What is a Dual Diagnosis?

Dual diagnosis emerged as a diagnosis more than 20 years ago. What is dual diagnosis? Why is it so important for drug and alcohol addiction treatment?

Dual diagnosis refers to an individual who suffers from both an addiction disorder and a mental illness. It is also known as co-occurring disorders.

How common is dual diagnosis?

SAMSHA reports substance use disorders are more common in individuals who struggle with mental health disorders.1 In fact, the National Alliance on Mental Illness (NAMI) reports that about a third of people who suffer from mental illness also deal with addiction issues.2 This is no small problem. The 2010 National Survey on Drug Use and Health (NSDUH) estimates that 9.2 million Americans suffer from co-occurring disorders.3 Thus, many individuals seeking treatment for substance also suffer from mental illness.

Percentage of those with mental illness who also are addicts

Past Year Substance Use among Adults Aged 18 or Older, by Any Mental Illness: 2010 – SAMHSA.gov

Sadly, only a small percentage receive appropriate treatment. The NSDUH estimates only 7.7% of those with co-occurring conditions receive appropriate dual diagnosis treatment.3

Mental health conditions commonly coupled with addiction

Addiction is often coupled with mental illness. The range of psychiatric disorders that can accompany drug or alcohol abuse is vast. Mental illness coupled with drug abuse can make an accurate diagnosis difficult as drugs can both mask mental illness and make some conditions worse. Some individuals abuse drugs as a form of self-medication. Additionally, some of the medications used to treat mental illness may be subject to abuse.

Among the more common mental disorders seen in conjunction with an addiction disorder include:

Bipolar Disorder

Also known as manic depression is marked by sudden changes in mood that can range from deeply depressed to an excessively excited, manic state. This can impact a person’s energy level, mood, and behavior. Those suffering from bipolar disorder are prone to addiction.

A study produced by the American Journal of Managed Care revealed that about 56% of participants had experienced addiction. Additionally, about 46% were abusing alcohol or drugs at the time of the study.

The emotional instability caused by manic depression make treatment more difficult, especially when it co-occurs with an addiction.

Attention Deficit Disorder (ADD or ADHD)

ADHD suffers abuse, or are dependent on, alcohol or drugs at about 3 times the rate as the general population. Drug of choice is usually marijuana or alcohol. However, this group isn’t necessarily engaged in substance use for recreational reasons. One Harvard study indicated that only about 30% of ADD suffers using drugs did so to get high.

The use of drugs or alcohol is done as a form of self-medication. They imbibe to improve focus or reduce social awkwardness. Addiction and substance abuse are less likely among those properly diagnosed. A lack of an accurate diagnosis can raise the risk of addiction to 50%. Alcohol or drug use can mask the symptoms of ADHD making diagnosis harder.


Addiction is dangerous on its own but is especially dangerous when coupled with a disorder such as depression. People who suffer from depression are more likely to also suffer an addiction disorder. Conversely, those with an addiction are more common to suffer from depression. This can result in a treacherous downward spiral.

The bi-directional nature of addiction and depression disorders makes it extremely hard to treat one without treating the other. Thus treatment of these co-occurring illnesses is best handled within a dual diagnosis treatment program.

Generalized Anxiety Disorder (GAD)

It is estimated that 18% – 28% of Americans suffer from an anxiety disorder. Among those suffering from GAD, 33% – 45% of these individuals also have a substance abuse disorder. These numbers are staggering.  Anxiety can also aggravate the withdrawal process. Sobriety is harder to maintain if the GAD has not been treated. Dual diagnosis treatment is important.

Post-Traumatic Stress Disorder (PTSD)

Drug and alcohol abuse is common among those suffering from PTSD as it is often a form of self-medication. Unfortunately, self-medication offers no cure. Eventually those self-treating find their addiction is creating new and additional problems in their life.

