What Is Dual Diagnosis?

Dual diagnosis is a phrase commonly used to describe when someone has both a substance abuse disorder, like alcoholism, and a separate mental health condition, such as depression. More than 1 co-occurring disorder can be present. Other commonly used terms include co-morbid disorders and comorbidity.

Dual diagnosis is extremely common. Although some mental health conditions are more or less likely to appear among alcoholics, alcoholics are much more likely to suffer from a mental health condition of some kind than non-alcoholics. Similarly, an individual with a mental health condition is much more likely to develop alcoholism than an individual without a mental health disorder. Approximately 7.9 million Americans classify as dual-diagnosis (with any substance and any disorder). Among this population, alcohol is by far the most commonly abused substance; this is much like the population as a whole.

The link between alcohol and mental health is very close and complex. Many individuals with mental health issues turn to alcohol as a method of escape or self-medication. Many mental health conditions make it more difficult for individuals to stop drinking, either over the course of a single night or over an extended period. This increases the likelihood of alcoholism and other risky drinking behaviors, like binge drinking. However, alcohol use actually makes the symptoms of many mental health conditions worse, brings them on prematurely and more frequently, and extends their durations. There is research that suggests that alcoholism can actually cause certain mental health conditions, especially depression, but those conclusions are controversial.

In the past, alcoholism and mental health were rarely treated together. It was common for mental health professionals to require their patents to stop drinking before treatment. At that time, the interactions between alcohol and mental health were more poorly understood; it was thought that they had to be treated separately. Now there is a much greater understanding that the 2 must be tackled simultaneously for the greatest likelihood of success.

Common Dual Diagnosis Conditions With Alcohol

Alcoholism can impact sufferers of any mental illness. However, sufferers of some conditions are much more likely to be alcoholics than others and vice versa. Some of the most common include:


Perhaps the most common mental health condition, depression is also the most frequent dual diagnosis condition present alongside alcoholism. Depression sufferers frequently turn to alcohol to help them alleviate the worst symptoms of their condition, such as sadness, hopelessness, loneliness, and suicidal thoughts. Unfortunately, the long-term result is often the opposite; alcohol generally greatly worsens depression symptoms.

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Almost 18% of Americans suffer from some form of anxiety issues at some point in their life. Alcohol is superficially attractive to anxiety sufferers because it can temporarily relax them and break their focus. Many individuals with social anxiety in particular feel that alcohol makes them more confident in social situations. However, alcohol generally makes anxiety worse over time; alcohol-influenced decisions often put individuals in high-anxiety situations.

Bipolar Disorder

Bipolar disorder and alcohol abuse are very frequently paired. Some studies have concluded that the majority of bipolar sufferers develop addiction issues at some point in their lives; abuse of alcohol is the most frequent. This includes 61% of Bipolar I patients and 48% of Bipolar II patients. Bipolar patients are attracted to alcohol for different reasons at different parts of their cycle, but it is dangerous at any point. Alcohol use during manic phases is especially risky because it fuels the increasingly reckless and careless behavior associated with mania.

Obsessive-Compulsive Disorder (OCD)

Approximately 25% of OCD sufferers also deal with alcohol abuse issues. Alcohol appeals to OCD sufferers because it takes their focus away from their symptoms and distracts them. As is the case with most mental illnesses, however, alcohol actually makes OCD symptoms worse over time. This quickly escalates to an addiction; the worse the symptoms get, the more the individual drinks to escape them. The more the individual drinks, the worse the symptoms get.

Impact Of Dual Diagnosis On Treatment

The presence of any dual diagnosis condition makes the treatment of alcoholism more difficult. Similarly, the presence of alcoholism makes the treatment of any mental illness more difficult. There are a number of reasons for this.

Because the symptoms of alcohol abuse and many mental health conditions are so similar, it is often very difficult (if not impossible) to properly diagnose a patient until they have stopped using alcohol. This is especially true when a patient suffers from multiple mental illnesses. Without proper diagnosis, proper treatment is unlikely.

Treatment itself is more complicated as well. To maximize the chances of success, both the alcoholism and the dual diagnosis condition should be treated concurrently. Doing so will reduce the symptoms of both. The less the individual drinks, the less severe and less frequent their symptoms will be and the less they will feel the need to drink to escape them. However, this will take more specialized treatment. The patient will need to be treated by both mental health and addiction experts. Until recently, most mental health patients had little experience in handling addiction; this is changing, however. Most rehab facilities, on the other hand, have extensive experience dealing with many mental health conditions because so many of their patients suffer from them.

Dual diagnosis can make recovery more challenging for many individuals, especially those that have not dealt with the mental condition in a meaningful way in many years. Also, some conditions make relapse more likely due to associated lapses in judgment. In no way does that mean that treatment is impossible, however. Most alcoholics with a dual diagnosis can dramatically improve with proper treatment, and many successfully maintain their sobriety.

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Symptoms Of Dual Diagnosis

Although every mental illness has different symptoms (and this is especially true when they are mixed with alcohol), there are some symptoms that are shared by many. Here are some common warning signs that many with a dual diagnosis exhibit:

  • Increasing isolation from family and friends
  • Increased or decreased appetite
  • Reduced energy and motivation
  • Difficulty concentrating and completing tasks
  • Decreasing performance at work and in personal life
  • Irritability, mood swings, and anxiety
  • Making excuses for alcohol use and strange behavior

Dual Diagnosis Treatment Options

There are many therapy options for treating dual diagnosis conditions and alcoholism. Some of the most common include:

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Dual diagnosis is very serious. The combination of alcoholism and mental illness can dramatically impact a sufferer’s life, and those of their families, for the worse. Personal relationships, jobs, health, and finances can all be impacted. Perhaps the biggest risk involves those mental illnesses that can lead to suicidal thoughts, which alcohol can dramatically increase. If you or a loved one is battling addiction, there is help available. Contact a treatment provider to discuss available treatment options.



Jeffrey Juergens

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  • Jeffrey Juergens earned his Bachelor’s and Juris Doctor from the University of Florida. Jeffrey’s desire to help others led him to focus on economic and social development and policy making. After graduation, he decided to pursue his passion of writing and editing. Jeffrey’s mission is to educate and inform the public on addiction issues and help those in need of treatment find the best option for them.

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Reviewed by Certified Addiction Professional:

Theresa Parisi

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  • Theresa Parisi received her bachelor’s degree in Addiction Science and Psychology from Minnesota State University in Mankato, Minnesota in 2010. She is currently working towards her master’s degree in Mental Health Counseling at Palm Beach Atlantic University in West Palm Beach, Florida. She is a Certified Addiction Professional (CAP), Certified Behavioral Health Case Manager (CBHCM), and International Certified Alcohol and Drug Counselor (ICADC) by the Florida Certification Board. Theresa is passionate about recovery having gone through addiction herself.

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