Dual Diagnosis: Co-Occurring Addiction And Mental Health Disorders

Drug and alcohol abuse affects the lives of millions of individuals and families in the United States in any given year.

Having a mental health disorder, or mental illness, is common among people who abuse drugs or alcohol. This is known as having co-occurring disorders, or a dual diagnosis.

Living with mental illness and a substance use disorder can affect the treatment and addiction recovery process.

The most effective treatment for people with both a mental health disorder and substance use disorder (SUD) is dual diagnosis treatment.

What Is A Dual Diagnosis?

Dual diagnosis is a type of specialty treatment offered in some mental health and addiction rehab programs for people who have a SUD and one or more mental health disorders.

This can be referred to as:

• dual diagnoses
• co-occurring disorders
• comorbid disorders
• comorbidity

Dual diagnosis is an integrated treatment approach that addresses all disorders a person may have, including mental illness, developmental disorders, and SUDs.

What We Know About Co-Occurring Disorders

About 9.5 million adults in the United States had both a mental illness and SUD in 2019, according to SAMHSA’s National Drug Use and Health Survey.

Either disorder can develop first. Many people develop mental health disorders at a young age, between the ages of 14 and 24. This is not true for everyone, however.

Common Co-Occurring Addiction And Mental Health Disorders

There are several types of mental health disorders that commonly co-occur with drug and alcohol issues.

Addiction And Anxiety Disorders

Anxiety disorders are common among people who seek treatment for substance abuse and addiction. There are multiple types of anxiety disorders that co-occur with addiction.

Common co-occurring anxiety disorders include:

• addiction and generalized anxiety disorder (GAD)
• social anxiety disorder and addiction
• panic disorder and addiction
• phobias (e.g. claustrophobia) and addiction
• addiction and separation anxiety disorder

Drugs or alcohol may be used to reduce the anxiety a person is experiencing. People with social anxiety may use alcohol or drugs like marijuana to feel more at ease in social settings.

Read more about co-occurring anxiety and addiction disorders

Addiction And Eating Disorders

Eating disorders, which affect an estimated 30 million Americans in their lifetime, can often co-occur with substance abuse.

People with eating disorders may use drugs or alcohol to:

• influence their weight
• influence eating habits
• cope with eating disorder-related stress

According to the National Eating Disorders Association (NEDA), bulimia nervosa and binge eating disorder have the highest overlap with substance abuse, followed by anorexia nervosa.

Common co-occurring eating disorders include:

• addiction and anorexia nervosa
• bulimia nervosa and addiction
• addiction and binge eating disorders
• addiction and avoidant/restrictive food intake disorder
• otherwise specified eating disorder and addiction

Read more about co-occurring eating disorders and addiction

Addiction And Personality Disorders

Personality disorders, such as antisocial personality disorder, borderline personality disorder (BPD), and narcissistic personality disorder can overlap with drug and alcohol addiction.

Common co-occurring personality disorders include:

• addiction and antisocial personality disorder
• avoidant personality disorder and addiction
• addiction and borderline personality disorder and addiction
• dissociative personality disorder and addiction
• histrionic personality disorder and addiction
• addiction and narcissistic personality disorder
• paranoid personality disorder and addiction
• addiction and schizoid personality disorder

People with personality disorders may use drugs or alcohol to cope with symptoms associated with their personality disorder, or past experiences of abuse, neglect, or other forms of trauma.

Read more about co-occurring personality disorders and addiction

Addiction And Mood Disorders

Mood disorders, such as depression and bipolar disorder (previously known as manic depression), commonly co-occur with substance abuse.

Common co-occurring mood disorders include:

• bipolar disorder and addiction
• addiction and mania
• addiction and depression
• postpartum depression and addiction
• addiction and seasonal affective disorder

People with mood disorders may use drugs or alcohol to self-medicate, in an attempt to reduce feelings of depression, hopelessness, anxiety, or grief.

Read more about co-occurring mood disorders and addiction

Addiction And Behavioral Disorders

Addiction can co-occur with behavioral disorders such as attention-deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder, and self-harm behaviors.

Substances may be misused by people with behavioral disorders to manage difficulties with concentration, compulsive behaviors, inattentiveness, or other forms of distress.

Common co-occurring behavioral disorders include:

• attention deficit hyperactivity disorder (ADHD) and addiction
• addiction and attention deficit disorder (ADD)
• self-harm and addiction

Some common drugs of abuse, including prescription stimulants, are also prescribed for the treatment of behavioral disorders like ADHD and ADD and can be misused.

Read more about co-occurring behavioral disorders and addiction

Addiction And Developmental Disorders

One in 54 children in the United States has some form of autism spectrum disorder, according to data collected by the Centers for Disease Control and Prevention (CDC).

In adulthood, drugs and alcohol may be used by teens and adults with autism to:

• reduce stress associated with social situations
• take the edge off
• boost self-confidence
• wind down

Common co-occurring developmental disorders:

• autism and addiction

Read more about co-occurring developmental disorders and addiction

Addiction And Obsessive-Compulsive Related Disorders

People with an obsessive-compulsive or related disorder may have certain obsessions, compulsions, or unusual habits that they struggle to control.