It is estimated that approximately 8% of Americans will have PTSD over the course of their lifetime. 50% of PTSD suffers abuse alcohol. Sadly suffers are 3 times more likely to develop a drug addiction. Proper treatment of the PTSD is required for those co-occurring addiction illness to maintain sobriety.

Simultaneous treatment is necessary

Since both disorders often can mirror and overlap one another, it is important that individuals receive treatment that addresses both their mental health and substance use problems. An effective treatment plan requires a proper diagnosis. It is important that clients are not overly medicated in early recovery as this can make a correct diagnosis harder. Symptoms of alcoholism and drug abuse are similar to mental health symptoms.

Treatment must deal with both illnesses. Addiction treatment, with little to no attention given to mental health, is rarely effective. Wellness is obtained by addressing both disorders. A personalized treatment plan must manage the delicate balance of treating each disorder.

Treatment of co-occurring disorders requires both psychiatric and medical staff

Comprehensive treatment requires a team comprised of both medical and clinical professionals. Medical staff should include both physicians and nurses. Clinical staff should be an equal combination of both master’s level clinicians and chemical dependency personnel. Ideally, the team has specific training in the treatment of co-occurring mental health disorders.

The majority of sufferers fare best from an inpatient rehabilitation center that provides 24/7 monitoring of both their physical and mental health. An inpatient setting provides for better medication control, as well as observation time required for an accurate diagnosis. This allows the development of an integrated treatment plan to meet the specific needs of the client.

Providers should incorporate numerous areas into treatment. Therapies and counseling should address mental health and emotional regulation, physical health and nutrition, spiritual engagement or personal enrichment, life skill cultivation and relationship skills.

A plan for ongoing support is important

Inpatient treatment is only the beginning of treating and caring for those suffering from both addiction and mental health illness.  Since co-occurring disorders may exacerbate one another, continued care for these should be sought. Post-treatment care and monitoring decrease the chances of relapse of substance use and mental health symptoms. Many patients benefit from a residential extended care or sober living program.

While many people find much relief from the 12step work and support groups, others require additional support and care. Patients benefit from psychotherapy that provides the individual with an understanding of how their behaviors and beliefs impact both illnesses. Cognitive behavioral therapy (CBT) is particularly effective for dual diagnosis patients as they learn new coping strategies, as well as shift ineffective thought patterns.

In conclusion

SAMSHA’s statistics indicate that most patients entering into addiction treatment have co-occurring disorders. Thus it is important for the client to obtain an accurate diagnosis. An effective treatment program treats both illnesses concurrently. Focus on 12-step work, emotional and therapeutic work, as well as mental health treatment, are all essential parts of a dual diagnosis treatment program. Treatment centers must have appropriately skilled personnel and a treatment program that provides exceptional care for all individuals.



1 Center for Behavioral Health Statistics and Quality. (2015). Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health (HHS Publication No. SMA 15-4927, NSDUH Series H-50). Retrieved from http://www.samhsa.gov/data/

2  Dual Diagnosis. National Alliance on Mental Illness. Retrieved from: https://www.nami.org/Learn-More/Mental-Health-Conditions/Related-Conditions/Dual-Diagnosis

3 Substance Abuse and Mental Health Services Administration. (2012). Results from the 2010 National Survey on Drug Use and Health: Mental Health Findings, NSDUH Series H-42, HHS Publication No. (SMA) 11-4667. Rockville, MD: Substance Abuse and Mental Health Services Administration. Retrieved from: http://archive.samhsa.gov/data/NSDUH/2k10MH_Findings/2k10MHResults.htm#Ch4

4 Jané-Llopis E, Matytsina I. Mental health and alcohol, drugs and tobacco: a review of the comorbidity between mental health disorders and the use of alcohol, tobacco and illicit drugs. Drug Alcohol Rev. 2006;25:515-536.

5 Kessler RC, Chiu WT, Demler O, et al. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication [published correction appears in Arch Gen Psychiatry. 2005;62:709]. Arch Gen Psychiatry. 2005;62:617-627.