What is Dual Diagnosis?
A person with a dual diagnosis has both a mental disorder and a secondary co-occurring alcohol or drug problem. These conditions occur together frequently. About half of people who have a mental disorder will also have a substance use disorder at some point in their lives and vice versa. The interactions of the two conditions can worsen both.
When a person is diagnosed with both a mental illness and a substance use disorder, they are said to have co-occurring disorders. Though the disorders can exist separately from one another, when they coexist in the same person, they usually cause the symptoms of both disorders to be amplified. It is common for a person with co-occurring disorders to have more severe symptoms than a person with only one of the disorders.
Co-occurring disorders are defined by the dual diagnosis of a mental health disorder and a substance use disorder in the same person. These diagnoses can be made at the same time, or they can be made one after the other, but the two disorders occur simultaneously in the same person.
What are the Signs that Someone Needs a Dual Diagnosis Treatment?
Because many combinations of dual diagnosis can occur, symptoms vary widely. Mental health clinics are starting to use alcohol and drug screening tools to identify people at risk. Symptoms of substance use disorder may include:
- Withdrawal from friends and family
- Sudden changes in behavior
- Engaging in risky behaviors
- Developing a high tolerance and withdrawal symptoms
- Feeling like you need a drug to be able to function
Symptoms of a mental health condition can also vary greatly. Warnings signs, such as extreme mood changes, confused thinking or problems concentrating, avoiding friends and social activities, and thoughts of suicide, maybe reasons to seek help.
Dual Diagnosis Warning Signs
Each illness has its symptoms, but common signs of mental illness in adults can include the following:
- Changes in sex drive
- Difficulty perceiving reality (delusions or hallucinations, in which a person experiences and senses things that don’t exist in objective reality)
- Inability to perceive changes in one’s own feelings, behavior or personality (”lack of insight” or anosognosia)
- Overuse of substances like alcohol or drugs
- Multiple physical ailments without obvious causes (such as headaches, stomach aches, vague and ongoing “aches and pains”)
- Thinking about suicide
- Inability to carry out daily activities or handle daily problems and stress
- An intense fear of weight gain or concern with appearance
- Excessive worrying or fear
- Feeling excessively sad or low
- Confused thinking or problems concentrating and learning
- Extreme mood changes, including uncontrollable “highs” or feelings of euphoria
- Prolonged or strong feelings of irritability or anger
- Avoiding friends and social activities
- Difficulties understanding or relating to other people
- Changes in sleeping habits or feeling tired and low energy
- Changes in eating habits such as increased hunger or lack of appetite
Mental Disorders that Co-Occur with Substance Abuse
There are several different kinds of mental health disorders that commonly co-occur with substance use disorders. The most common co-occurring disorders with substance abuse fall into five categories:
- Mood disorders
- Anxiety disorders
- Psychotic disorders
- Personality disorders
- Eating disorders
While there are differences among them, many of them have similar attributes as to how they are diagnosed, what causes them to co-occur, and how the two disorders affect one another. Examples of co-occurring disorders include:
Mood disorders are characterized by disruptions in mood that affect a person’s life, such as major depressive disorder and bipolar disorder. Mood disorders and substance abuse disorders are commonly co-diagnosed. It is unclear which disorder is more commonly diagnosed first in patients that have both, but it is clear that one affects the other.
In many cases, patients with co-occurring substance use and mood disorders have more severe symptoms than either disorder alone. It is common to try and treat a substance use disorder first and then address the mood disorder. However, studies have shown that treating both conditions simultaneously improves patient outcomes.
Anxiety disorders include generalized anxiety disorder, social anxiety disorder, obsessive-compulsive disorder, and post-traumatic stress disorder. Anxiety and substance abuse are also commonly diagnosed and are among the most common co-occurring disorders.
As is the case with mood disorders, substance abuse and anxiety disorders tend to be more severe in a person that is co-diagnosed than a person that has either one of the disorders alone. However, it is less common for anxiety disorders to be substance-induced than mood disorders. People with anxiety disorders may use substances to self-medicate and relieve their anxiety symptoms, which can lead to substance abuse.
Psychotic disorders involve changes in the way a person thinks and perceives themselves, others, and their environment. Examples of psychotic disorders include schizophrenia, delusional disorder, and schizoaffective disorder. A common symptom among psychotic disorders is psychosis, which is a temporary state where a person experiences hallucinations or delusions.
Psychotic disorders and substance abuse disorders can be hard to co-diagnose because psychosis can sometimes be a symptom of substance abuse. Drug-induced psychosis occurs when a person taking a substance experiences temporary hallucinations or delusions. Withdrawal from certain substances can also have psychotic effects. To be co-diagnosed, psychotic symptoms must also be present in the absence of substance use.
Schizophrenia and substance abuse, in particular, are commonly co-diagnosed. Substance use can make schizophrenia symptoms significantly worse. The underlying genetic conditions that increase a person’s risk of developing schizophrenia can also make a person vulnerable to a substance use disorder. Because of genetic predisposition, substance use may start early in life, causing the person to be more at risk for developing a substance use disorder.
Personality disorders cause people to have unhealthy thoughts and behaviors that affect their everyday life and relationships. Common personality disorders that co-occur with substance use disorders include borderline personality disorder, antisocial personality disorder, and narcissistic personality disorder, with the most common being borderline and antisocial personality disorders.
Personality disorders and substance abuse disorders are more commonly co-diagnosed in people with drug use disorders rather than alcohol use disorders. The high prevalence of co-diagnosis is usually a result of a personality disorder being followed by a substance use disorder.
Eating disorders are characterized by dysfunctional eating habits. Examples of eating disorders include binge eating disorder, anorexia nervosa, and bulimia nervosa. People with bulimia nervosa or anorexia nervosa with binge eating and purging habits tend to be at a higher risk of substance use than individuals with other types of eating disorders.
