Frequently Asked Questions About Dual Diagnosis

What Does Dual Diagnosis Mean?

Technically, dual diagnosis (also known as co-occurring or concurrent disorders) means being diagnosed with two or more specific, co-existing conditions. This includes two mental health disorders, two physical illnesses, a mental health disorder and a physical illness, or a mix of mental, physical, and substance use disorders.

More commonly, however, the term dual diagnosis is used to specifically refer to someone struggling with both a mental health disorder and a substance use disorder at the same time.

What Is the Difference Between Dual Diagnosis and Co-Occurring Disorders?

Both terms typically mean the same thing and are often used interchangeably to describe two or more distinct disorders that exist concurrently. The key difference is in their scope.

Dual diagnosis generally has a more specific focus and has come to refer to the specific pairing of a mental health disorder and a substance use disorder.

Co-occurring disorders, on the other hand, is a more inclusive, umbrella-type term that covers a broader range of possible combinations that are not limited to the pairing of mental illness and substance use disorder. It can include more than two conditions, none necessarily substance abuse-related.

What Are Some Examples of Dual Diagnosis Versus Co-Occurring Disorders?

Examples of dual diagnosis include having both major depressive disorder plus alcohol or opioid addiction; post-traumatic stress disorder plus opioid or alcohol addiction; bipolar disorder plus addiction to amphetamines or cannabis; or generalized anxiety disorder plus addiction to prescription drugs.

Examples of co-occurring disorders include non-substance-related combinations such as major depressive disorder plus generalized anxiety disorder; schizophrenia plus obsessive-compulsive disorder; or bipolar disorder plus PTSD.

Is There a Link Between Mental Health Disorders and Substance Use Disorders?

Although substance use disorders may or may not directly cause mental health disorders, or the other way around, studies have shown that people with mental health disorders are more likely to have a concurrent substance use disorder than those who do not.

In people who do have both disorders, symptoms of one condition tend to make the other condition worse, and a key challenge is to determine whether one co-occurring disorder caused the other, or if they developed independently.

People with a mental health disorder, for instance, may self-medicate by using drugs or alcohol to help numb their symptoms and enable them to cope. This leads to a substance use disorder when the relief is only temporary. Then their symptoms become worse, and their body craves more and more of it to be able to function.

Substance use disorders, on the other hand, can trigger changes in brain structure, chemistry, and function, leading to the development of a mental health disorder or worsening the symptoms of an already existing one.

Left untreated, mental health issues can cause substance abuse to get worse, and an increase in substance use can cause mental health issues to worsen as well, creating a difficult cycle to break.

What Are the Most Common Co-Occurring Dual Diagnosis Disorders?

Some of the most commonly co-occurring disorders in a dual diagnosis include:

Generalized anxiety disorder (GAD): Generalized anxiety disorder is characterized by a persistent, unrelenting anxiety that tends to manifest as an irrational fear that takes over the person’s mind, often leading to a panic attack.

It is the condition most associated with self-medicating behavior and becoming reliant on prescription medications to help calm them down. Relief is only temporary, however, and does not treat the underlying condition. Eventually, more and more of it is needed to provide the same effect, and the person may use it in combination with alcohol or other drugs and develop a substance abuse disorder as well.

Bipolar disorder: Bipolar disorder is caused by a chemical imbalance in the brain and is characterized by severe mood swings between intense episodes of mania and high energy, and episodes of depression. People with bipolar disorder often turn to alcohol or other substances to help them cope with their intense feelings, which may provide temporary relief but worsen symptoms in the long run and cause the mood swings to intensify.

Major depressive disorder: Major depressive disorder and addiction are commonly linked. People suffering from it often turn to drugs or alcohol to help cope with their symptoms, but long-term, it causes the symptoms to get worse. Worsening symptoms lead them to need more and more of their substance to produce the same effect. In other cases, it is the substance use disorder that comes first and brings on the depression.

Post-Traumatic Stress Disorder (PTSD): Post-Traumatic Stress Disorder is the result of experiencing or witnessing a terrifying event that the brain is unable to fully process, causing it to get stuck in danger mode. People suffering from it experience symptoms such as vivid flashbacks, nightmares, and feeling anxious and on edge even when there is no actual threat. Often, they turn to drugs or alcohol to help them cope with their racing mind and emotional distress, and numb their feelings of fear.

Schizophrenia: Schizophrenia is characterized by trouble distinguishing fantasy from reality. People suffering from it may be prone to disorganized thinking, delusions, and/or hallucinations. They often misuse drugs or alcohol to help them cope with their symptoms, which can worsen psychotic symptoms and interfere with treatment.

How Is Dual Diagnosis Treated?

The best, most effective treatment for dual diagnosis is a comprehensive, integrated approach that identifies and addresses both the mental health disorder and the substance use disorder simultaneously rather than separately. If only one condition is treated, the untreated one can interfere with progress, and the risk of a relapse after treatment ends is significantly increased.

Treatment needs to be individualized, as there is no one-size-fits-all approach. Depending on which substances and mental health disorders are involved, and how the symptoms of one are affecting the other, it may include inpatient care, behavioral therapy, medication, lifestyle changes, and/or peer support.

Inpatient care: Co-occurring disorders treatment centers provide comprehensive care that combines medical and mental health services, including medication management and therapy.

Therapy: The most commonly used therapies for treating co-occurring disorders include Cognitive Behavioral Therapy (CBT), which helps reshape negative thinking patterns by teaching you how to identify and reframe negative thought patterns; Dialectical Behavioral Therapy (DBT), which focuses on emotional regulation, stress management, and reducing self-harm behaviors; and mindfulness-based techniques.

Medication: Drugs may be prescribed to help relieve the symptoms of one or both conditions, stabilize mood, and enable better engagement in therapy.

Peer Support: Peer support groups provide a safe space to connect with others who have experienced and understand what you are going through, get emotional and social support, and share experiences and tips for day-to-day challenges.

Are There Any Self-Help Tips That Can Help?

The following are some effective self-help tips that can help you sustain your recovery long-term.

Know your triggers and establish an action plan: Understand what your triggers are and have a plan for how to deal with them in a healthy way if you are unable to avoid them.

Stay connected with others: Having regular face-to-face contact with friends and loved ones, and being involved in a support group can help calm your nervous system.

Keep from making random changes to your treatment routine: Arbitrarily stopping treatment once you feel better is a common reason for relapse in people with co-occurring disorders. Always consult your doctor or mental health practitioner before changing your treatment routine.

Engage in healthy lifestyle practices: Engaging in healthy lifestyle practices such as regular exercise, relaxation and stress management techniques, healthy eating, and adequate sleep can help. These are natural ways to reduce stress or anxiety, improve your mood and outlook, and regulate your energy level.

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