Dual Diagnosis - Substance Abuse and Mental Illness

A person with dual diagnosis (or co-occuring mental illness) has both a mental illness and an alcohol or drug problem. These conditions occur together frequently. In particular, alcohol and drug problems tend to occur in people with Depression, Anxiety Disorders, Schizophrenia, and Personality Disorders. Sometimes mental problems occur first, which can lead the person to drugs or alcohol to make them feel better temporarily. Sometimes the substance abuse happens first. Which over time can lead to emotional and mental problems.

Diagnosing a primary psychiatric illness in substance abusers is challenging as drug abuse itself often induces psychiatric symptoms, thus making it necessary to differentiate between substance induced and pre-existing mental illness.

Those with co-occurring disorders face complex challenges. They have increased rates of relapse, hospitalization, homelessness, and HIV and Hepatitis C infection compared to those with either mental or substance use disorders alone. The cause of co-occurring disorders is unknown, although there are several theories.

About 50% of people with severe mental health disorders also have a substance abuse problem. 29% of all individuals diagnosed with a mental illness abuse alcohol or drugs, compared to 15% of the general population who abuse drugs and/or alcohol. People with Schizophrenia are over 4 times more likely to have a substance abuse problem. People with bipolar disorder are over 5 times more likely to have a substance abuse problem. Only a small proportion of those with co-occurring disorders actually receive treatment for both disorders. In 2011, it was estimated that only 12.4% of American adults with co-occurring disorders were receiving both mental health and addictions treatment. Clients with co-occurring disorders face challenges accessing treatment, as they may be excluded from mental health services if they admit to a substance abuse problem, and vice versa.

A person with dual diagnosis must treat both conditions. A person with dual diagnosis must stop using alcohol or drugs in order for treatment to be effective. Treatments can include medication, behavioral therapy and support groups. 

Mental illness and substance abuse often occur together, yet these conditions are often treated seperately by different teams of doctors prescribing different, and sometimes contradictory, treatments. Partial treatment involves treating only the disorder that is considered primary. Sequential treatment involves treating the primary disorder first, and then treating the secondary disorder after the primary disorder has been stabilized. Parallel treatment involves the client receiving mental health services from one provider, and addictions services from another. An integrated treatment program coordinates treatment for multiple disorders, without division between mental health and substance abuse treatment. 


Dual Diagnosis resources and related links