What Is A Dual Diagnosis?

Many people diagnosed with a substance use disorder (SUD) also suffer from a co-occurring mental or behavioral condition, which is known as a dual diagnosis. The terms dual diagnosis and co-occurring disorder are often used interchangeably and refer to the same condition.

About half of people who have a mental health disorder will also have a SUD at some point in their lives.

The best way to treat a dual diagnosis is with an integrated treatment plan that addresses both disorders as interconnected issues.

Dual Diagnosis

video thumbnail

A dual diagnosis is when someone has both an addiction and a mental health condition. Sometimes, the addiction part is addressed while the mental health condition goes without treatment. Dr. Ashish Bhatt explains the importance of accurately diagnosing and treating patients with a dual diagnosis.

Why Do Substance Use Disorders And Mental Disorders Occur Together?

While mental disorders and SUDs can occur simultaneously, it does not necessarily mean that one causes the other. The National Institute on Drug Abuse highlights a few reasons why dual diagnosis is so common.

Substance Use As Mental Health Treatment

Some research points to the idea that those with an underlying mental health condition, such as depression or anxiety, will turn to substances as a way to deal with their unpleasant symptoms. For example, if you have trouble relaxing in social situations due to anxiety, you may choose to drink or use a drug to relax and feel more comfortable.

Mental Health Conditions A Byproduct Of SUD

Another theory is that continued use of a substance that becomes an addiction often leads to negative impacts on a person’s daily life and relationships. This, in turn, can initiate the beginnings of a mental health condition.

Shared Risk Factors

Both SUDs and mental disorders share similar risk factors, such as trauma, genetics, and stress.

Common Mental Health Issues And Addiction

Some of the more common mental health disorders linked to substance misuse are:

Attention-Deficit Hyperactivity Disorder (ADHD)

People with ADHD may be more inclined to abuse substances as a way to cope with their symptoms. Many people are prescribed stimulants to treat their ADHD, which can be habit-forming and lead to a toxic pattern of substance abuse.

Bipolar Disorder

About half of the people with bipolar disorder also struggle with addiction. Bipolar disorder causes severe mood swings, which can be very difficult to cope with, leading many with the disorder to use substances as a way of masking their symptoms.

Borderline Personality Disorder (BPD)

According to a 2018 study, approximately half of those with BPD also have at least one current SUD, most commonly alcohol use disorder (AUD). This is not unusual, considering the emotional and mental instability many with BPD experience.


Many people diagnosed with depression try to self-medicate with drugs or alcohol. This often makes the problem worse. The crash after the high can be devastating for those with a pre-existing depressive condition.

Generalized Anxiety Disorder (GAD)

The most common mental health condition in the US, generalized anxiety disorder (GAD) affects 18% of the adult population. People who suffer from GAD may be more likely to abuse drugs and alcohol to manage their symptoms. People may also abuse benzodiazepines, which are highly addictive prescription medications used to treat anxiety disorders.

Post-traumatic Stress Disorder (PTSD)

When a person develops post-traumatic stress disorder (PTSD), their brain produces fewer endorphins than a healthy brain; this makes the afflicted person more likely to turn toward alcohol or drugs to feel happy. As many as 50% of adults with both AUD and PTSD also have one or more other serious psychological or physical problems.


Schizophrenia is characterized by hallucinations and delusional thinking. Diagnosing schizophrenia alongside an addiction can be difficult because the two conditions have overlapping effects.

Paid Advertising. We receive advertising fees from purchases through BetterHelp links.

Online Addiction Counseling

Get professional help from an online addiction and mental health counselor from BetterHelp.

Get Matched
Begin Therapy
  • Personalized Matching Process
  • Easy Online Scheduling
  • 30,000+ Licensed Therapists


Dual Diagnosis Risk Factors

Some factors could put you at higher risk for a dual diagnosis, including:

  • Genetics: Genetics can play a role in the development of several mental health conditions as well as addiction. Studies have shown that the A1 form (allele) of the dopamine receptor gene DRD2 is present in those with dual diagnosis. This gene is responsible for affecting how substances interact with the reward system in the brain, showing how your genetic makeup could contribute to you experiencing mental health issues and addiction.
  • Triggers in the environment: Chronic stress or a traumatic event can precede the development of an addiction or mental disorder.
  • Exposure at an early age: People who experiment with drugs or alcohol at a young age may develop a substance abuse problem and/or mental health disorder later on. In adolescence, your brain is still developing and, therefore, more susceptible to damage caused by substances.

Warning Signs Of A Co-Occurring Disorder

While the signs and symptoms can vary greatly from person to person, there are a few common signs to look out for.

Some behavioral changes may include:

  • Frequent absences from work or school
  • A significant drop in work or school performance
  • Engaging in secretive or suspicious behaviors
  • Changes in eating or sleeping patterns

  • Mood swings, irritability, or angry outbursts
  • Personality or attitude changes
  • Lack of motivation
  • Unexplained anxiety, fear, or paranoia

Some of the physical warning signs include:

  • Red eyes or change in pupil size
  • Weight changes
  • Poor physical hygiene

  • Tremors
  • Slurred speech
  • Impaired coordination

You may also notice some changes in social behavior, such as:

  • Loss of interest in previous hobbies
  • Change in friend group
  • Unexplained need for money or financial problems
  • Continuing to use substances even though it is causing issues in relationships

Treatment For Dual Diagnosis

The combination of extensive substance abuse and a neglected mental condition generally requires the help of both mental health and addiction professionals who can treat the conditions simultaneously.


Therapeutic intervention is an important part of dual diagnosis treatment. Some of the therapies used include:

  • Cognitive behavioral therapy (CBT) is an approach that focuses on changing certain thought patterns that lead to destructive behaviors.
  • Dialectical behavioral therapy (DBT) will help you learn coping skills to handle intense emotions, which may help change behaviors and improve relationships.
  • Group therapy is a very effective intervention that allows you to share with others on a similar journey to recovery and healing.
  • Contingency management (CM) is a type of therapy that encourages healthy changes by offering vouchers or rewards for desired behaviors.


Many mental health symptoms can be alleviated with prescription medicine. Some addictions, such as alcohol, opioids, and nicotine, can also be treated with medication to help alleviate withdrawal symptoms and cravings.

Rehab As Part Of Dual Diagnosis Treatment

In the case of a dual diagnosis, an inpatient rehab center’s structured and safe environment can be extremely beneficial.

When deciding on a rehab center, choose one that specializes in your or your loved one’s type of addiction and co-occurring disorder.

You can ask some of the following questions to help you make an easier and more informed decision:

  • Do you offer individualized treatment plans for dual diagnosis?
  • What types of therapy do you offer?
  • Will I or my loved one be evaluated by a licensed psychiatric professional or physician before admission?
  • Are both of my disorders viewed as interconnected health issues, or are they viewed as separate illnesses?
  • Does your facility offer aftercare referral services?

If you are ready to start your recovery journey toward a healthier, addiction-free life, explore our rehab directory, where you can filter by substance, treatment type, and location.

You can also reach out to a treatment provider today to get started.

Featured Centers Offering Dual Diagnosis Treatment