What is Dual Diagnosis?

Read on to learn about dual diagnosis and the best type of treatment to overcome comorbid disorders.

Dual Diagnosis

Table of Contents

What is Dual Diagnosis?

Dual diagnosis is the term given to a person that has been diagnosed with not only a substance use disorder but also a mental health disorder. The two issues can worsen the severity of each other, making it very difficult to function. Just because a person has a dual diagnosis does not mean that one of the disorders caused the other to occur. Normally, they co-exist due to similar risk factors.1

How Common Is a Dual Diagnosis?

It is believed that approximately 50% of people that have a mental health condition have struggled with substance use disorder during their life.1 Because there is such a strong link between substance abuse and mental health conditions, a person might be more at risk for developing one or the other when one is present.

The Link Between Substance Abuse and Mental Health

So far, scientists have narrowed down the link between substance abuse and mental health down to three main factors. The first one is the fact that they both share a lot of common risk factors such as stress, trauma, and genetics.1

Moreover, people who struggle with mental health disorders are more likely to try to self-medicate to cope with the symptoms, which can lead to addiction. Finally, substance use disorder can also lead to the development of a mental health disorder due to changes in the brain’s chemistry.1

Common Mental Health Issues Associated with Addiction

Many mental health issues have gained a reputation of being linked to addiction because mental health disorders can be very difficult to cope with. If these issues are left untreated, a person normally attempts to self-medicate to get through life. Because of this fact, it is essential to seek dual diagnosis treatment.

Personality Disorders

According to the American Psychological Association, “personality disorders are long-term patterns of behavior and inner experiences that differs significantly from what is expected.” There are ten main types of personality disorders such as borderline personality disorder, narcissistic personality disorder, and several others.2

One study found “the comorbidity between (personality disorders) and (substance use disorders) is rampant.”3 They found that these were most common among people that had a borderline personality disorder and antisocial personality disorder.


Post-traumatic stress disorder “is a psychiatric disorder that may occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, or rape or who have been threatened with death, sexual violence, or serious injury” according to the American Psychiatric Association.4

PTSD is often co-occurring with substance use disorder. The VA found that 20% of veterans have both PSTD and substance use disorder. They also found that 30% of veterans that seek out treatment for substance use disorder also have PTSD.5

Attention-Deficit Hyperactivity Disorder (ADHD)

The APA defines the symptoms of attention-deficit hyperactivity disorder as inattention, hyperactivity, and impulsivity.6

Several studies have found that a person struggling with ADHD is five to ten times more likely to develop alcohol use disorder. Studies have also shown that roughly 25% of people who struggle with substance use disorders have ADHD. Researchers believe this aspect is due to impulsivity and genetics.7

Bipolar Disorder

Bipolar disorder is a condition where a person goes between emotional highs and lows which are referred to as mania and depression. Normally, these are extreme mood swings that happen unpredictably.8

People with bipolar disorder are more likely to develop substance use disorder than people who do not have the condition. It is believed that somewhere between 30-50% of people that struggle with bipolar disorder will develop an addiction.9

Borderline Personality Disorder

As discussed earlier, BPD is very commonly associated with substance use disorder. Borderline personality disorder “impacts the way you think and feel about yourself and others, causing problems functioning in everyday life.”10 Many people will try to self-medicate or use drugs as an attempt to stabilize relationships, but drugs can worsen the side effects of BPD.

Major Depression

Depression and substance use disorder has a bi-directional relationship, which means that people who struggle with one are more likely to develop or struggle with the other. Almost 33% of people who struggle with addiction also struggle with depression.11

Eating Disorders

It is believed that almost 50% of people that have struggled with an eating disorder also struggle with substance use disorder.12 In addition, people who struggle with substance use disorder are eleven times more likely to develop an eating disorder. Eating disorders and substance use disorders have a lot of risk factors in common, which might explain the strong link.

