Dual Diagnosis: Substance Abuse and Mental Health

February 14, 2022 | Alcohol Addiction , Drug addiction

Dual diagnosis is a term used to describe a mental health disorder and a substance abuse problem. This can be difficult to treat, as both disorders need to be addressed.

Dual diagnosis is sometimes referred to as co-occurring disorders. It’s important to note that someone can have mental illness and drug or alcohol abuse with no other history. Still, they are considered dual diagnoses when there is a pattern of one disorder emerging following the onset. For example, someone with schizophrenia may begin self-medicating with drugs or alcohol as their hallucinations and paranoia become more uncontrollable.

Someone else may go through a period of depression following the death of a loved one and seek comfort in substance abuse by abusing prescription medication or turning to illicit substances such as marijuana or cocaine.

Dual diagnosis is unique to each individual, depending on their unique history and risk factors for each disorder.

Dual diagnosis is not uncommon, although the exact number of Americans affected is unknown. However, more than 20 percent of people with severe mental illness also have a substance abuse problem, and about 50 percent of people with an addiction also suffer from another mental illness.

Why do substance use disorders and mental disorders occur together?

One way to examine this question is by looking at the symptoms of mental disorders and substance use disorders and how they correlate to see if there are similarities. This can better understand why people with mental illness might also be dealing with substance abuse issues.

Of course, another way to address the question is to conduct research that examines causation. Suppose researchers can determine why substance use disorders and mental illnesses occur together. In that case, there could be better treatment options developed for people who would potentially benefit from both types of therapy.

According to a study published in the journal Addiction, there are several reasons why substance use disorders and mental illness occur together.

1. The National Institute on Drug Abuse explains that people who have developed substance use disorders may also be struggling with undiagnosed mental illnesses that they are self-medicating with drugs or alcohol. This is often referred to as a “dual diagnosis” (substance use disorder and mental illness).

2. several symptoms are common between substance abuse disorders and mental illnesses, including paranoia, depression, feelings of isolation, suicide ideation (or attempts), schizophrenia symptoms like hallucinations or delusions, mania symptoms like irritability or reckless behavior, and symptoms of anxiety disorders. Each of these symptoms can be a problem on its own and can also lead to problems with substance abuse.

3. People may have unresolved symptoms from previous mental illness diagnoses or from an untreated mental illness that was never diagnosed at all. This could cause symptoms of mental illness to show up as people struggle to deal with trauma, coping mechanisms, stress and other issues related to substance abuse

It is important for people dealing with substance use disorders and mental illness to seek proper treatment. If you or someone you know believes that the two may be related, it is a good idea to speak with a medical professional as soon as possible.

Recognizing a Dual Diagnosis

It is important for individuals with substance use disorder and their loved ones to recognize separate problems. It’s a vital part of any substance abuse treatment plan. However, once the spotlight is on the dual diagnosis, there are sometimes more questions than answers about what exactly that means.

Thankfully, for those wondering what constitutes a dual diagnosis or how to recognize it, some general symptoms typically indicate both a substance use disorder and another mental health disorder are present.

There are three different categories for symptoms or syndromes associated with dual diagnosis. The first is people who may have two separate disorders that involve substance abuse and mental health disorder.

The second is those with symptoms that indicate an actual dual diagnosis, such as schizophrenia and substance use disorders, often complicate treatment for the affected individual and the treatment team.

And finally, there is a group of people who may be misdiagnosed with a dual diagnosis because they truly do not have a dual diagnosis at all. This can be frustrating for those who have been told they have a dual diagnosis and struggle to find out why.

To help clarify these issues, here is some information about the more common symptoms that indicate a possible dual diagnosis and some of the most common disorders that result in this type of misdiagnosis.

Symptoms of a possible dual diagnosis include:

– Having two or more medical conditions with separate causes, such as lung cancer and heart disease, requires different treatment plans for recovery.

– Experiencing distressing mood or behavior changes that occur independently rather than in response to either the substance abuse or the mental health disorder, such as irritability with no known cause.

– Having two or more psychiatric disorders that are unrelated, such as schizophrenia and an eating disorder.

You are experiencing a decreased performance at work or school due to substance abuse, even if this is not related to other mental health conditions.

