What Is a Dual Diagnosis?

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A dual diagnosis, also referred to as a co-occurring disorder, is when a person is diagnosed with both a mental health disorder and a substance use disorder.

An example of a dual diagnosis is having an alcohol or drug use disorder along with a mental health condition such as a mood or anxiety disorder, says Dana Cavallo, PhD, assistant professor of psychiatry at Yale School of Medicine.

If you or a loved one have a dual diagnosis, you’re not alone. In 2020, 17 million adults in the United States experienced a mental health condition along with a substance use disorder.

Having a dual diagnosis often isn’t a coincidence. “Mental illness is about twice as prevalent in people diagnosed with an addiction,” says Dr. Cavallo. The National Institute on Drug Abuse (NIDA) notes that approximately half the people who experience a substance use disorder also experience a mental illness at some point during their lifetime, and vice versa.

This article explores the causes, diagnostic process, and treatment options for dual diagnosis, as well as some coping strategies that might be helpful.

Causes of a Dual Diagnosis

Listed below are some reasons why substance use disorders co-occur along with mental health conditions, according to the National Institute on Mental Health (NIMH).

Common Risk Factors

Both substance use disorders and mental health conditions have common risk factors, such as stress and trauma. Genetic factors may also play a role, as mental health conditions and substance use disorders tend to run in families.

Mental Health Conditions Can Lead to Substance Use

Mental health conditions can change a person’s brain, making them more susceptible to the rewarding effects of alcohol. This can make them more likely to continue using the substance and develop an addiction to it.

Dana Cavallo, PhD

A person with mental health issues may use alcohol or substances to self-medicate their symptoms.

For instance, someone with anxiety, depression, or post-traumatic stress disorder (PTSD) may turn to substances such as alcohol or drugs to feel better. However, while substances can offer a temporary escape, they worsen the symptoms of these conditions over time.

Substance Use Can Lead to Mental Health Conditions

Similarly, substance use can change the brain in ways that make a person more likely to develop a mental health condition. A person using alcohol or substances may therefore be more susceptible to mental health issues, and the longer they use substances, the greater the risk of developing mental illnesses, says Dr. Cavallo.

Though substance use disorders and mental health conditions may occur together, it can be difficult to determine which came first or caused the other. “The etiology of co-occurring disorders is sometimes difficult to ascertain,” says Dr. Cavallo.

Diagnosing Co-Occurring Disorders

The National Alliance on Mental Illness (NAMI) notes that the symptoms of co-occurring disorders can vary considerably depending on which conditions the person has.

A dual diagnosis is identified when a professional, usually a psychiatrist or psychologist, conducts a thorough patient evaluation, asking about the symptoms of various conditions and understanding the onset of symptoms and their evolution over time, says Dr. Cavallo.

Often, it is challenging to untangle the symptoms because mental health symptoms may be related to a pattern of substance use, intoxication effects, or even withdrawal related to a particular substance, Dr. Cavallo explains. “For example, a person may stop cocaine use and the acute effect may be a depressed mood.”

Therefore, it is also important to ask about symptoms that may or may not have been present prior to substance use and whether the substance use exacerbated the mental health symptoms, says Dr. Cavallo. “Recognizing psychosocial triggers such as significant stress or trauma history that may underlie both disorders is also important.”

Treating Co-Occurring Disorders

Treating co-occurring disorders requires an integrated approach.

“Dual diagnosis treatment must address both mental illness and substance use simultaneously, since both together have such an impact on a person’s life. Treatment therefore consists of integrating the two disorders together rather than focusing on each one separately,” says Dr. Cavallo.