In general, eating disorders and substance abuse are commonly co-diagnosed. Studies have suggested that a genetic link could be the cause. Genetic factors that make a person more liable to eating disorders are also found among those that make a person liable to substance use disorders.
What are the Causes of Co-Ocurring Disorders needing Dual Diagnosis?
Although these problems often occur together, this does not mean that one caused the other, even if one appeared first. It can be hard to figure out which came first. Researchers think that there are three possibilities as to why they occur together:
- Common risk factors may contribute to both mental disorders and substance use disorders. These factors include genetics, stress, and trauma.
- Mental disorders can contribute to drug use and substance use disorders. For example, people with mental disorders may use drugs or alcohol to try to feel better temporarily. This is known as self-medication. Also, mental disorders may change the brain to make it more likely you will become addicted.
- Substance use and addiction can contribute to the development of a mental disorder. Substance use may change the brain in ways that make you more likely to develop a mental disorder.
Substance Use Disorders
As a country, we have a serious substance misuse problem — the use of alcohol, illegal drugs, and/or prescribed medications in ways that produce harm to ourselves and those around us. These harms are significant financially with total costs of more than $420 billion annually and more than $120 billion in healthcare. But these problems are not simply financial burdens — they deteriorate the quality of our health, educational, and social systems, and they are debilitating and killing us — particularly our young through alcohol-related car crashes, drug-related violence, and medication overdoses.
Genetic, brain imaging and neurobiological science suggest that “addiction” is qualitatively different from substance use and is now best understood as an acquired chronic illness, similar in many respects to type 2 diabetes — illnesses that can be managed but not yet cured.
A “substance” is defined as any psychoactive compound with the potential to cause health and social problems, including addiction. These substances may be legal (e.g., alcohol and tobacco); illegal (e.g., heroin and cocaine); or controlled for use by licensed prescribers for medical purposes such as hydrocodone or oxycodone (e.g., Oxycontin, Vicodin, and Lortab). These substances can be arrayed into seven classes based on their pharmacological and behavioral effects:
- Nicotine — cigarettes, vapor-cigarettes, cigars, chewing tobacco, and snuff
- Alcohol — including all forms of beer, wine, and distilled liquors
- Cannabinoids — Marijuana, hashish, hash oil, and edible cannabinoids
- Opioids — Heroin, methadone, buprenorphine, Oxycodone, Vicodin, and Lortab
- Depressants — Benzodiazepines (e.g., Valium, Librium, and Xanax) and Barbiturates (e.g., Seconal)
- Stimulants — Cocaine, amphetamine, methamphetamine, methylphenidate (e.g., Ritalin), and atomoxetine (e.g., Stratera)
- Hallucinogens — LSD, mescaline, and MDMA (e.g., Ecstasy)
Advantages of Dual Diagnosis Treatment Programs
Someone with a dual diagnosis must treat both conditions. For the treatment to be effective, you need to stop using alcohol or drugs. Treatments may include behavioral therapies and medications. Also, support groups can give you emotional and social support. They are also a place where people can share tips about how to deal with day-to-day challenges.
Common Therapies Offered at a Dual Diagnosis Treatment
A good dual diagnosis drug treatment program and drug addiction therapy facility need to be able to treat both conditions without treating one as the sole cause of the other. Addiction is a complicated disease and no one thing is to blame for it. There are various options available to handle drug addiction therapy.
A proper drug treatment program will offer several levels of therapy as well as multiple treatment options. This allows the rehabilitation facility to meet the individual needs of its patients.
Most programs begin with a detox process to remove the physical dependence on any substances then a residency program. This type of program can last as long as two months and is designed to provide intensive focused therapy in a controlled environment to help you get over the first hurdle and give you the tools necessary to face the cravings and temptations of everyday life.
During the inpatient treatment process, dual diagnosis cases are identified and treatment begins. The next step is an intensive outpatient drug treatment program that provides drug addiction therapy by meeting at the site several times a week for intensive therapy that can help you deal with what occurs in daily life. Finally, a standard outpatient therapy program provides the continued support necessary to maintain a sober condition.
For the Best Possible Chance of Full Recovery, Your Dual Diagnosis Care Should Include:
- Therapy that enables the client to make choices is the most reliable and widely used approach.
- In the treatment process, all household members, including partners, spouses, children, and any other members of a household or household members should all be involved regardless of whether they receive individual treatment or take part in family meetings
- Specialists in substance abuse and mental health treatment work together to ensure your mental health and substance abuse needs are met.
- Psychotherapy plays a key role in treating co-occurring disorders, but prescription medication may also be required.
Dual Diagnosis Treatment Centers Near Me
As the addiction treatment community begins to realize that addiction is itself a mental disorder, the relationship between substance abuse and mental disorders becomes more complicated. The greater treatment community largely lacks a proper understanding of dual diagnosed conditions, so these conditions are still treated separately, or worse–not treated or diagnosed at all. Our dual diagnosis treatment centers in Florida, California, Texas, New Jersey, and Washington are some of the facilities that have professionals trained to help treat co-occurring disorders concurrently. This type of tandem treatment provides some of the best success rates. Get dual diagnosis treatment for individuals struggling with substance abuse and mental health disorders.
 Dual Diagnosis – U.S. Department of Health and Human Services National Institutes of Health
 Substance Misuse and Substance use Disorders: Why do they Matter in Healthcare? – National Center for Biotechnology Information
 Mental Health and Substance Use Disorders – Substance Abuse and Mental Health Service Administration
 A Call for Standardized Definition of Dual Diagnosis – National Center for Biotechnology Information