Many people who chronically abuse drugs and alcohol to the point where they are addicted are also living with a mental health disorder. In the addiction treatment and medical fields, this condition is known as a co-occurring disorder or dual diagnosis, a term that has been used since the 1990s to describe the combination of a mental health disorder and an addiction. Another medical term for it is comorbidity.
Acknowledging Dual Diagnosis Addiction
Dually diagnosed individuals come from all walks of life. They can be members of low-income households, military veterans, or people with general medical illnesses, as well as those who may have experienced trauma early in life.
Table of Contents
It is widely agreed upon that the most effective way to help dually diagnosed people is to treat their mental health disorder and substance use disorder at the same time. Because both conditions are present, their needs are different from people who have only one condition. Finding a drug rehab that specializes in dual diagnosis is key in helping people in this demographic.
Common addiction comorbidities
- Anxiety disorders:Generalized anxiety disorder, obsessive-compulsive disorder (OCD), panic disorder, post-traumatic stress disorder (PTSD), social anxiety disorder
- Behavioral disorders: Attention-deficit/ hyperactivity disorder (ADHD); oppositional defiant disorder (ODD)
- Mood disorders: Depression, bipolar disorder
- Eating disorders: Anorexia nervosa, bulimia nervosa, binge-eating disorder
- Personality disorders: Borderline personality disorder, schizophrenia
- Excessive fears, worries
- Confused thinking
- Concentration difficulties
- Flashbacks, memories of traumatic events
- Depression (feelings of hopelessness, sadness, irritability)
- Severe mood swings
- Suicidal thoughts
Sometimes a person’s actions or how they live are also symptoms of co-occurring disorders. A dually diagnosed person may experience:
- Aggressive or violent behavior
- Poor health and hygiene habits
- An inability to keep a job
- An inability to keep a residence
- Financial problems
- Legal problems
- Sexual deviance, prostitution
Dual Diagnosis Addiction Statistics
Dual diagnosis affect more people than is realized. These statistics offer some insight into how co-occurring disorders affect U.S. residents.
- In 2015, among the 19.6 million adults with a past year Substance Abuse Disorder (SUD), 8.1 million (41.2 percent) had Any Mental Illness (AMI) in the past year.
- Among the 8.1 million adults with co-occurring AMI and an SUD, in the past year, about 48 percent received either mental health care or substance use treatment at a specialty facility in the past year. That means, about half of the adults with co-occurring AMI and an SUD in the past year did not receive either type of service.
- More than 8.9 million persons have co-occurring disorders, which means they have both a mental and substance use disorder. Only 7.4 percent of individuals receive treatment for both conditions with 55.8 percent receiving no treatment at all.
- Men, particularly between the ages of 18 to 44, are more likely to develop a co-occurring disorder than women.
The high rate of comorbidity among drug abuse and addiction and other mental disorders argues for a comprehensive approach to intervention that identifies and evaluates each disorder concurrently, providing treatment as needed, the National Institute on Drug Abuse reports.
The Relationship Between Mental Illness and Addiction
There is an established link between substance addiction and mental illness, but the exact relationship between the two is complex and not always fully understood. Though it commonly occurs among youth and adults, there appears to be no single answer as to why substance dependence and addiction often accompany mental health disorders.
It is widely accepted that drug addiction is a mental illness. Addiction changes the brain in ways that interfere with the order of needs and desires of a person. Substance users substitute these needs with priorities related to securing and using the addictive substance of their choice.
According to the National Institute on Drug Abuse (NIDA), “Diagnosis of a mental disorder may not take place until the symptoms have progressed far along enough to be recognized.” It also writes, “However, subclinical symptoms may also prompt drug use or abuse started can create confusion as to which came first.”
Self-Medication is Common Among Dual-Diagnosis Clients
One condition can contribute to the other or make it worse. Many people use substances to self-medicate as they attempt to manage the symptoms of a mental health disorder on their own. Or, substance abuse can trigger mental health disorders.
NIDA advises that three scenarios may help people understand why substance use and co-occurring disorders happen together:
- Drugs of abuse can cause users to experience one or more symptoms of another mental illness.
- Mental illnesses can lead to drug abuse.
