Dual Diagnosis: What is it, and How is it Treated?

Published: 04/1/2022 | Author: Mark Harrigan

Addiction commonly co-occurs with a mental health disorder, such as major depressive disorder, bipolar disorder, or borderline personality disorder. This is commonly referred to as dual diagnosis. Because the two conditions can interact and impact each other, a dual diagnosis requires specialized treatment that addresses the symptoms and root causes of both disorders.¹ Many people with co-occurring substance use and mental health disorders choose to attend a dual diagnosis treatment center, which usually takes the form of inpatient rehab.
In this article:

• What is Dual Diagnosis?
• Why Do Mental Health Disorders and Addiction Commonly Co-Occur?
• Dual Diagnosis Treatment
• How to Find a Dual Diagnosis Treatment Program

What is Dual Diagnosis?

Dual diagnosis refers to co-occurring mental health and substance use disorders (SUD). For example, a person with alcohol use disorder may also have a diagnosis of anxiety disorder. Because one disorder can often mask or mimic the symptoms of the other, a dual diagnosis can sometimes be difficult to diagnose and treat.¹

Some mental health disorders that commonly co-occur with SUD include:^2,3

• Depression
• Anxiety disorders
• Bipolar disorder
• Attention deficit hyperactivity disorder (ADHD)
• Personality disorders such as borderline personality (BPD) and antisocial personality disorder
• Schizophrenia
• Psychosis

According to the 2020 National Survey on Drug and Health, 17 million American adults experienced both mental illness and a substance use disorder in 2020.¹ Further, nearly 50% of people with mental health disorders will also have a SUD at some point in their lives, and co-occurring mental illness is associated with lower rates of treatment engagement, retention, and completion.⁴

Why Do Mental Health Disorders and Addiction Commonly Co-Occur?

While substance use and mental health disorders often co-occur, it does not mean that one caused the other. However, co-occurring disorders can worsen the outcome of both. It is often difficult to know which of the conditions came first, as symptoms for both can overlap.²

Researchers have developed three theories as to why SUDs and mental health disorders frequently co-occur:²

• Common risk factors can contribute to both mental health disorders and substance use disorders: Both mental health conditions and SUDs tend to run in families, suggesting a genetic component. Environmental factors like trauma and stress can also cause genetic changes that are passed down through future generations, which may contribute to the development of mental health conditions or addictions.
• Substance use and addiction can contribute to the development of other mental health conditions: Substance use can trigger changes in brain function and structure that may increase a person’s likelihood of developing a mental health disorder.
• Mental health conditions can contribute to substance use and addiction: Research has shown that people with mental health disorders such as anxiety, posttraumatic stress disorder, and depression, may turn to drugs or alcohol as a form of self-medication or coping. While this may temporarily provide them some relief, substance use can actually worsen symptoms over time. Furthermore, people with mental health disorders may experience more rewarding effects from substance use, which reinforces their use and may lead to addiction.

Dual Diagnosis Treatment

To optimize treatment and improve recovery outcomes, you should receive treatment for both conditions together rather than separately. It is recommended that dual diagnosis treatment be undertaken in an inpatient rehab setting that can provide comprehensive, 24/7 care in an environment focused solely on recovery. When you enter dual diagnosis treatment, you should be evaluated by a specialist for each of the disorders to determine the appropriate course of treatment.²

Treatment should be tailored specifically to meet your individual needs. Some factors your medical team will consider when developing your treatment plan include:²

• Age
• Co-occurring medical conditions
• Specific combination of disorders and symptoms
• Substance being misused

For treatment to be effective, you must obtain sobriety and stop using alcohol or drugs.¹ The first stage of treatment is detoxification. Once you complete the withdrawal period from your substance of misuse, you can begin to engage in treatment for other symptoms of your co-occurring disorder.⁵

Dual Diagnosis Therapies

Comprehensive dual diagnosis treatment involves a combination of behavioral therapy, medication, and support groups.¹ Some effective behavioral therapies for dual diagnosis treatment include:^2,3

