Millions of Americans suffer from both a substance use disorder (SUD) and mental illness, or dual diagnosis. Treatment can be complex because there is likely a connection between the two disorders, making it essential to address and treat both conditions.

Dual Diagnosis Mental Health And Addiction Treatment

Integrated care, or treating both mental health and addiction at the same time, is crucial for treating dual diagnosis. Once a person stops using drugs or alcohol, they can receive treatment for both conditions, which may include medication, behavioral therapy, and support groups. Treating one condition, and not the other, risks worsening both disorders and a person’s overall health.


Receive Treatment from Dual Diagnosis after stopping drug and alcohol use

What Is A Dual Diagnosis?

Dual diagnosis, also called comorbidity and co-occurring disorders, is when two illnesses or disorders are found in the same person. This condition implies the two disorders interact in ways that affect the course of treatment for each illness. Dual diagnosis is the term used to describe a substance use disorder (SUD) that occurs simultaneously with another mental health disorder, like schizophrenia or bipolar disorder.

Either an SUD or mental illness may develop first. Although it’s difficult to determine which disorder came first, there are three general scenarios that help explain dual diagnosis:


  • Some drugs of abuse, like marijuana or hallucinogens, increase the risk of people experiencing symptoms of mental illnesses, like psychosis or delusional thinking.


  • Mental illnesses can lead to substance abuse because people attempt to self-medicate their symptoms. For example, many people suffering from schizophrenia are addicted to cigarettes because they believe it improves their thinking and cognition. Self-medication is risky because it may cause dependence, addiction, and other health problems.


  • SUDs and mental illnesses are both caused by similar factors, including genetic history, early contact with trauma or stress, and underlying brain problems.

While each diagnosis is different, these scenarios may contribute to why many people suffering from an SUD also struggle with mental illness, or visa versa. While dual diagnosis may seem unlikely, it’s more common than one thinks.

How Common Is A Dual Diagnosis?

A 2014 National Survey on Drug Use and Health found almost 8 million people suffer from both mental illness and a substance use disorder (out of around 20 million found to have an SUD). More than half of the people suffering from co-occurring disorders turned out to be men. Many mental health conditions tend to overlap with substance abuse because many disorders, like depression and bipolar disorder, increase the risk a person will develop an SUD.


8 Million People Suffer From Both Dual Diagnosis as of 2014

Symptoms Of Dual Diagnosis

There are many combinations of dual diagnosis and the symptoms will vary. But, there are general symptoms, or warning signs, of substance use disorders and mental illnesses. Signs of a substance use disorder may include:


  • engaging in risky behaviors
  • developing high tolerance and withdrawal symptoms
  • feeling the need to use drugs to function
  • loss of control over substance use
  • sudden changes in behavior
  • using substances in dangerous situations
  • withdrawal from family and friends

The symptoms of mental illnesses are wide-ranging and depend on the condition. However, some general warnings signs and symptoms of mental illnesses may include:


  • avoiding friends and family
  • concentration problems
  • difficulties understanding or relating to other people
  • excessive worrying or fear
  • extreme mood changes
  • thoughts of suicide

While the exact symptoms of dual diagnosis vary depending on the particular illness and substance of abuse, there are some mental health conditions that occur frequently with substance abuse and addiction.

Co-Occurring Disorders And Addiction

Suffering from both a mental health disorder and a substance use disorder (SUD) can be difficult to overcome. In order for treatment to be effective, the mental health of an individual struggling with an SUD should always be considered. The following includes some common mental health conditions associated with substance abuse and addiction:  

Anxiety Disorders

Anxiety disorders occur when intense feelings of fear and distress overwhelm a person from functioning in daily life, and are the most common mental health disorders in the United States. Benzodiazepines are highly addictive substances that may be prescribed to treat anxiety, which may lead to substance abuse.

Attention Deficit Hyperactivity Disorder (ADHD)

ADHD is commonly diagnosed in young people, and includes impulsive, hyperactive, and inattentive behavior. Stimulants are prescribed to treat ADHD, and young people may be at risk of developing a substance use disorder to attempt self-medication.

