics make them better suited for different individuals.

Inpatient treatment centers are ideal for individuals with more severe conditions, less social support or inadequate housing.

Pros

• 24/7 continuous care is available for managing withdrawal symptoms and cravings and accessing emotional support.
• A change of scenery can help deal with triggers and temptations.
• Recovery takes time. Full-time commitment can improve outcomes by instilling new habits.

Cons

• It may be more expensive but financial alternatives are available and insurance may cover it.
• If individuals have full-time jobs or children under their care then it can be difficult to live in a facility.

Outpatient treatments are best suited for individuals with less severe conditions who are transitioning from inpatient care or have jobs or family obligations.

Pros

• Flexible schedules may help individuals who cannot put their lives on hold while recovering.
• It can be more financially viable for some people.

Cons

• In more severe cases or for people starting their recovery journey triggers and temptations may be overwhelming without distance from negative environments.
• It requires attending scheduled meetings, reliable transportation and constant support from loved ones.

Therapies Used in Dual Diagnosis Recovery

There are several therapies for managing co-occurring disorders.

Cognitive behavioral therapy (CBT) helps individuals retrain thoughts and ideas that can promote substance abuse and increase negative emotions. CBT can promote behavior change and reduce emotional symptoms

Dialectical behavior therapy (DBT) is a type of CBT that teaches skills for emotion regulation, distress tolerance, mindfulness and healthy behavior by balancing acceptance and change. These skills may reduce substance use and emotional distress.

Trauma-informed therapy is a valuable tool to help people who struggle with the effects of trauma. Both SUDs and mental health conditions are affected by past negative events. A trained therapist can help uncover how the past is affecting the present, proposing interventions that address dual diagnoses impacted by trauma.

Working with a dual diagnosis therapist has many benefits. They employ evidence-based intervention with proven efficacy. They can handle the overlapping and unique challenges of battling co-occurring disorders because they have done it before, and more importantly, they can connect you to resources, like support groups, focused on dual diagnoses.

Medication Management

Dual diagnosis treatment may require medications for both conditions.

Medication-assisted treatment (MAT) like Suboxone or Vivitrol is often the first step toward SUD recovery. Its effectiveness in supporting long-term recovery and reducing cravings after quitting is invaluable.

Psychiatric meds may also be fundamental in addressing symptoms and effects of conditions like depression and anxiety.

Dual diagnosis centers have clinical staff that can combine these different medication classes in a way that’s safe and elevates recovery chances.

Peer Support and Long-Term Recovery

Recovery is a long-term project. You’ll grow daily as a person and develop skills to maintain your hard-earned sobriety.

This is why aftercare plans are so important. Through them, you get access to carefully designed interventions to continue counseling, educational workshops and peer support groups.

Groups like Dual Recovery Anonymous and others provide a network of like-minded individuals focused on healing. Meeting with them will provide you with a safe space to share wins and losses, get encouragement and find accountability. This will ensure that you don’t walk alone on one of your life’s most meaningful journeys.

When to Get Help

Mental illness and addiction can happen to anyone. They are medical conditions that deserve care.

If you or someone you love is having difficulties functioning in daily life due to mental health symptoms or substance use then it’s wise to consider seeking treatment.

Warning signs like persistent low mood, self-harm thoughts, using substances despite their negative consequences for your life and a desire to quit yet feeling incapable of doing so can suggest that it’s time to act.

Delaying seeking help for co-occurring disorders can worsen your symptoms and repercussions. Early interventions have a higher probability of success.

FAQs About Dual Diagnosis

Get Help for Dual Diagnosis Today

Help for dual diagnoses exists. We can help match you with the best treatment centers in the United States. Detox.com is a leading resource for locating dual diagnosis facilities that adapt to your unique challenges.

Dual diagnosis and detox can help. Call now to get help.

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