Anxiety Disorders

People that struggle with anxiety tend to “have intense, excessive and persistent worry and fear about everyday situations.”13 Significant anxiety can bring about a need to escape or to self-medicate, which could lead to addiction.


According to the American Psychiatric Association, OCD causes someone to have reoccurring and unwanted thoughts or sensations. These obsessive thoughts drive someone to repetitive, compulsive acts.14 Approximately 25% of people with OCD also struggle with substance use disorder. A person with OCD might seek out substances to try to mitigate some of their compulsions or obsessions.


A person that struggles with schizophrenia might have delusions, disorganized speech, hallucinations, struggles with motivation, and difficulties thinking/decluttering thoughts.15 Certain substances can trigger schizophrenia within a patient, but it is not the cause of the disorder. Drug use can also worsen symptoms, causing more severe hallucinations and delusions.16

Signs and Symptoms of a Dual Diagnosis

There are multiple warning signs that you or a loved one might be struggling with both a mental health condition and substance use disorder. Some of these symptoms are primarily from a mental health condition, but they are often amplified due to dual diagnosis.

Impulsive Behavior

One of the most significant signs of a dual diagnosis is impulsive behavior. A person with BPD, anxiety, ADHD, or any other mental health condition might react impulsively to different situations, especially if under the influence. Additionally, because dependency causes a person to crave a substance, the brain might begin to give more signals to impulsively take the substance once again.

Suicidal Behaviors

Suicidal ideation is a common symptom among multiple mental health conditions. Substance use disorder is linked heavily with depression, and the shame and guilt incorporated with it can lead to an increase in suicidal ideation.

Because of the dual diagnosis, a person is more at risk to not just contemplate but also attempt suicide. It is essential to seek out medical treatment if you or a loved one are struggling with a dual diagnosis.

Unexplained Physical Pain

Another sign that a person has a dual diagnosis is physical pain in different areas of their body that are unexplainable. This issue can come from withdrawals or changes within the brain. However, one of the main reasons for this factor is added stress inside of a person’s life because of the co-occurring conditions.

Avoiding Social Activities

Isolation tends to be one of the most challenging issues when a person is struggling with dual diagnosis disorders. BPD, depression, anxiety, and many other conditions can make socializing extremely difficult. Substance abuse can also lead to further isolation from activities.


In some cases, a person might begin to experience hallucinations, where they hear or see something that is not there. This issue is especially true in patients that have schizophrenia. The use of hallucinogens can also can chronic hallucination problems. Having a mental health condition on top of drug use increases your risk of developing hallucinations.

Cognitive Impairments

Finally, both mental health conditions and substance use disorders can reshape the brain and drastically impact neurochemistry. Because of this matter, people might struggle with cognitive impairment, which is when they struggle with remembering, concentrating, or learning new things.17 If you or a loved one are experiencing any of these symptoms alongside substance use or a mental health condition, it would be wise to seek out advice from a medical professional.

Why Co-Occurring Disorders Are Treated Differently

Co-occurring disorders are treated differently because two separate conditions are working within a person. If one goes untreated, then the person is not receiving a holistic solution. One of the most significant reasons that co-occurring disorders are treated differently are overlapping factors.

Substance use disorders and mental health conditions tend to have several overlapping factors in common.

Early Age Exposure

Studies show that teenagers that were exposed to alcohol or drugs early in life become two to three times more likely to develop substance use disorder.18 The chemicals can also impact the brain’s chemistry, which can lead to the development of mental health disorders.

Brain Response

Most scientists believe that mental health conditions can come from issues with neurotransmission, the brain’s response, and the brain’s communication system. Lower levels of things such as serotonin can lead to a lot of mental health issues.19

As such, a person might seek out something that stimulates the brain or gives them an increase in their dopamine levels. This increase can lead to chemical dependency or substance addiction.


Studies have shown that both mental health conditions and substance use disorders can be partially a result of genetics. If either or both run inside of a family, a person might be more at risk of developing a dual diagnosis condition than someone who does not have a family history of mental health conditions or substance use disorder.