Bipolar Disorder

Bipolar disorder can cause extreme mood changes, the inability to think clearly, and unusual energy. Mood disorders are commonly associated with substance abuse and addiction. When a person experiences an extreme “low,” they may use drugs or alcohol to self-medicate.

Borderline Personality Disorder (BPD)

BPD is another mood disorder characterized by extreme difficulty controlling emotion. The lack of emotional control can result in poor self-image, intense emotional responses from stress, and problems with relationships. This hardship with emotions makes people susceptible to substance abuse and addiction.


Depressive disorder is a serious mental condition that changes day to day functioning, and an estimated 7% of Americans suffer from it. Nearly a third of all people struggling with a substance use disorder also struggle with depression.   

Eating Disorders

Eating disorders are mental health conditions that cause both physical and emotional problems that may lead to low self-esteem and the feeling of lacking control. Because of how eating disorders damage emotional well-being, some may turn to substances to alleviate bad feelings.

Obsessive Compulsive Disorder (OCD)

Symptoms of OCD include unwanted thoughts (obsessions) and irrational urges to do things (compulsions). The irrational compulsions and unwanted obsessions can lead to depression and anxiety, which may increase the risk a person abuses drugs or alcohol.

Posttraumatic Stress Disorder (PTSD)

PTSD is a condition when traumatic events, like an accident or military combat, have lasting effects on a person’s mental health. Because this condition can cause anxiety, depression, and other mental health problems, substance abuse is common for those suffering from PTSD.


Schizophrenia is a serious mental illness that complicates thinking, relationships, managing emotions, and making decisions. Hallucinations and delusions are common symptoms, and using drugs like LSD may cause schizophrenia. People may also use substances to alleviate unwanted symptoms of the illness, making diagnosis and treatment difficult.

Dual Diagnosis Treatment

Because of how each condition relates to the other, treating dual diagnosis must address both disorders. An integrated approach or intervention, where a person receives treatment for both mental illness and a substance use disorder, is the best treatment for dual diagnosis.

While treatment for each person and their disorders should be individually assessed for the best route of care, there are several common methods that are part of most treatment plans, including:


  • A Medically Supervised Detox Program — This is the first step in treatment and occurs in a hospital or inpatient treatment center to assist a person with symptoms of withdrawal. Stopping use of all substances is essential to treatment, and staff can provide support and care to ensure safety during detox, possibly administering medication when necessary.  


  • Inpatient Rehab — A person suffering from both mental illness and substance abuse is best served by inpatient rehabilitation because they can receive around the clock, 24-hour medical care to treat both conditions at the same time. Inpatient rehab may also provide a stable environment, access to medication and therapy, and other health services to meet the complex needs of dual diagnosis.


  • Behavioral Therapy — Psychotherapy is usually an important part of treating dual diagnosis because it focuses on mental illness. Other behavioral therapies, like cognitive behavioral therapy (CBT) or motivational interviewing, can help change a person’s thinking and attitudes towards drugs to help reduce unhealthy patterns of substance abuse and addiction.


  • Medications — Used to treat mental illness, as well as some substance use disorders, medications can alleviate symptoms of both conditions and aide in the recovery process.


  • Supportive Housing — People recovering and living with mental illness and a substance use disorder can live in a home together to work towards independence and remain sober after treatment.


  • Support Groups — Dual diagnosis is a life-long condition that requires ongoing support and care. Support groups, like Double Trouble in Recovery or Alcoholics Anonymous (AA), can help people with shared experiences to connect with community resources, encourage sobriety and recovery, and learn from one another to achieve balance.


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MedlinePlus—Dual Diagnosis

National Alliance on Mental Illness—Anxiety Disorders, ADHD, Bipolar Disorder, BPD, Depression, Eating Disorders, OCD, PTSD, Schizophrenia

National Alliance on Mental Illness—Dual Diagnosis

National Alliance on Mental Illness—Understanding Dual Diagnosis

National Institute on Drug Abuse—Comorbidity: Addiction and Other Mental Illnesses