These are some of the treatment approaches healthcare providers may recommend, for a dual diagnosis:

• Detoxification: The first step, which can be a major hurdle, involves stopping use of the substances and flushing them out of the system. The detox process is often undertaken in an inpatient setting, so that healthcare providers can monitor the patient and provide medication and care in case the person experiences withdrawal symptoms.
• Psychotherapy: Therapy is often a major part of the treatment plan. Cognitive behavioral therapy (CBT) is often helpful in changing unhealthy thought patterns that contribute to substance use. Some people may need intensive therapy initially, but once they get their symptoms under control and learn helpful coping skills, they may be able to reduce the frequency of their treatment sessions, says Dr. Cavallo.
• Medication: In addition to helping with withdrawal symptoms, medication can also help reduce craving for drugs and alcohol as well as help with the symptoms of mental health conditions.
• Inpatient rehabilitation: People with co-occurring disorders may benefit from inpatient rehabilitation, where they can receive continuous monitoring and mental healthcare.
• Support groups: Grappling with a dual diagnosis can be challenging. Support groups offer an avenue for people to share advice, celebrate successes, vent frustrations, find resources, and offer help and inspiration.

Dana Cavallo, PhD

A dual diagnosis treatment plan needs to take into account that co-occurring disorders may be more persistent and severe than having only one disorder, and you can’t treat one without assessing the risk factors for the other.

For example, you wouldn’t want to treat anxiety with medication that may have abuse potential; similarly, you wouldn’t want to treat a substance use disorder without understanding the circumstances in which the person uses the substance and what effect it has on them, explains Dr. Cavallo.

A 2018 study notes that an integrated approach is critical because a lack of improvement in either disorder can lead to a relapse of both conditions.

Coping With a Dual Diagnosis

Dr. Cavallo shares some strategies that may be helpful for coping with a dual diagnosis:

• Seek help: The first step to helping someone cope with a dual diagnosis is to convince them to seek help. Finding a compassionate provider who is willing to listen and understand how the diagnoses are affecting their physical well-being, emotional health, and social life is necessary for a successful intervention.
• Participate actively in treatment: Talking to a professional is just the beginning of the recovery process. Active participation in treatment is critical. Fully engaging in treatment with adequate support from within and outside of the treatment program is very beneficial.
• Focus on feeling better: Any mental health or substance use disorder can create a variety of challenges for the patient, their friends, and their family. A dual diagnosis may complicate the treatment plan, but education, support, therapy, and medication can help individuals recover and lead very productive lives.

Dana Cavallo, PhD

Remember that people can and do get better with the proper treatment. It’s important to keep an open mind, find a support team, and not give up on the recovery process.

A Word From Verywell

Coping with a substance use disorder can be challenging, and it can be even harder with a dual diagnosis, since having co-occurring disorders can worsen both conditions. It’s important to seek help for these conditions, get an accurate diagnosis, and participate in treatment in order to start feeling better.

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

1. Substance Abuse and Mental Health Services Administration. Key substance use and mental health indicators in the United States: Results from the 2020 National Survey on Drug Use and Health.
2. National Institute on Drug Abuse. The connection between substance use disorders and mental illness.
3. National Institute on Mental Health. Substance use and co-occurring mental disorders.
4. National Library of Medicine. Dual diagnosis. Medline Plus.
5. National Alliance on Mental Illness. Substance use disorders.
6. McGovern MP, Lambert-Harris C, Gotham HJ, Claus RE, Xie H. Dual diagnosis capability in mental health and addiction treatment services: an assessment of programs across multiple state systems. Adm Policy Ment Health. 2014;41(2):205-214. doi:10.1007/s10488-012-0449-1
7. National Alliance on Mental Illness. Substance use disorders.
8. Subodh BN, Sharma N, Shah R. Psychosocial interventions in patients with dual diagnosis. Indian J Psychiatry. 2018;60(Suppl 4):S494-S500. doi:10.4103/psychiatry.IndianJPsychiatry_18_18
9. National Library of Medicine. Dual diagnosis.

By Sanjana Gupta
Sanjana is a health writer and editor. Her work spans various health-related topics, including mental health, fitness, nutrition, and wellness.

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