What is Dual Diagnosis?

Published: 03/1/2022 | Author: Mark Harrigan

Dual diagnosis refers to the presence of a substance use disorder, or addiction, and a co-occurring mental health disorder like depression or anxiety. When you have co-occurring disorders, it’s important to receive treatment at a dual diagnosis facility where you will receive comprehensive and integrated treatment.¹

In this article:

• What is Dual Diagnosis?
• How Do Addiction and Mental Health Affect Each Other?
• What is Dual Diagnosis Treatment?
• What Does Dual Diagnosis Treatment Entail?

What is Dual Diagnosis?

Dual diagnosis is the term for when drug and alcohol addiction and a mental health condition co-occur. In terms of mental health or substance use issues, dual diagnosis treatment aims to treat both substance misuse and the mental health condition at the same time. About half of people who have a substance use disorder (SUD) will also deal with a co-occurring mental illness as well.¹

If you are dealing with a dual SUD and mental health condition, you are more likely to experience negative consequences of your substance misuse. Dual diagnosis, for people with severe mental illness, is associated with higher rates of the following:²

• Relapse
• Homelessness
• HIV contraction
• Legal problems
• Violence
• Treatment noncompliance
• Relationship problems

Certain factors can increase the risk that you may develop a co-occurring condition. These risk factors include:³

• Genetics
• Stress
• Previous trauma, such as physical abuse, sexual assault, or being in combat

What Mental Health Conditions Commonly Co-Occur With Addiction?

Certain mental health conditions are common in people with SUD. These include:^1,4

• Anxiety disorders, such as generalized anxiety and panic disorder
• Posttraumatic stress disorder (PTSD)
• Depression
• Bipolar disorder
• Attention-deficit hyperactivity disorder (ADHD)
• Personality disorders, such as borderline personality disorder and antisocial personality disorder
• Schizophrenia

Research shows that the more severe a mental health condition is, the more likely there will be negative consequences associated with substance use.²

How Do Addiction and Mental Health Affect Each Other?

There are different theories about why addiction and mental health disorders co-occur. The link between SUD and mental health is complex. Possible explanations include:²

• Overlapping risk factors: There are overlapping risk factors for substance misuse and mental health conditions. These overlapping risk factors could lead you to develop both a SUD and mental health condition.
• Secondary substance misuse: This theory suggests that severe mental illness increases the risk of developing a SUD. An example of this is if someone starts using substances as a way to manage the symptoms of bipolar disorder.
• Secondary psychiatric disorder: A mental illness may be the result of substance use. Without using substances, someone may not have developed their mental health condition. For example, substances may create brain changes that then result in mental health symptoms like anxiety.
• Bidirectional model: This explanation states that either a mental health condition or substance misuse can increase the likelihood of developing the other.

What is Dual Diagnosis Treatment?

Dual diagnosis treatment can look different depending on your individual needs. If you are dealing with co-occurring substance misuse and mental health symptoms, you should choose a provider who has significant experience in treating both conditions.

Dual diagnosis is a different specialty than treating SUD or mental health alone. A rehab that doesn’t have expertise in dual diagnosis treatment may not be able to appropriately assess, determine, or provide the type of care you need. In order for treatment to be effective, you need to be treated for both conditions at the same time.^1,3

The severity of the SUD and mental health condition will determine how much care you need. Different levels of care for dual diagnosis treatment include:⁵

• Inpatient rehab: Inpatient rehab involves living at the facility and receiving 24/7 treatment and care while you receive mental health and substance use therapy and therapeutic services. Inpatient rehab is the most intensive option with a set routine that helps provide structure to your early recovery. Inpatient dual diagnosis care may be a good fit for you if you are able to live away from home for a time and require 24/7 care in order to stay sober or safe.
• Partial hospitalization programs (PHPs): The most intensive outpatient option, PHPs provide several hours of treatment per day, for most days per week, with care being over 20 hours per week. It serves as a good bridge between inpatient and outpatient care and may be helpful if you need a high level of intensity but need to stay at home.
• Intensive outpatient programs (IOPs): A step down from PHPs, IOPs provide a few hours of care, for three to five days per week. Generally, treatment is anywhere from nine to 20 hours per week.
• Outpatient: Traditional outpatient care means meeting with a treatment provider at regularly scheduled intervals such as weekly, biweekly, or monthly. For example, you may see a therapist or psychiatrist in outpatient care. This is the least intensive option and is probably not sufficient for dual diagnosis treatment.

Generally, inpatient dual diagnosis treatment programs last anywhere from 30 days to 90 days, although treatment may take longer, especially to address the underlying factors influencing both conditions.

What Does Dual Diagnosis Treatment Entail?

Aside from the level of care you might receive in dual diagnosis treatment, there are other differences compared to receiving care for a SUD or mental health condition alone.

Treatment for dual diagnosis means you are receiving treatment for your SUD and mental health condition at one time. Treatment is integrated instead of treating one of the conditions first followed by the other. Professional dual diagnosis care considers how these disorders influence the progression of one another.

Treatment for SUD and mental health can include:³

• Medication: Medication can be used to treat certain SUDs or mental health symptoms. Someone may only need medication for one of these disorders but could need medication for both. For example, someone with depression and alcohol use disorder could benefit from an antidepressant like Zoloft as well as naltrexone, which treats alcohol addiction. A psychiatrist who is skilled in treating dual diagnoses will be able to determine which medications are a good fit and work well together.
• Therapy: Therapy for dual diagnosis can include individual, family, couples, or group therapy. Therapy can support you in developing coping skills for mental health symptoms or cravings to drink or use drugs. A common therapy method is cognitive behavioral therapy (CBT). CBT examines the connection between your thoughts, feelings, and behaviors to change maladaptive behaviors. CBT can be helpful in dual diagnosis treatment. For example, someone with an anxiety disorder might think in a certain way that leads them to feel anxious and then use drugs to manage their anxiety symptoms. CBT can help shift the thought patterns, which then can result in less anxiety and urges to use substances.
• Peer support groups: Peer support groups, such as 12-step meetings and SMART Recovery groups, can be integrated into any level of care or type of dual diagnosis treatment. Twelve-step meetings are often associated with substance use, but other 12-step meetings are meant to support you in different types of recovery. For example, Eating Disorders Anonymous or Codependents-Anonymous serve to support people in recovery from disordered eating or codependency. Peer support groups like this offer an opportunity to give or receive feedback and support from peers who are going through a similar situation as you.

If you think you could benefit from dual diagnosis treatment, please call 888-647-0051 (Who Answers?) to speak with a specialist. We can help you find a treatment program that is right for you and has significant experience in treating your specific conditions.

Resources

1. National Institute of Mental Health. (March 2021). Substance Use and Co-Occurring Mental Disorders.
2. Mueser, K.T., Drake, R.E., & Wallach, M.A. (1998). Dual diagnosis: A review of etiological theories. Addictive Behaviors, 23(6), 717-734.
3. National Library of Medicine. (n.d). Dual Diagnosis.
4. National Institute on Drug Abuse. (April 2020). Part 1: The Connection Between Substance Use Disorders and Mental Illness.
5. National Institutes of Health. (January 2018). Types of Treatment Programs.