Two or more psychiatric disorders are closely related, such as bipolar disorder and depression or panic disorder and agoraphobia.

People who have actual dual diagnosis typically have combinations of the following symptoms:

– Symptoms for one mental health condition coexisting with another mental health disorder while also exhibiting symptoms of a substance use disorder.

– Symptoms for one mental health condition coexisting with another mental health disorder while also experiencing other symptoms that indicate a possible dual diagnosis, such as the examples listed above.

People who have been misdiagnosed with a dual diagnosis typically have combinations of the following symptoms: 

– Symptoms that indicate a possible dual diagnosis, such as those listed above.

– Symptoms for one mental health condition that appear to worsen due to the presence of another mental health disorder, such as feeling significantly more depressed because of social anxiety.

To determine whether an individual truly has a dual diagnosis or simply experiencing distressing mood or behavior changes unrelated to either of their two conditions, some things should be considered.

  • A diagnosis can only be made based on an individual’s actual symptoms, not because they have a substance use disorder or another mental health condition.
  • Suppose someone has similar or identical psychiatric symptoms as those listed above. In that case, it may be possible that they have a dual diagnosis or that one of their conditions has worsened as a result.
  • Suppose an individual with mental health symptoms begins experiencing distressing mood and behavior changes, and the presence of another mental health condition appear to make no difference in these symptoms. In that case, they likely do not truly have a dual diagnosis.

In some cases, it may be difficult to discern whether an individual has a dual diagnosis or not. If this is the case, further evaluation and testing by a qualified mental health professional can help determine whether there is truly a coexisting substance use disorder and another mental health condition or if these symptoms are simply related to one of the two.

Signs and Symptoms of Substance Abuse and Mental Health Disorders

Substance Use Disorder

People who have a substance use disorder typically experience feelings of depression, guilt, or anxiousness that are severe enough to cause significant emotional distress. They may feel like they cannot control their need for the substance and worry about obtaining more of it.

They also most likely will exhibit social, family, work, or school-related problems resulting from their substance use. These may include keeping secrets or lying about activities due to fear of getting caught with the substance, neglecting family members because they are preoccupied with obtaining and using it, firing employees due to missed work due to intoxication, as well as legal problems as a result of their substance use, such as DUIs.

Mental Health Disorder Symptoms

People who have mental health disorders typically experience mood swings that are severe enough to cause significant emotional distress. With many mental health disorders (although this is not the case with all), there are often periods of feeling sad or down accompanied by difficulty concentrating and making decisions because of anxiety.

They may also be preoccupied with feelings of guilt or shame, making it difficult to attend school or work regularly. These feelings are typically associated with self-injury or thoughts of self-harm and suicidal thoughts and behaviors. There also may be feelings of hopelessness that cause them to believe that things will never get better.

They may also experience severe mood swings that occur in response to something that triggers them, such as an anniversary of the death of someone close to them or getting fired from their job. It is important to note that these mood changes are typically temporary and do not usually last for more than two weeks at a time.  

Although people with either a mental health disorder or a substance use disorder may experience feelings of sadness, anxiety, and hopelessness as well as mood swings that do not last for more than two weeks at a time, these symptoms can be due to other causes and need to be assessed by a professional.

Alcoholism and Personality Disorders

It is common for people who have a substance use disorder to also have personality disorders, such as borderline personality disorder or antisocial personality disorder. These two types of disorders share many characteristics that can make them difficult to diagnose: both involve emotional instability and impulsivity; engaging in self-harming behaviors; and having intense mood swings, anger outbursts, and a lack of empathy for others.

Suppose you think that you might have a dual diagnosis or that someone you know has both of these conditions. In that case, it is important to receive an assessment by a qualified mental health professional who can help determine the extent of their symptoms.

Dual Diagnosis Treatment Techniques

The most commonly used treatment techniques for dual diagnosis patients are psychotherapy, including dialectical behavior therapy, family therapy, problem-solving skills training, and medications. The type of treatment used for each patient depends on their specific needs and the severity of their symptoms.

People who benefit from psychotherapy often receive medication to help control any anxiety they feel in social situations or make them less impulsive. This combination of treatment aims to help the patient change their distorted thinking patterns and behavior, which are part of what makes each disorder difficult to manage on its own.