- Both substance abuse disorders and mental illness are brought about by overlapping factors such as underlying brain deficits, genetic vulnerabilities, and/or early exposure to stress or trauma.
How comorbidity develops depends on several factors. Among them are:
- Whether early drug use is a factor for later substance abuse problems and later occurrence of mental illnesses
- Whether having a mental health disorder in childhood or adolescence can increase later drug abuse problems, which can occur with conduct disorders and untreated attention-deficit hyperactivity disorder.
Many people who abuse substances and have a mental health disorder turn to drugs, alcohol, and other addictive substances to manage their symptoms on their own. It has been found that the more severe a person’s mental illness, the more likely it is that the person will use or abuse an illegal substance. In this population, commonly abused substances include alcohol, marijuana, and cocaine.
While some dual diagnosis clients may truly believe they are helping themselves when they use substances to relieve pain or manage it, the truth is they could be doing more damage to their physical and mental health.
Using addictive substances in this way can only worsen the condition of dually diagnosed people and put them on the road to addiction. Drugs and alcohol also can only increase symptoms of a mental illness or create new ones.
A person who takes prescription medication for a diagnosed mental health disorder risks making it less effective if it interacts with drugs and alcohol.
Getting Screened for Dual Diagnosis
Health care or mental health professionals will evaluate a person to see if co-occurring disorders are present. Any signs or symptoms found are checked against the latest version of theDiagnostic and Statistical Manual of Mental Disorders to determine if comorbidity is present. This process can be tricky.
The symptoms of one disorder can appear as symptoms of another, and as noted earlier, it is not always clear if substance abuse is the cause of one’s mental illness or if the mental illness causes substance abuse. If it is determined that dual diagnosis is the case, then people who meet the criteria may be eligible to enroll in a treatment center that offers specialized, integrated care. Each illness must be treated separately but in the same period as the other.
Signs and Symptoms that Indicate Substance Use Disorders (SUDs)
Compulsive use of addictive substances is a major sign that a person has a substance use disorder. How do you know if someone has a substance use disorder? Here are some signs. If any are present, consider it a red flag.
- Does the individual continue to use despite the negative effects on their health, daily routines, or relationships?
- Does the person experience intense, frequent drug cravings?
- Have spending habits changed to support buying addictive substance, even to the point where it is unaffordable?
- Is the substance used longer or more often than intended?
- Is recovery from substance use extensive? Does the recovery period last days or weeks?
- Is there an inability to stop using the substance despite wanting to?
- Has a high tolerance to the substance developed with regular, prolonged use of the substance? Is more of the substance needed to achieve a high?
- Are more attempts being made to obtain the substance? Have these attempts become illegal or reckless?
- Do withdrawal symptoms occur when the individual suddenly stops using the drug?
Ready to get help?Let's get started nowLet our treatment experts call you today.
Dual Diagnosis Treatment: Taking Action
People who have dual diagnosis can receive help they need to recover from it and manage it without toxic drugs and harmful behaviors. Treatments that address the substance use disorder and the mental health disorder at the same time have been found to be the most effective for dually diagnosed clients.
Dual Diagnosis Addiction Treatment Plans
Comprehensive treatment plans typically start with a medical detox and then continue with therapies that address the root of the addiction and the mental health disorder. Before a treatment plan is developed for a client, all of the person’s needs and preferences should be taken into consideration. Dually diagnosed clients have several treatment options and therapy programs to choose from. They are:
Individuals who have severe substance addictions or have managed co-occurring disorders for a long time may benefit most from an inpatient program. In this kind of program, clients live at a licensed treatment facility for the duration of treatment, which can last for 28 days or more, depending on the program. A team of addiction, health care, and mental health care specialists are available to help clients receive rehabilitative treatment in a 24-hour monitored environment.
This means they will receive medications during detox for uncomfortable symptoms of drug withdrawal or those needed to ease symptoms of mental health disorders and help clients achieve physical, emotional, and psychological stability. Therapies that address behavior, trauma, 12-step fellowships, and more are typically available at inpatient centers. Clients can also receive individual counseling, group therapy, or family therapy, if needed.
