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Dual Diagnosis: When Mental Illness and Addiction Coexist

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Dual Diagnosis: When Mental Illness and Addiction Coexist

Dual diagnosis is a term commonly used to describe the co-occurrence of a substance abuse disorder in addition to a mental health condition. In fact, many people who suffer from addiction also experience an underlying mental illness such as depression, anxiety, bipolar disorder, or post-traumatic stress disorder.

The reason for this is simple – people who have experienced adverse events in childhood and/or struggle with mental health are more likely to become dependent on substances as they are used as a means to self-medicate. In turn, the use of substances will often eventually make these problems worse, and therefore, contributes to a downward spiral of mental disease.

Moreover, recent evidence has shown that at least one-third of those who have mental illness also exhibit a substance use disorder, and 50% of those with a severe mental health condition also have a substance abuse problem. Overall, it is believed that about 30% of alcoholics and 50% of drug abusers have a mental illness.

How Mental Heath Is Closely Associated With Substance Abuse

Dual Diagnosis | Just Believe DetoxAs noted, people who abuse substances are often doing so in an attempt to self-medicate. Very few people in the U.S. (about 1 in 10) report seeking care for mental health problems, and therefore, rely on their own devices.

There are a number of reasons why – one, there is still a stigma attached to mental illness and people – especially men and those in rural areas – fear being judged by family, friends, and co-workers. Second, adequate mental health care isn’t easily obtained. People who receive Medicaid get minimal treatment and risk not being accepted by many providers because of the low reimbursement rates offered by state medical programs.

Those who don’t qualify for Medicaid may be unable or unwilling to pay for private health insurance, which, even under the Affordable Health Care Act, may still be expensive. And for those who actually have adequate coverage, there may be hefty co-pays.

Therefore, many people suffering from mental disease do not receive treatment and turn to substances to temporarily dull the pain. But as noted, this effect is temporary. Drugs and alcohol use can exacerbate the symptoms of mental illness, and even replicate them outright in those who haven’t traditionally experienced them.

People who use substances heavily and for long periods are at a heightened risk from a multitude of mental and physical health effects, such as psychosis, lethargy, social isolation, aggressive or violent behavior, suicidal ideations, and adverse changes in emotions and thought processes.

Withdrawing from substance use can have its own difficulties. Drug and alcohol withdrawals present with a wide range of unpleasant effects, such as depression, anxiety, agitation, and mood swings. The experience of substance withdrawal is often enough to prompt people to relapse, another reason why shaking addiction, especially without professional help and support, can be incredibly challenging.

Why Seek Professional Help?

Dual Diagnosis | Just Believe DetoxThe first step in the recovery process is usually detox. Detoxing in an unsupervised environment is not advised by medical professionals. Symptoms are at times, unpredictable, and can in rare cases prove fatal.

Clinical supervision also prevents relapse, and the patients can be administered medication to mitigate many of the worst symptoms of withdrawals.

After detox, long-term treatment is recommended for at least 30 days or more. This treatment can be residential (inpatient) or intensive outpatient treatment for those who need more flexibility to maintain homes, jobs, and families.

But treatment for substance abuse alone is enough – if underlying mental illness and negative thought processes and feelings are not addressed, the desire to use substances will likely return. Some people relapse, while others find a different addiction to fill the hole left by the previous dependency.

One of the essential characteristics of a drug treatment center should always be the ability to treat co-occurring mental health conditions effectively.

Who is at Risk for A Dual Diagnosis?

Common factors found among people who suffer from both mental health issues and substance abuse include, but are not limited to:

  • Inherited genetic traits – having a blood relative, such as a parent or sibling, with a mental illness
  • Prenatal exposure to environmental stressors, inflammatory conditions, toxins, alcohol or drugs
  • Brain chemistry –  impairments in neural networks and naturally-occurring neurotransmitters and brain chemicals
  • Adverse childhood experiences including all forms of abuse and neglect
  • Predispositions to emotional dysregulation, impulsivity, poor decision-making
  • Stressful life events such as financial issues, death, or divorce
  • A chronic medical condition, such as diabetes
  • Traumatic brain injury
  • Traumatic experiences, including military combat or being the victim of an assault
  • Having few friends/family or healthy relationships


Substance abuse is often an effect of mental illness, and understandably so. Adequate mental health treatment can be challenging to find, and a singificant amount of stigma associated with mental illness remains.

Unfortunately, drug and alcohol use can make the symptoms of mental illness worse, and chronic use itself can hijack the brain’s ability to regulate emotions and make healthy, thoughtful decisions.

Treatment for substance use should also include therapy and counseling for mental health issues when present, and each condition should be addressed and treated in conjunction with the other.

Get Help Today For A Dual-Diagnosis

If you or someone you love is abusing substances, please seek treatment as soon as possible. There are many resources available to help you or your loved one.

Please call us today at 877-497-6180 for a free consultation.

~ G. Nathalee Serrels, M.A., Psychology