Obsessive-compulsive and related disorders include:

• obsessive-compulsive disorder (OCD)
• addiction and body dysmorphic disorder
• hoarding disorder
• addiction and body-focused repetitive disorder

Read more about co-occurring obsessive-compulsive related disorders and addiction

Addiction And Stress-Related/Trauma-Related Disorders

Exposure to trauma is a risk factor for substance abuse, as well as trauma-related disorders such as posttraumatic stress disorder (PTSD).

Examples of trauma include:

• sexual abuse
• molestation
• violence
• childhood neglect
• growing up in poverty
• racial discrimination
• wartime combat
• surviving a deadly incident (e.g. a shooting, vehicle accident)
• domestic abuse
• losing a loved one

Common stress/trauma-related disorders and addiction include:

• post-traumatic stress disorder (PTSD) and addiction
• addiction and acute stress disorder
• addiction and adjustment disorder
• reactive-attachment disorders and addiction

Heavy drinking or drug use can become a coping mechanism for survivors of neglect, abuse, assault, or wartime combat who have experienced trauma in childhood or adulthood.

Read more about co-occurring stress/trauma-related disorders and addiction

Addiction And Impulse Control Disorders

Impulse control has a link to drug and alcohol addiction. People with impulse control disorders, such as kleptomania or pyromania, may abuse drugs or drink heavily.

Common co-occurring impulse control disorders and addiction:

• addiction and kleptomania
• pyromania and addiction
• intermittent explosive disorder and addiction

Several symptoms of impulse control disorders, such as impulsivity and reckless behavior, are also seen with substance addiction. This can in part explain some of the overlap.

Read more about co-occurring impulse control disorders and addiction

Addiction And Psychotic Disorders

People with psychotic disorders, such as schizophrenia or schizoaffective disorder, may use substances to self-medicate symptoms of psychosis, such as paranoia, hallucinations, or delusions.

Common co-occurring psychotic disorders and addiction:

• addiction and schizoaffective disorder

Depressants may be used to suppress psychotic symptoms or to sedate. Some drugs, like cocaine or marijuana, may exacerbate or trigger psychosis in people predisposed to psychotic disorders.

Read more about co-occurring psychotic disorders and addiction

Addiction And Codependency

Codependency is generally recognized by emotional dependence on a partner – either a romantic partner or friend.

While it is not an official mental disorder or personality disorder, the effects of co-dependency on either an enabler or manipulator can negatively impact a person with an addiction.

A co-dependent existence can occur in a romantic relationship, or with friends or children.

Read more about co-occurring addiction and codependency

Addiction And Perfectionism

Though not an official diagnosis, perfectionism is a mindset where self-imposed or external pressures place high standards which can cause extreme disappointment, feelings of judgment, and self-loathing when “failure” occurs.

People that identify as perfectionists tend to be highly competitive and self-critical.

Read more about co-occurring perfectionism and addiction

Symptoms Of A Dual Diagnosis

Signs and symptoms of co-occurring mental health and substance use disorders can vary depending on the type of substance used and the specific mental health condition.

Common symptoms of co-occurring disorders include:

• changes in mood
• loss of interest in activities previously enjoyed
• changes in weight (e.g. weight loss, weight gain)
• engaging in risky behaviors
• withdrawing from friends and family members
• increasingly agitated or subdued
• loss of control over substance use

Both drugs and mental illness can affect how a person thinks, feels, and behaves. These changes can be sudden, or can worsen and become more apparent over time.

How Common Are Co-Occurring Disorders?

Millions of people in the United States, including both teenagers and adults, have co-occurring addiction and mental illness, according to national survey data.

Rates of co-occurring disorders vary depending on the substance of misuse. Not all drugs are equally as likely to become drugs of abuse among people with mental illness.

Dual diagnosis statistics:

• According to the National Institute on Drug Abuse (NIDA), people with mood and anxiety disorders are twice as likely to develop drug dependence or drug abuse, and vice versa.
• About 15 percent of people diagnosed with an anxiety disorder meet the criteria for a substance use disorder (SUD).
• An estimated 20 percent of people with depression also struggle with drug or alcohol abuse at some point in their lifetime.
• People with SUDs have eating disorders like anorexia or bulimia at a rate that is 11 times higher than the general population.
• Anywhere from 30 to 60 percent of people who seek treatment for substance abuse develop PTSD at some point in their lifetime.
• Around 25 percent of people with a serious mental illness (SMI) also have a SUD.

What Causes Co-Occurring Disorders?

The underlying causes of co-occurring disorders can be complex. Causes can vary depending on the individual. Here are some of the potential causes identified by researchers.

Shared Risk Factors

Substance abuse and many mental disorders share common risk factors. These can vary by the type of disorder.

Risk factors for both substance abuse and mental health disorders:

• stress
• history of trauma
• childhood abuse and neglect
• genetic vulnerabilities
• family history of substance abuse or mental illness

Drug-Induced Mental Illness

Many substances of abuse, including alcohol, can produce symptoms associated with mental illness, such as paranoia, depression, and mood swings.

