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Dual Diagnosis & Co-Occurring Disorders | Overview, Risk Factors, Warning Signs, & Treatment

Published on April 19, 2021
Dual Diagnosis & Co-Occurring Disorders

It’s estimated that almost 50 percent of people with substance use disorder (SUD) also suffer from a mental health disorder. It’s also understood that many people with mental illness struggle with substance abuse problems.

While it’s impossible to determine which condition came first, it’s crucial to receive integrated treatment for addiction and any co-occurring mental health issues at the same time. 

What Is Dual Diagnosis?

Dual diagnosis is a term for when someone suffers from addiction and a co-occurring mental health disorder. Almost four percent of the adult population in the United States struggled with dual diagnosis in 2018.

Also called co-occurring disorders or comorbidity, dual diagnosis requires an integrated treatment approach to effectively address each condition during the same program.

Although treating co-occurring disorders can be challenging, integrated care uses both addiction treatment and mental health professionals to provide a whole-patient approach.

To better identify, address, and treat dual diagnosis, it’s important to understand each condition.

Substance Use Disorder

Substance use disorder (SUD) is the medical term for addiction and is defined by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 

Addiction is a chronic disease that includes the repeated misuse of drugs or alcohol despite harmful consequences. People with alcohol or drug addiction engage in compulsive behaviors that can create health issues and social problems at home, work, or school.

It’s important to remember that substance use disorder is a mental illness. Addiction changes the chemistry of the brain and replaces the person’s behavior, needs, and priorities with finding and using drugs or alcohol.

Mental Illness

Mental illness involves any health condition that affects thinking, behavior, or mood. Mental health problems are wide-ranging and can interfere with: 

  • day-to-day life
  • how a person relates to others
  • decision-making
  • overall health and well-being

There is nothing “wrong” with you if you have mental illness. In fact, mental health issues are common—one in five U.S. adults experience mental illness every year, and many unfortunately self-medicate with drugs or alcohol instead of seeking professional care.

Mental Health Disorders That Frequently Co-Occur With Addiction

For many patients in substance abuse treatment, there is an underlying mental health condition that plays a role in their substance use. Here are some common mental health conditions that frequently appear in SUD patients.

Depression

Over seven percent of adults in the U.S. have one major depressive episode per year. Depressive disorder changes day-to-day function and includes symptoms, like a loss of energy or lack of interest in favorite activities, that last for at least two weeks.

Depression and other mood disorders are the most common mental health conditions among SUD patients.

Learn more about Depression & Addiction

Anxiety Disorders

Anxiety disorders include social anxiety disorder, generalized anxiety disorder (GAD), panic disorder, and various phobias. They include both physical and emotional symptoms, as well as undue fear or worry in non-threatening situations.

One survey of over 40,000 adults found that 17.7 percent of respondents had a dual diagnosis of an anxiety and substance use disorder.

Learn more about Anxiety Disorders & Addiction

Bipolar Disorder

Bipolar disorder features dramatic changes in mood, energy, and thinking ability. People with this condition go back and forth from an extreme high or elation (mania) to an extreme low (depression). This mood disorder may worsen overtime and lead to an SUD if left untreated.

Learn more about Bipolar Disorder & Addiction

Eating Disorders

Eating disorders involve an unhealthy obsession with food and weight issues. This obsession makes it harder and harder to focus on day-to-day activities and other life issues. Eating disorders include anorexia nervosa, bulimia nervosa, and binge eating disorder (BED).

Eating disorders are more likely to occur within the addiction recovery community than the general population, and bulimia nervosa commonly co-occurs with alcohol abuse.

Learn more about Eating Disorders & Addiction

Obsessive-Compulsive Disorder (OCD)

Obsessive-compulsive disorder (OCD)  is defined by unwanted and repetitive thoughts or obsessions along with irrational urges to carry out certain actions or compulsions. People are likely aware that what they’re doing is irrational, but they still can’t stop themselves.

One study found participants with OCD most commonly abused substances like marijuana, alcohol, and cocaine.

Learn more about OCD & Addiction

Posttraumatic Stress Disorder (PTSD)

Posttraumatic stress disorder (PTSD) occurs after a traumatic event like an accident, sexual assault, natural disaster, or miltary combat experience. There are both short-term and long-term symptoms, and PTSD often co-occurs with substance use, anxiety, and depression.

It’s estimated that nearly 40 percent of veterans and the general population struggle with a dual diagnosis of PTSD and SUD.

Learn more about PTSD & Addiction

Attention Deficit Hyperactivity Disorder (ADHD)

Symptoms of ADHD include inattention, hyperactivity, and impulsivity, and is commonly diagnosed in children and young adults. Children and young adults with ADHD have an increased risk of developing an addiction.

Learn more about ADHD & Addiction

Schizophrenia

Schizophrenia is a serious mental health condition that affects thinking, emotions, decision-making, and relationships with others. Symptoms include hallucinations, delusions, disorganized thinking, and speaking in a disconnected way.

People with schizophrenia have higher rates of substance use disorder than the general population at large.

Learn more about Schizophrenia & Addiction

Borderline Personality Disorder (BDP)

Borderline personality disorder (BPD) involves feeling intense emotions for long-periods of time, difficulty controlling these emotions, and having a hard time calming down after a triggering event. 

Some people may use alcohol or drugs to better control their emotions, and many with BPD will be diagnosed with SUD at some point.