Triggers in One’s Environment

Trauma and other environmental factors can be a big risk factor. Many times, treatment plans will focus on teaching new ways to cope with stress and working through past trauma because they can be triggers for relapse or triggers for mental health symptoms.

Co-occurring disorders need to be treated differently because all these factors impact patients in different ways, and it affects both the substance use disorder and the mental health condition.

Dual Diagnosis Treatment Options

A mental health diagnosis can be a very scary time for an individual. The stress of this is amplified when a substance use disorder is added on top of that. Several treatment options can help you be successful during your recovery process.

Detoxing Options

The first step is detox. Detox is the process of getting a chemical out of your body. Detox can be a very difficult time and should not be done in isolation. In fact, some detox processes can be fatal if not done under medical supervision (alcohol).

Therefore, it is best to seek out either an in-patient or outpatient treatment center. If you do not have access to one right away, it might be best to consult with a medical professional.

Inpatient and Outpatient Treatment

An inpatient treatment center normally cares for you all hours of the day and it is in a non-hospital setting. There are short-term inpatient treatment centers and long-term ones that can last up to a year. During this time, a patient will receive therapy to work through their dual diagnosis. Depending on the mental health condition, a doctor may attempt to use either cognitive behavioral therapy or dialectical behavior therapy.20

An outpatient treatment plan can vary depending on the severity of the addiction or mental health condition. It can be a great option for someone that maybe has a full-time job and a lot of social supports. Many outpatient treatment plans use group counseling to help with substance use disorder and mental health conditions.


Due to the complexities of dual diagnosis, many doctors will use medications to help treatment. Some common mental health medications relieve the symptoms of a mental health disorder. There are a few medications that can also help with addiction treatment.

Mental Health Medications

There are several medications a doctor may use to treat your condition depending on what it is. Antidepressants are the most common mental health medication. However, there is a chance that they might prescribe anti-anxiety medications, antipsychotics, mood stabilizers, or stimulants depending on the specific disorder.21 Moreover, a doctor might change the type of medication based on the specific substance you might struggle with.

Medications for Addiction Treatment

There have been a few different medications that help treat alcohol, opioid, or nicotine addictions. Substances such as buprenorphine, methadone, naltrexone, acamprosate, naltrexone, and disulfiram may be used in different parts of the recovery process. Some of these medications are necessary to help somebody during the withdrawal process, while others help a person maintain long-term success.22

Why Is Self-Medication Dangerous?

Self-medication is one of the largest reasons for the development of a dual diagnosis. Many times, a person might self-diagnose a condition that they might not have. Moreover, self-medication can worsen symptoms or give a false sense of proper treatment.

Some risks include receiving an incorrect diagnosis, taking dangerous substances to regulate symptoms, overdosing, choosing the wrong type of therapy, running the risk of dependence, and having a lack of treatment from a medical professional.23 Many people who choose self-medicating over seeking professional help develop substance use disorders and worsening mental health symptoms. It is best to seek advice from a professional.

Frequently Asked Questions

After receiving a dual diagnosis, it is very common to have a lot of questions. Hopefully, this section can answer most of them. If you have more, you can always reach out to us at The PAC Program.

What Is Dual Diagnosis in Disability?

Dual diagnosis does refer to a combination of any mental disorder and substance use disorder. Sometimes, people will struggle with another disability, which could be a learning disability, intellectual disability, or behavior disorder.

The benefit of dual diagnosis treatment is that doctors consider these other factors when developing a treatment plan. Regarding disability in the eyes of the US government, it can vary depending on the mental health condition that a person is struggling with and the severity of its symptoms.

What Is Meant by Co-Existing Needs?

A person that has co-occurring conditions will have some needs that will overlap with one another, which is why dual diagnosis treatment normally does not take much longer than a normal treatment plan. Someone struggling with substance abuse and mental health issues will benefit from receiving therapy that is aimed towards stress, trauma, and the underlying roots/causes of the issue. They both need strong support to work through these issues, and their treatment plans should reflect the needs of both aspects of dual diagnosis.