Outpatient programs (OPs) allow clients more flexibility in how they receive addiction and mental health care treatment. They can schedule treatment around their personal obligations and are not required to live at a treatment center full time as they receive care. Intensive outpatient programs (IOPs), which can last from one month to 90 days, offer clients intensive therapies that promote sobriety, and teaches them tools and strategies to live sober full time.
These therapies can include 12-step facilitation and relapse prevention planning. Sessions can last from a half hour (30 minutes) to an hour and a half (90 minutes). Intensive outpatient programs also benefit dual-diagnosis clients by offering them recovery community that includes therapists and mental health professionals who can ensure they get the needed care for their condition(s).
Like outpatient programs, Partial hospitalization programs (PHPs) offer some flexibility to accommodate the dually diagnosed client’s schedule and specific needs. They are typically offered during the day for a certain number of hours during the week. In this arrangement, clients will have to able to live on their own as 24-hour supervision or around-the-clock medical assistance are not provided.
They also must demonstrate the ability meet their weekly requirements and attend their intensive therapy sessions. Dually diagnosed clients who are transitioning from a higher level of care, such as inpatient or residential, may also benefit from PHPs. These programs offer just the right setting for clients who need more time before they rejoin society full time.
5 Mental Health Disorders and How Dual Diagnosis Addiction Treatment Helps
People with anxiety disorders, which include panic disorder, social anxiety disorder, and specific phobias, are two to three times more likely to have an alcohol or other substance abuse disorder at some point in their lives, according to the Anxiety and Depression Association of America.
The association also writes, “About 20 percent of Americans with an anxiety or mood disorder such as depression have an alcohol or other substance use disorder, and about 20 percent of those with an alcohol or substance use disorder also have an anxiety or mood disorder.
- Tension, nervousness, restlessness
- Having a sense of impending danger, panic or doom
- Increased heart rate
- Rapid breathing(hyperventilation)
- Fatigue, weakness
- Concentration difficulties, preoccupied thoughts
- Sleeping difficulties
- Gastrointestinal (GI) problems
- Difficulty with controlling worry
- Actively avoiding things that trigger anxiety
- Benzodiazepines such as Xanax, Klonopin, Valium, Ativan,
- Prescription sleep medications such as Ambien, Lunesta
Cognitive behavioral therapy treatment can help clients recognize thought patterns that make them feel anxious or fearful and give them the tools to find new ways to cope with those emotions in stressful or taxing situations.
Depression (major depressive disorder)
Depression and addiction go hand in hand for the millions of people who use substances. Data show that major depressive disorder is the leading cause of disability in the United States for ages 15 to 44. More than 16.1 million U.S. adults are affected by this disorder. To cope with it, many of them are drinking alcohol, and most are likely drinking to forget and numb themselves to stressful or troubling thoughts. But drinking excessive amounts of alcohol only worsens the problem and raises the risk of alcohol addiction.
- Feeling sad, empty or hopeless
- Angry outbursts, irritability or frustration, even over small matters
- Little to no interest or pleasure in activities, such as sex, hobbies, or sports
- Sleep disturbances, including insomnia or oversleeping
- Tiredness, low to no energy
- Difficulty with completing small tasks because they take extra effort
- Reduced appetite and weight loss or increased food cravings, weight gain
- Anxiety, agitation or restlessness
- Slowed thinking, speaking or body movements
- Feeling guilt or worthlessness, fixating on past failures or self-blame
- Concentration difficulties, thinking difficulties
- Struggling with decision-making, remembering things
- Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide
- Unexplained physical problems, such as back pain or headaches
- Marijuana (which can worsen symptoms of depression)
Anxiety and depression are commonly linked, so cognitive behavioral therapy will also help people who self-medicate with drugs to deal with their depression. Motivational therapy can give clients a new outlook on life and a process to follow as they make healthy changes. Holistic therapies can help lift one’s mood, making one think and feel better and seeing a clearer picture of their life goals.
Post-Traumatic Stress Disorder (PTSD)
People who experience traumatic experiences may turn to drugs or alcohol as they battle against flashbacks, nightmares, and other difficult things that stem from an unresolved situation in their lives. According to the National Center for Post-Traumatic Stress Disorder, about eight percent of the population will have PTSD at some point in their lives. Anywhere from 11 to 20 percent of U.S. veterans have PTSD in any given year.
