Dual Diagnosis: Substance Abuse and Mental Health Disorders

People who receive a dual diagnosis have both a substance use disorder (SUD) and a mental health condition. 

Having two conditions that affect mental and behavioral health at the same time can complicate treatment. This makes recovery more difficult to achieve, especially if healthcare providers are unaware of one disorder.

Yet effective dual diagnosis treatment can help people learn to manage mental health and addiction symptoms through targeted therapy and coping skills.

Find out more about dual diagnosis, including different mental illnesses that occur with alcohol and drug abuse, symptoms, and the best treatments.

What Is a Dual Diagnosis?

A dual diagnosis happens when people have both a substance abuse issue (drug or alcohol addiction) and a mental disorder, like an anxiety disorder, depression, or bipolar disorder.

The combination may also be called co-occurring disorders or a comorbidity. Having an addiction or a mental illness is hard enough. Having two or more of these conditions can make recovery that much more difficult.

Symptoms of each disorder may aggravate or worsen the other disorder. With substance abuse and mental health disorders present, you may experience disruptions to daily life, including work, school, and relationships.

The right treatment programs that are made with dual diagnosis in mind, like ours at Otter House Wellness, can address these issues effectively and help put you on your way to recovery.

Quick Facts on Dual Diagnosis

  • Substance abuse happens twice as much in adults who also have a mental illness.
  • Alcohol and drug use can worsen mental illness symptoms.
  • Because treating a dual diagnosis is challenging, the best treatment is a multidisciplinary approach of several different treatments according to a person’s unique needs.
  • Dual diagnosis can affect anyone, but is more likely in people with multiple risk factors for both addiction and mental illness, like homelessness, incarceration, and trauma.

The Link Between Substance Abuse and Mental Health

If you have an alcohol or drug addiction, it’s not a guarantee that you’ll develop a mental health condition, or vice versa. 

However, dual diagnosis is a possibility if you have one of these disorders. That’s because each is a risk factor for the other, meaning they can make you more likely to develop the other disorder.

Alcohol and Drug Use as a Self Medication

While it’s not the only reason that people begin using drugs or alcohol, many mental health symptoms cause people to begin using substances as a way to self-medicate.

If people already have a mental health disorder and mild substance use issues, they may increase their alcohol or drug use over time, worsening the issue into an addiction.

For example, people with anxiety disorders experience feelings of dread, panic, and fear and may look to alcohol for a calming feeling. 

People with depression experience periods of extreme lows and could look to drugs like cocaine or prescription stimulants to boost their mood. 

These aren’t safe methods and the person may not be aware that they’re in danger of forming a condition they will need help for — but it’s often what happens.

How Mental Health Disorders Form 

Addiction can have far-reaching effects. As it worsens, it could cause you to have trouble at school, your job, or with loved ones.

With time, you may experience mental health symptoms for the first time, such as feelings of depression or panic. 

This is not the only way a mental health condition can form, but addiction can be a contributing factor.

Risk Factors for Addiction and Mental Health Disorders

Because these two conditions affect both mental and behavioral health, they often have overlapping risk factors.

Risk factors are the elements present in your life that make you more likely to experience certain health conditions.

Here are the risk factors for a dual diagnosis (addiction and mental health disorders):

  • Childhood trauma
  • Physical abuse
  • Sexual abuse or sexual assault
  • Verbal or emotional abuse
  • Family history of addiction/mental health issues
  • High levels of stress
  • Experiencing homelessness
  • History of jail time or incarceration
  • Having a severe medical condition, like cancer

Mental Health Issues That Commonly Occur with Addiction

A range of mental health problems may occur with drug or alcohol use disorders. 

Here are some of the most common mental health conditions that occur alongside addiction:

  • ADHD: Attention deficit hyperactivity disorder affects adolescents and young adults most and leads to doing things quickly, often without thinking, and trouble paying attention.
  • Anxiety disorders: Known for causing feelings of panic, dread, an increased heart rate, and sweating, anxiety is one of the most common co-occurring disorders.
  • Depression: Mood disorders like depression lead to periods of extreme lows, extreme highs, lack of interest in doing regular activities, and sometimes suicidal thoughts.
  • Bipolar disorder: Extreme mood swings and prolonged periods of extreme highs followed by dangerous lows are common in people who have bipolar.
  • Eating disorders: This is a serious mental illness as people with eating disorders often require hospitalization. These disorders often go hand in hand with drug or alcohol abuse.
  • Personality disorders: People with personality disorders have a hard time engaging in what’s considered acceptable social behavior and often have extreme relationship troubles.
  • PTSD: Post-traumatic stress disorder happens when someone experiences a traumatic event, like a sexual assault or a natural disaster. The person may experience deepened fears of memories of the event, sleep troubles, and other issues.
  • Schizophrenia: A person with schizophrenia or other psychotic disorders may suffer from delusions, hallucinations, or psychosis that make it difficult for them to understand what’s real in the world around them.