People with both a substance use disorder and a mood disorder may experience different symptoms related to each condition at different times, making it difficult to know whether they are experiencing symptoms of one disorder or the other.

It is possible for people with a dual diagnosis to reduce their symptoms by sixty percent to ninety percent if they remain actively engaged in treatment. If these individuals also have supportive family members, this can help them stick with their treatment plan and achieve better results.

For those with a dual diagnosis, treatment can be challenging and is often long-term. However, with a supportive family and professional team, many patients can manage their symptoms successfully over time.

Finding the right treatment program

There are many options—inpatient and outpatient, group and individual—and you can speak with your doctor or therapist to find one that suits your needs.

Dual diagnosis treatment techniques typically involve psychotherapy, medications, and support from family members. Many patients can successfully manage their symptoms with a supportive team of mental health professionals and family members.

Other alternatives include Alcoholics Anonymous (AA) or Narcotics Anonymous (NA), which are twelve-step programs designed to help individuals change their harmful drinking patterns. Other self-help groups, such as SMART Recovery, can also help patients with substance use disorder maintain abstinence by learning how to manage cravings and avoid triggers.

Many patients can manage their symptoms successfully with the right medications and a supportive team, including family members and mental health professionals.

While there is not yet a universal standard for treating the dual diagnosis, most treatment centers share the goal of helping individuals live more productive lives with fewer consequences related to their substance use disorder.

If you or someone you know has a dual diagnosis, talk with your doctor or therapist about treatment options today.

Self-help for a dual diagnosis

If you are struggling with a substance abuse problem and a mental health condition, it is important to get help. Dual diagnosis treatment can provide you with the support you need to manage both conditions. There are a few things you can do to help yourself when undergoing dual diagnosis treatment:

1. Stay positive. It can be tough to cope with two conditions at once, but it is important to stay positive. Remember that you can and will get better with treatment.

2. Be honest with your doctor and therapist. It is important to be honest with your doctor and therapist about your substance abuse and mental health problems. This will help them provide you with the best possible care.

3. Seek support from loved ones. Talk to your family and friends about both conditions you are dealing with. They want to help you, but they can’t if they don’t know what is going on with you.

4. Take medications as prescribed. If your doctor prescribes any medications for either condition, be sure to take them as directed. This will prevent relapse and reduce your symptoms.

5. Stay on top of your treatment plan. Staying on top of your treatment plan—you are attending therapy sessions, taking medications as prescribed, not using any illicit substances—will help support both conditions and show that you are serious about getting better.

10 Things You Should Know About Dual Diagnosis Treatment

1. Dual diagnosis treatment is a specialized form of addiction treatment that simultaneously addresses both substance abuse and mental health issues.

2. Patients who receive dual diagnosis treatment have a higher chance of successfully recovering from addiction.

3. Dual diagnosis treatment can be expensive, but many resources are available to help patients and their families pay for treatment.

4. Dual diagnosis treatment requires commitment and cooperation from both the patient and their family.

5. Dual diagnosis treatment is not always successful, but it offers patients the best chance of recovering from addiction and mental health issues.

6. Dual diagnosis treatment uses a variety of evidence-based and research-driven therapies and treatments to help patients recover from substance abuse and/or mental health issues, both of which can be co-occurring disorders.

7. Most people with substance abuse or mental health issues do not seek treatment on their own — family members typically play an important role in helping to encourage their loved ones to seek treatment.

8. Patients in dual diagnosis treatment often experience intense feelings of guilt, shame, and self-hatred. Family members need to be there for their loved ones receiving treatment and supportive of them as they work through these emotions.

9. Some of the most common dual diagnosis treatment techniques include cognitive behavioral therapy, dialectical behavior therapy, family counseling, and 12-step support groups such as Alcoholics Anonymous.

10. Many people have misconceptions about addiction and mental health issues. Dual diagnosis treatment is an important step in overcoming both substance abuse and mental health issues, leading to lasting recovery.

The Takeaway

As you can see, dual diagnosis treatment is an important step in overcoming substance abuse and mental health issues. It’s not easy to do by yourself—you need support from your family members who want the best for you.