According to an article on VeryWellMind.com, substance use disorders are more likely to follow the development of PTSD, so the disorder actually may increase the risk for substance use problems.
- Anger outbursts
- Flashbacks or behavior or feelings associated with reliving the incident (feeling stuck in time)
- Increased paranoia
- Intense emotional feelings when reminded of the event
- Intense and uncontrollable physical sensations (heart palpitations, sweating, shortness of breath, feeling faint, nausea, feeling a loss of control)
- Avoiding any thoughts, conversation, people, activities, feelings, or places associated with the event
- Difficulty in remembering vital parts in the trauma
- Constant negativity
- Insomnia or difficulties staying asleep
- Easily startled
- Ongoing physical pain
- Prescription pain relievers (opioids such as OxyContin)
Starting and completing a recovery program that addresses PTSD and substance-abusing behaviors can help people with PTSD understand why they abuse drugs and how doing so affects the symptoms of their disorder. Cognitive-behavioral therapy, trauma therapy, Eye Movement Desensitization and Reprocessing therapy or EMDR, and trauma therapy can be part of a program that specializes in co-occurring disorders. Some studies, such as this one, have shown that treatment that addresses PTSD and substance abuse can reduce severity of both symptoms. Treatment that addresses both conditions also can restore self-esteem.
Adult Attention-Deficit/Hyperactivity Disorder (ADHD)
Attention-deficit/hyperactivity disorder is a chronic medical condition in which people may be hyperactive and are unable to control their impulses or attention span. For most people with ADHD, these behaviors can affect one’s school, home, or work life. According to WebMD, adults with ADHD may have challenges with managing their time, being organized, setting goals, and keeping a job. Problems with relationships, self-esteem, and addiction are common in this population.
ADHD is the most commonly diagnosed mental disorder of children, according to WebMD, and it can continue into adulthood. According to the U.S. National Library of Medicine, up to five percent of children meet the criteria for ADHD, but many go undiagnosed until they reach their teen or adult years. Untreated adults with ADHD are at higher risk of developing a substance use disorder than adults without ADHD.
- Excessive activity, restlessness
- Disorganization problems (often losing things)
- Prioritization problems
- Poor time management skills
- Have trouble following directions
- Problems with focusing on, following through and finishing tasks
- Multitasking problems
- Poor planning
- Low frustration tolerance
- Frequent mood swings
- Fidgeting or squirming a lot
- Trouble coping with stress
- Caffeine (excessive coffee drinking may be a sign)
According to the U.S. Department of Health and Human Services, teenagers with ADHD are more likely to try drugs at a younger age, use multiple illegal drugs and have gotten drunk in the past six months.
An effective recovery program for ADHD and a substance abuse problem offers a multilayered approach to treatment. It can include family therapy, behavioral therapy, or even holistic therapy programs that offer nutritional therapy, exercise programs, and other healthy ways to manage stress. Treatment plans can also help clients determine if medication is needed for treating their ADHD, and if so, which medications are needed.
Bipolar disorder (also known as manic depression or manic-depressive illness) is a mental disorder characterized by extreme mood swings that can range from depression to mania. “Sometimes the mood switches from high to low and back again are dramatic and rapid, but more often they are gradual and slow, and intervals of normal mood may occur between the high (manic) and low (depressive) phases of the condition. The symptoms of both the depressive and manic cycles may be severe and often lead to impaired functioning,” writes MedicineNet.com.
Ready to get help?Let's get started nowLet our treatment experts call you today.
According to the site, about 5.7 million adults in the United States, or about 2.6 percent of the population aged 18 or older, have bipolar disorder. When someone is manic, their thinking, judgment, and social behavior can be affected, which can lead to unwise or unfavorable decisions. When they are in the depressive phase, the same areas can also be affected. According to research presented in the American Journal of Managed Care, 56 percent of people with bipolar disorder have experienced addiction in their lifetime.