Signs of Co-Occurring Disorders

Each person and mental health disorder is quite different from the next, so symptoms may vary greatly as well. 

However, a person with a dual diagnosis may exhibit changes in behavior, physical health issues, and social behavior changes. 

Common signs to watch for if you believe a loved one may have a dual diagnosis:

  • Red eyes
  • Pinpoint pupils
  • Acting secretive
  • Hiding things
  • Lying
  • Sleep troubles
  • Drastic weight loss
  • Uncontrollable shaking
  • Trouble speaking properly
  • Forgetting to shower or brush teeth
  • Not fulfilling usual tasks/obligations
  • Using substances even after loved ones express concern
  • Suddenly withdrawing from friends/family members
  • Being late to work or school (if this is not normal behavior)
  • Withdrawal symptoms like agitation, irritability, and mood swings
  • Irrational fear or paranoia

Top Treatments for Dual Diagnosis

You may find a range of treatment options that work well for your dual diagnosis. If you’re unsure which type of treatment is right for you  — don’t worry. 

You can get a full evaluation from a mental health professional, who can offer you a referral for the right level of care.

Here are some of the top treatment services offered by Otter House Wellness and other dual diagnosis treatment centers.

Rehab Programs

Rehab programs for addiction and mental health often provide dual diagnosis care programs. That’s because these specialized treatment centers understand how important it is to address both issues in tandem.

Dual diagnosis rehab programs can be inpatient (where you stay at the facility for the length of the program) or outpatient where you get to complete treatment while keeping up with daily life.

The best dual diagnosis programs will integrate both substance abuse treatments and mental health treatments tailored specifically to your needs, symptoms, and disorders.

Medications and Medication Assisted Treatment

Treatment plans may also involve medications to address your mental health disorder, such as anti-anxiety medications, anti-psychotics, or antidepressants. 


If you need these medications, programs often offer medication management to make sure they don’t interfere with any medications you may be taking for addiction.

Medication-assisted treatment (MAT) is a form of addiction treatment for people addicted to opioids or alcohol. It’s a crucial way to help people conquer withdrawal symptoms so they can respond better to treatment.

People with severe addictions that cause potentially severe or life-threatening withdrawal symptoms may need to undergo detoxification (detox) before starting any medications.

Behavioral Therapy

Therapy and counseling are core components for all dual diagnosis treatment plans, since they can aid in helping you manage both addiction and mental health.

Examples of behavioral therapy include cognitive behavioral therapy, dialectical behavior therapy, and motivational interviewing.

These forms of psychotherapy help you learn which behaviors and thoughts are lending to addiction or mental health issues and find ways to change them for the better.

Family and Group Therapy

Support groups, also known as group therapy, can offer you encouragement from peers in dual diagnosis recovery. 

This is especially crucial for people with a dual diagnosis, who can benefit from extra support as they navigate the challenges of recovering from more than one disorder at a time.

And family therapy can help your family members talk about and heal from the effects of alcohol or drug addiction and mental health, and the issues that contributed to them, like family trauma.

Tips for Finding the Right Dual Diagnosis Care

You may be intimidated by the idea of finding a dual diagnosis program that can address your health issues and help you find lasting recovery. It’s a tough decision, after all, and an important one.

Look to the following tips to make finding the optimal dual diagnosis program easier:

  • Find a treatment program that’s long enough to allow you to achieve growth and your recovery goals.
  • Be sure the rehab center offers custom treatment programs. These can be tailored to the symptoms you’re experiencing and to what you want to get out of treatment. Otherwise, you may end up going through treatment again or leaving without the results you want.
  • Look for a continuum of care for dual diagnosis. This refers to multiple levels of care, with varying levels of intensity. With step-down levels of treatment, you can get the care you need at each stage of recovery, setting you up for success.
  • Find a program with evidence-based treatments like behavioral therapy, MAT, medication management, and run by licensed and trained professionals.

Get Dual Diagnosis Treatment at Otter House Wellness

If you’re ready to break free of the cycle a dual diagnosis has you in, Otter House Wellness can help.

We offer a full outpatient continuum of care for mental health disorders, including dual diagnosis disorders. And for people who need more intensive care, we partner with local hospitals to get it.

Reach out to our helpline today if you or a loved one is ready to live a life of mental wellness in North Carolina.

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