• Cognitive Behavioral Therapy (CBT): CBT is a psychotherapy technique that can help you recognize unhelpful, irrational, and negative thinking and shift it into positive healthy talk. By recognizing the connection between thoughts, feelings, and behaviors, patients can learn to make healthier choices and build coping skills for dealing with stressful situations.
• Dialectical Behavior Therapy (DBT): DBT builds on mindfulness, self-awareness, and acceptance of the present moment. Your DBT therapist will teach you skills to improve relationships, reduce self-destructive and harmful behaviors, and regulate and control difficult or intense emotions.
• Contingency Management: (CM) Contingency management is a common therapeutic approach for substance use. Your therapist will encourage you to avoid using substances and choose healthy, constructive behaviors by providing you with vouchers or rewards when you make certain decisions or engage in certain desired behaviors.
• Integrated Group Therapy (IGT): IGT is a group therapy specifically for people with co-occurring bipolar disorder and substance use. This therapy focuses heavily on CBT techniques as well as adjunct medication treatment. IGT helps you recognize the relationship between your thoughts and behaviors and how they contribute to your recovery or relapse.
• Exposure Therapy: Exposure therapy aims to treat anxiety and post-traumatic stress disorders by exposing people to feared objects, situations, traumatic events, or memories. Exposure therapy is always conducted in a controlled environment, but the exposure can be real, imagined, or simulated. By gradually exposing you to the feared experience, it helps desensitize you to the triggering event and develop coping skills to reduce symptoms.
• Brief Strategic Family Therapy (BSFT): This family therapy approach for adolescents targets specific family dynamics and interactions that may contribute to adolescent substance use and other problematic behaviors, such as:
  • Aggression
  • Violent behavior
  • Risky sexual behavior
  • Oppositional behavior
  • Delinquency
  • Conduct issues
• Multidimensional Family Therapy (MDFT): A therapeutic approach that works with the whole family to address multiple adolescent behaviors, such as substance use, mental health, school problems, etc.
• Multisystemic Therapy (MST): MST targets specific factors that are associated with adolescent antisocial behavior and substance misuse. These factors include:
  • Family
  • Peer pressure
  • Attitudes
  • School culture
  • Neighborhood culture

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  Dual Diagnosis Medications

  Many people with co-occurring mental health and substance use disorders will require medication to stabilize their condition and reduce symptoms. Prescription medications such as selective serotonin reuptake inhibitors (SSRIs) may be prescribed for mental health disorders like anxiety and depression.⁶

  While benzodiazepines are sometimes prescribed as a treatment for anxiety, these are typically avoided if you have a SUD due to their high potential for misuse and addiction. Similarly, if you have ADHD, you may be prescribed non-stimulant medications rather than stimulant medications due to their high misuse and addiction potential.⁶

  If you have alcohol use disorder or opioid use disorder, you may be prescribed medications as a form of maintenance treatment to help prevent relapse and manage cravings. These medications may include:^2,6

  • Methadone: A tablet or injectable that is prescribed to reduce cravings and help alleviate pain for those experiencing opioid withdrawal
  • Buprenorphine: A partial opioid agonist that helps reduce symptoms of opioid withdrawal
  • Naltrexone: A tablet or injectable used to help reduce cravings and the rewarding effects of both alcohol and opioids
  • Disulfiram: An alcohol antagonist drug that creates unpleasant reactions when taken with alcohol.
  • Acamprosate: A tablet used to reduce cravings for alcohol.

  How to Find a Dual Diagnosis Treatment Program

  If you or someone you love is struggling with symptoms of co-occurring substance use and mental health conditions, you are not alone. Call 888-647-0051 (Who Answers?) to speak with an addiction treatment specialist about dual diagnosis treatment centers near you.

  Resources

  • 1. U.S. National Library of Medicine. (2016, March 25). Dual Diagnosis.
    2. National Institute on Mental Health. (2021). Substance Use and Co-Occurring Mental Health Disorders.
    3. National Institute on Drug Abuse. (2020). Common Comorbidities with Substance Use Disorders Research Report.
    4. Substance Abuse and Mental Health Services Administration. (2021, November 4). Co-Occurring Disorders and Other Health Conditions.
    5. National Alliance on Mental Illness. (2020). Substance Use Disorders.
    6. Substance Abuse and Mental Health Services Administration. (2020). Substance Abuse Treatment for People with Co-Occurring Disorders. Treatment Improvement Protocol (TIP) Series No 42.