- Abnormally upbeat, jumpy or wired
- Increased activity, energy or agitation
- Exaggerated sense of well-being and self-confidence (euphoria)
- Reduced need for sleep
- Highly talkative
- Racing thoughts
- Poor decision-making — for example, going on buying sprees, taking sexual risks or making foolish investments
- Caffeine (excessive coffee drinking may be a sign)
People in a recovery program that specializes in treating bipolar disorder and addiction at the same time can learn techniques and strategies to manage strong cravings for addictive substances. They can also attend individual or therapy sessions that support physical and me.
Dual Diagnosis Aftercare Treatment
Once a person with co-occurring disorders leaves rehab, their journey to recovery is not over—it is just beginning. Recovering from the substance abuse and a mental health illness is a long process. Dual diagnosis aftercare treatment should be a part of any recovery plan.
The aftercare stage typically includes support that helps dually diagnosed individuals manage their mental health conditions and sobriety efforts successfully. Some people may attend daily or weekly support group meetings or join 12-step fellowships, such as Alcoholics Anonymous or Narcotics Anonymous, that connect them with like-minded people with similar experiences. Some people may attend an alumni program that can also keep their minds focused on their newfound sobriety with activities and people who can hold them accountable.Outpatient treatment that provides customized care is also an option.
Is Dual Diagnosis Addiction Treatment for You?
The following checklist offers signs and symptoms of co-occurring disorders. If you experience these symptoms, a recovery program addressing dual diagnosis could benefit you.
- Do you feel extreme guilt or anxiety when you use?
- Has your substance abuse or addiction strained your interpersonal relationships?
- Do you feel depressed or exhibit cloudy judgment?
- Do you know how to recover from substance abuse or your mental health disorder on your own?
- Do you experience peer pressure or are you around triggers that prompt you to abuse substances?
- Do you seek to abuse substances when dealing with negative situations?
- Do you have sudden mood swings, bouts of anger, or extreme anxiety?
- You’ve tried alternative options, but haven’t been successful?
Start Dual Diagnosis Treatment Today at Pathway to Hope
At Pathway to Hope, a Delphi Behavioral Health Group facility, we specialize in helping people who have a substance addiction and a mental health disorder. We don’t just treat the substance addiction; we also treat the thought patterns and behaviors that can lead to abusing substances with effective treatments that focus on the roots of your addiction and mental health condition. If you or someone you know is struggling with substance addiction or mental illness, Pathway to Hope can help.
Call us at (844) 557-8575 or contact us online today so we can help you find the right treatment program for you or someone you know. We also can walk you through the process to help determine if you need intensive outpatient treatment, partial hospitalization services, or another recovery arrangement that better fits your needs. Don’t delay. If you need addiction treatment, get help now.
National Institute on Drug Abuse, (March, 2011).Comorbidity: Addiction and Other Mental Disorders. National Institute on Drug Abuse. Retrieved March, 2018 from https://www.drugabuse.gov
National Institute on Drug Abuse, (February, 2017).Common Physical and Mental Health Comorbidities with Substance Use Disorders. National Institute on Drug Abuse. Retrieved March, 2018 from https://www.drugabuse.gov
Khaleghi, M, (February, 2017).What Is Dual Diagnosis?. Psychology Today. Retrieved March, 2018 from https://www.psychologytoday.com
Bose, J, (September, 2016).Key Substance Use and Mental Health Indicators in the United States: Results from the 2015 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration. Retrieved March, 2018 from https://www.samhsa.gov
Tull, M, (December, 2017).Self-Medicating—A Risky Form of Self-Treatment for PTSD. Verywell Mind. Retrieved March, 2018 from https://www.verywellmind.com
Mathias, R, (June, 2003).Joint Treatment of PTSD and Cocaine Abuse May Reduce Severity of Both Disorders. National Institute on Drug Abuse. Retrieved March, 2018 from https://archives.drugabuse.gov
Pub Med, (June, 2016).Attention Deficit Hyperactivity Disorder (ADHD). Pub Med. Retrieved March, 2018 from https://www.ncbi.nlm.nih.gov
Sherman, C, (June, 2016).The Truth About ADHD and Addiction. ADDitude. Retrieved March, 2018 from https://www.additudemag.com