In time, after getting sober and with treatment, some of these symptoms may go away. This will not necessarily be the case if you have a chronic mental health disorder.

Using Substances To Self-Medicate

Drugs and alcohol can be used by some people to alleviate or manage symptoms of mental illness, such as depression, anxiety, and symptoms of psychosis.

Using drugs and alcohol in this way is a sign of substance abuse. Over time, this can become a dangerous and compulsive habit that can worsen symptoms of mental illness.

How Are Co-Occurring Disorders Diagnosed?

For people without a previous mental health diagnosis, diagnosing a mental illness in someone with a SUD may take time.

Diagnosing mental health disorders in someone who has abused drugs or alcohol can be complicated by the fact that many symptoms of these issues overlap.

A doctor or mental health clinician may need to observe a person’s symptoms throughout the beginning stages of their treatment to determine an accurate diagnosis.

Diagnosing co-occurring disorders may involve:

• physical lab tests
• psychological testing
• assessing former medical and mental health history
• observation over a period of time

Within a treatment setting, a clinician can make an informed judgment about a person’s diagnostic profile by observing whether symptoms stay or go away after detox and withdrawal.

Treatments For Dual Diagnosis In Rehab

Dual diagnosis treatment is offered within some inpatient rehab programs, outpatient treatment programs, and by individual treatment providers.

For adolescents, dual diagnosis treatment may include:

• multisystemic therapy (MST)
• cognitive behavioral therapy
• family therapy
• psychiatric services
• medication

For adults, dual diagnosis treatment may include:

• cognitive behavioral therapy (CBT)
• dialectical behavioral therapy (DBT)
• assertive community treatment (ACT)
• integrated group therapy
• medication
• family therapy
• exposure therapy
• therapeutic communities

Your dual diagnosis treatment plan will be developed according to the type of mental health disorder, or symptoms, you have.

What Are The Benefits Of Dual Diagnosis Treatment?

Previous approaches to the treatment of co-occurring disorders would sometimes favor treating one disorder at a time. This is believed to be less effective than dual diagnosis.

According to research, benefits of dual diagnosis include:

• better treatment retention (i.e. more likely to stay in treatment)
• reduced risk of relapse
• lower risk of suicide
• better quality of life outcomes
• greater knowledge of relevant coping skills and tools

Providing comprehensive support through this integrated approach can equip people with tools and strategies to support a successful future in addiction recovery.

Dual Diagnosis FAQs

Having questions about dual diagnosis, including definitions and causes, is common. Find answers to some of the most frequently asked questions about dual diagnosis here.

❓ What Is The Difference Between A Dual Diagnosis And Co-Occurring Disorder?

✔️ Dual diagnosis and co-occurring disorder are two terms that are used to describe having both a substance use and mental health disorder.

Dual diagnosis can also refer to a specific type of treatment used to treat co-occurring disorders. Co-occurring disorders can be defined as having one or more medical, behavioral, or developmental disorders.

❓ What Causes Dual Diagnosis?

✔️ The causes of a dual diagnosis can vary depending on the type of disorder and the drug of abuse. Dual diagnosis can be caused by a variety of hereditary, environmental, and personal factors.

According to research, possible explanations for co-occurring disorders include:

• Shared risk factors: Many psychiatric disorders share common risk factors with substance use disorders, such as a history of trauma, poor stress management, and a family history of mental illness or substance use.
• Self-medication: People with psychiatric or developmental disorders may use drugs or alcohol to self-medicate or reduce symptoms of their disorder.
• Effects on the brain: Substance use disorders can trigger symptoms of mental disorders in part as result of the effects of drug abuse on the brain.

❓ What Is The Dual Diagnosis Model Of Treatment?

✔️ Dual diagnosis is an integrated treatment model that integrates both mental health and substance abuse treatment for people with co-occurring disorders.

The dual diagnosis treatment model often incorporates both individual services, such as individual behavioral therapy, as well as group-based treatment services.

Dual diagnosis treatments emphasize:

• stress management
• developing supportive coping skills
• supporting motivation for recovery
• teaching effective communication skills
• skills for building and maintaining healthy relationships
• relapse prevention

Treatment services offered within a dual diagnosis treatment program may vary depending on the treatment provider and the co-occurring diagnosis.

❓ What Does The Research On Co-Occurring Disorders Show Us?

✔️ Integrated treatment programs like dual diagnosis have been found to be superior in their effectiveness, compared to the treatment of each diagnosis separately.

Research shows that having co-occurring disorders is linked to higher treatment dropout rates, more severe illness, and a higher risk of relapse.

Research shows that integrated dual diagnosis treatment can:

• increase treatment retention
• improve recovery outcomes
• provide more comprehensive support
• reduce rates of future hospitalization
• reduce risk of future arrest or recidivism

Many dual diagnosis treatment providers also coordinate with organizations that provide social services to address issues such as unemployment, homelessness, and legal problems.

Find Dual Diagnosis Treatment Near You Today

Dual diagnosis is the most effective type of treatment for people who have both a SUD and mental health disorder.

If you’re looking for treatment for yourself or a loved one with co-occurring disorders, browse our website to find a treatment center to contact today.

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Written by the Addiction Resource Editorial Staff