What is Dual Diagnosis?
Substance use and mental health are two issues faced by many Americans. A 2018 survey estimated that over 53 million Americans aged 12 or older had used illicit drugs in the last year.1 About 20.3 million people had a substance use disorder.1 Approximately 9.2 million American adults had some type of mental illness and a substance use disorder in 2018.1
Dual diagnosis, also known as a co-occurring disorder, refers to when a person is diagnosed with both a substance use disorder and a mental illness.2 When a person has a co-occurring disorder, dual diagnosis treatment centers can provide services that identify and focus on both the addiction and the mental health issue.2
What is a Co-Occurring Disorder
Substance abuse and mental health issues frequently occur together; approximately half of people with a mental health disorder develop an issue with substance use at some point in their lives.2 (paragraph 1), 3 (what is dual diagnosis) The reason for this could be due to the following:
- Self-medicating: People may use substances in an attempt to cope with symptoms of mental health issues.2 ,3, 4 The mental health issue may also create changes in the brain thereby increasing the risk of developing an addiction.3, 4
- Substance use results in a mental health disorder: Using substances can create changes in the brain that can increase the likelihood of developing mental health disorders.3 The areas of the brain affected by substance use are the same as those affected by certain mental illnesses, such as anxiety disorders, depression, bipolar disorder, or schizophrenia.4
- Genetic predisposition: genetics, stress, and trauma can cause a person to develop issues with both mental health and addictions.3
Common Co-Occurring Disorders
Some mental health disorders are commonly associated with co-occurring substance use disorders. While it is possible to manage mental health disorders through therapy and medication, abusing some types of prescribed medications can put a person at increased risk of developing a problem with substance use.5
Attention-Deficit/Hyperactivity Disorder (ADHD)
Attention-deficit/hyperactivity disorder (ADHD) is a long-standing pattern of difficulty paying attention and/or hyperactive, impulsive behavior that makes it difficult to function in one or more environments, such as at school, home, or work.6
People with ADHD may struggle with focusing on tasks, organization, sitting still, being too talkative, acting without thinking about consequences, or taking risks.6 Substance use disorders occur frequently in people with ADHD, especially in those who are untreated.4
It is commonly treated with stimulant medication, such as Ritalin or Adderall, which have a risk for abuse or addiction.4, 5 Out of around 16 million adults in the United States who are prescribed stimulant medications, 5 million reported misusing them at least once, and nearly half a million have an addiction to them.7
Bipolar disorder is a diagnosis that includes episodes of mania, which involves a reduced need for sleep, euphoric moods, racing thoughts, increased energy, and increased risk-taking, along with the deep lows associated with depressive episodes, where a person feels down and fatigued and experiences loss of interest and pleasure in activities and feelings of guilt or worthlessness.6
Research shows that up to 60% of people with bipolar disorder struggle with substance use disorders at some point.8, 9 This could be due to increased risky behavior, as well as attempts to self-medicate, especially when feeling the intense lows of a depressive episode.8
Generalized Anxiety Disorder (GAD)
Generalized anxiety disorder is characterized by uncontrollable worry about various activities or occurrences, and often impairs a person’s ability to function in their daily life.6
Their concerns are excessive and frequently center around ordinary tasks or situations, including routine responsibilities at home or work; fears about their family, health, or financial affairs; or even scheduling.6 This type of anxiety frequently appears without warning, is distressing, and is long-term.6
Up to 15% of people who have generalized anxiety disorder are dually diagnosed.10 Benzodiazepines are one of the medications used to treat this disorder, but there is a risk for misuse and addiction.5, 10 Some types of benzodiazepines are quick-acting and may be used to manage symptoms, but can also lead to abuse or self-medication.10
Depression is a debilitating disorder that involves long periods of depressed mood, loss of pleasure in activities, excessive fatigue, feeling worthless or guilty, thoughts of death or suicide, changes in eating or sleep patterns, and difficulty thinking or concentrating.6
Co-occurring disorders are nearly twice as common in people who have severe depression than those who don’t have mental illness, and people with a substance use disorder are up to 4 times more likely to have depression than those who don’t abuse substances.4, 11