What Is the Difference Between Dual Diagnosis and Comorbidity?

Dual diagnosis specifically refers to a person that has been diagnosed with a mental health condition and a substance use disorder at the same time. A person with comorbidity has two or more disorders that have occurred or are occurring in the same person. They do not have to occur at the same time as one another, but there is an implication that they can worsen one another.24

What Does a Dual Diagnosis Worker Do?

A dual diagnosis worker helps a program identify support that is available with a community, and they inform staff about discharge plans for patients. In addition, they will work with clients to become more aware of possible reasons why they might be more likely to misuse substances, and they will help them develop new, alternative coping mechanisms.25 This is normally done through therapy.

Get Help for A Dual Diagnosis at The PAC Program

If you are struggling with a dual diagnosis, The PAC Program could be the perfect place for you. Our staff is extremely knowledgeable when it comes to treatment for both substance use disorders and mental health disorders. We have a strong community support system and resources to help you with continued support after you have gone through the treatment process. Moreover, our holistic therapies are perfect for treating co-occurring conditions. If you would like to find out more about The PAC Program, contact our team today.


  1. https://medlineplus.gov/dualdiagnosis.html
  2. https://www.psychiatry.org/patients-families/personality-disorders/what-are-personality-disorders
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6241194/
  4. https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd
  5. https://www.ptsd.va.gov/understand/related/substance_abuse_vet.asp
  6. https://www.psychiatry.org/patients-families/adhd/what-is-adhd
  7. https://www.webmd.com/add-adhd/adhd-and-substance-abuse-is-there-a-link
  8. https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/symptoms-causes/syc-20355955
  9. https://www.webmd.com/connect-to-care/addiction-treatment-recovery/bipolar-disorder-and-addiction
  10. https://www.mayoclinic.org/diseases-conditions/borderline-personality-disorder/symptoms-causes/syc-20370237
  11. https://www.psycom.net/depression-substance-abuse
  12. https://www.nationaleatingdisorders.org/substance-abuse-and-eating-disorders
  13. https://www.mayoclinic.org/diseases-conditions/anxiety/symptoms-causes/syc-20350961
  14. https://www.psychiatry.org/patients-families/ocd/what-is-obsessive-compulsive-disorder
  15. https://www.psychiatry.org/patients-families/schizophrenia/what-is-schizophrenia
  16. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6094954/
  17. https://www.cdc.gov/aging/pdf/cognitive_impairment/cogimp_poilicy_final.pdf
  18. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3664402/#:~:text=Early%2Dexposed%20adolescents%20were%20approximately,also%20had%20significantly%20more%20criminal 19.https://www.ncbi.nlm.nih.gov/books/NBK20369/#:~:text=Most%20scientists%20believe%20that%20mental,certain%20medications%20for%20the%20illness. 
  1. https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/drug-addiction-treatment-in-united-states/types-treatment-programs
  2. https://www.nimh.nih.gov/health/topics/mental-health-medications
  3. https://www.drugabuse.gov/publications/principles-adolescent-substance-use-disorder-treatment-research-based-guide/evidence-based-approaches-to-treating-adolescent-substance-use-disorders/addiction-medications
  4. https://pubmed.ncbi.nlm.nih.gov/20615179/#:~:text=Potential%20risks%20of%20self%2Dmedication,severe%20disease%20and%20risk%20of 
  1. https://www.dartmouth.edu/eap/library/dualdiagnosis1.pdf
  2. https://www.nursingtimes.net/roles/mental-health-nurses/developing-a-dual-diagnosis-role-in-mental-health-08-05-2008/#:~:text=Dual%20diagnosis%20worker%20role&text=This%20liaison%20work%20involves%20identifying,and%20explore%20alternative%20coping%20mechanisms

If you or a loved one needs help, please call us at
623-523-4748 and our team at Blueprints For Recovery in Arizona will help.

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