Learn more about BPD & Addiction

Risk Factors For Co-Occurring Substance Use/Mental Health Disorders

The relationship between addiction and mental illness is complex. Many people who struggle with mental illness are likely to develop a substance use disorder in their lifetime, and people with addiction increase their risk of developing mental illness.

Having a dual diagnosis means each disease interacts with the other, which affects how each condition plays out. Although researchers are still trying to figure out why addiction frequently co-occurs with mental health issues, there are several known risk factors.

Brain

Multiple areas of the brain are affected by mental illness and addiction. The brain is a complex network of circuits or connections, and these circuits regulate your decision making, impulse control, emotions, and more. 

Both substance abuse and mental illness disrupt these areas, which may suggest why having one condition increases the risk of developing another.   

Genetics

Experts believe the vast majority of substance use disorders are tied directly to your genetics. If you have a close relative with addiction or another mental health disorder, then your chances of developing one or both conditions are increased.

Trauma

Experiencing physical or emotional trauma can lead to mental health issues like posttraumatic stress disorder (PTSD). People with a history of trauma or abuse may also use substances to avoid dealing with the traumatic issue or to help lessen their anxiety. 

Stress

Scientists are intrigued by the link between stress and both substance use and mental health disorders. Stress is a significant risk factor for relapse after addiction treatment, and long-term or chronic stress from a young age can also play a role in developing psychiatric disorders.

Environment

The environment where people live can influence their risk for mental illness, substance abuse, or both. Growing up in a situation with heavy drug or alcohol use, stressful situations, traumatic experiences, and other events may put people at risk from a young age. 

Warning Signs & Symptoms Of Dual Diagnosis

There is no clear set of signs and symptoms for co-occurring disorders because each person experiences mental illness differently, and each substance use and mental health disorder has unique warning signs.

However, to identify someone with co-occurring disorders, look for signs of both addiction and mental illness:

  • excessive smoking, drinking, or drug use
  • losing interest in things that used to be enjoyed
  • low energy; sleeping too much or too little
  • spending more time alone; avoiding activities with family or friends
  • fearing body weight or image; dieting or exercising too much
  • cutting or burning skin
  • doing risky things alone or with friends
  • suicidal thoughts or ideation
  • periods of extreme energy or activity
  • hearing or seeing things other people cannot

Additional signs and symptoms of addiction include:

  • abrupt changes in behavior
  • using drugs or alcohol in dangerous situations
  • losing control over substance use
  • building a tolerance, or needing more to achieve intoxicating effects
  • needing the substance to function
  • experiencing withdrawal symptoms after a period of no use

Additional signs and symptoms of mental illness include:

  • excessive feelings of sadness, worry, or fear
  • concentration and learning problems; confused thinking
  • irritability/anger
  • difficulties trying to understand or relate to family members
  • problems carrying out day-to-day activities or handling stress

If someone is repeatedly using drugs or alcohol to deal with any of the feelings or signs on the above lists, they likely need to seek help as soon as possible. 

Dual Diagnosis Treatment With Integrated Care

Treating and diagnosing co-occurring disorders is complicated and requires an integrated treatment approach. Integrated care involves a team of multidisciplinary professionals and treatment options that can address both addiction and mental illness at the same time.

Effective integrated treatment includes a collaboration between clinical providers, addiction treatment professionals, and supportive services to address the wide-ranging issues that contribute to mental illness and substance use.

Professionals who may be involved in a treatment plan for dual diagnosis include:

  • nurses
  • doctors
  • psychiatrists
  • psychologists
  • licensed substance abuse counselors
  • social workers
  • support staff

Integrated care also allows for an individualized approach that hinges on effective communication and coordination of services. With this approach, someone suffering from dual diagnosis should have access to a full continuum of care, which may include:

  • medical detox
  • inpatient/outpatient rehab
  • partial hospitalization programs
  • behavioral therapy
  • medication
  • support groups

Learn more about Dual Diagnosis Treatment

Dual Diagnosis Facts & Statistics

Consider the following dual diagnosis facts and statistics that were pulled from a 2018 SAMHSA National Survey on Drug Use and Health:

  • 47.6 million Americans experienced mental illness
  • 19.3 million Americans had substance use disorder
  • 10.2 million Americans had substance use disorder, but not mental illness
  • 38.4 million Americans had mental illness, but no substance use disorder
  • 9.2 million Americans had both a substance use and a mental health disorder
  • 3.7 percent of Americans over 18 had dual diagnosis
  • Americans with serious mental illness used illicit drugs more than other adults with any mental illness or no mental illness
  • 2.4 million young adults in the U.S. had dual diagnosis

If you or a loved one has been diagnosed with a substance use and mental health disorder, our treatment centers use a whole-patient approach to address both disorders.

We understand living with mental illness is difficult, but getting started with treatment is easy. Contact us to connect with a trained treatment specialist today.

Written by Ark Behavioral Health Editorial Team
This page does not provide medical advice.

American Society on Addiction Medicine (ASAM) - Definition of Addiction
National Alliance on Mental Illness (NAMI) - Dual Diagnosis
National Alliance on Mental Illness (NAMI) - Mental Health Conditions
National Institute on Drug Abuse (NIDA) - What are the treatments for comorbid substance use disorder and mental health conditions?
National Institute on Drug Abuse (NIDA) - Why is there comorbidity between substance use disorders and mental illnesses?
NIDA for Teens - Co-Occurring Conditions
Substance Abuse and Mental Health Services Administration (SAMHSA) - Recovery Housing: Best Practices & Suggested Guidelines

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