Substance use may be an attempt to self-medicate in an effort to manage the painful emotional symptoms or increase one’s energy.11
How Dual Diagnosis Treatment Works
Unlike traditional substance use treatment, dual diagnosis rehab involves additional elements of care. People may use substances to relieve mental health symptoms, which can exacerbate symptoms, leading to the need for more substances.2 During dual diagnosis treatment, it is essential to treat co-occurring disorders at the same time.2 This is known as integrated care.5
Treatment plans should be tailored to the unique needs of each individual.5 The experience of a co-occurring disorder isn’t the same for everyone, and treatment shouldn’t be either. Different levels of care and treatment methods are available because people might respond better to some types of services than others.5
Treatment should focus on all present health concerns, including addiction, mental health, physical issues, and any other areas of functioning that are problematic.5 Recovery from addiction and mental health issues takes time, and may involve relapses requiring additional treatment episodes.5
Research shows that staying in treatment longer has better recovery outcomes, with a suggested minimum of 90 days of care.5
Treatment for mental illness may need to be ongoing, depending on the diagnosis and severity. The most common type of treatment for dual diagnosis is counseling, which can be provided in individual, family, and group settings, and may need to be combined with medication for increased effectiveness.3, 4, 5
Finally, during treatment, a person’s needs frequently change.5 Treatment plans should be reviewed regularly and modified as needed to reflect updated needs.5
Benefits of Dual Diagnosis Treatment
Integrated treatment for co-occurring disorders is recognized as the most effective method.2 This increases the likelihood of a lasting recovery by understanding the root cause and how each disorder affects the other.2 Treatment planning is individualized to address specific issues, symptoms, and concerns that a person faces.2 Treating multiple diagnoses simultaneously provides the best chance for recovery, as opposed to treating each disorder separately.2, 4
Are you Looking for Dual Diagnosis Treatment?
Are you or someone you love struggling with substance abuse? Are you using drugs or alcohol to cope with the symptoms of a mental health condition? If your answer to either of these questions is yes, it may be time to consider asking for help.
American Addiction Centers Can Help
Many treatment providers offer dual diagnosis treatment in the United States. American Addiction Centers is a leading provider of dual diagnosis care in the United States, offering 8 facilities across the country in various states, including:12, 13
Still Unsure About Seeking Treatment?
Learning about addiction and treatment options may feel overwhelming. If you are still unsure about how treatment works, how to ask for help, or how to get treatment, consider the following guides:
- Substance Abuse and Mental Health Services Administration. (2019). Key substance use and mental health indicators in the United States: Results from the 2018 National Survey on Drug Use and Health. Rockville, MD: Center for Behavioral Health Statistics and Quality.
- National Alliance on Mental Illness. (2013). Substance use disorders.
- U.S. National Library of Medicine. (2020). Dual diagnosis.
- National Institute on Drug Abuse. (2020). Common comorbidities with substance use disorders.
- National Institute on Drug Abuse. (2018). Principles of drug addiction treatment: A research-based guide (3rd edition).
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
- National Institute on Drug Abuse. (2018). Five million American adults misusing prescription stimulants.
- Substance Abuse and Mental Health Services Administration. (2016). An introduction to bipolar disorder and co-occurring substance use disorders. Advisory, 15(2), 1-12.
- Gold, A.K., Peters, A.T., Otto, M.W., Sylvia, L.G., Magalhaes, P.V. da S., Berk, M., … Deckersback, T. (2018). The impact of substance use disorders on recovery from bipolar depression: Results from the Systematic Treatment Enhancement Program for Bipolar Disorder psychosocial treatment trial. Australian & New Zealand Journal of Psychiatry, 52(9), 847-855.
- Kehoe, W.A. (2017). Generalized anxiety disorder.
- Rappeneau, V., & Bérod, A.(2017). Reconsidering depression as a risk factor for substance use disorder: Insights from rodent models. Neuroscience and Biobehavioral Reviews, 77, 303-316.
- American Addiction Centers. (2020). American Addiction Centers.
- American Addiction Centers. (2020). Our treatment centers.
- American Addiction Centers. (2020). Substance abuse treatment services.