Addiction is rarely simple and straightforward. It often presents as a tangled web of wide-reaching consequences and hidden underlying issues. Unresolved childhood issues, undiagnosed mental disorders, and disappointing life circumstances can commonly be found beneath the surface of addiction. Mental health issues, in particular, are extremely common in association with addiction. And some, like anxiety and depression, can be difficult to diagnose when drinking and drug use is involved.

Dual diagnosis is notoriously difficult to recognize because the effects of drugs and alcohol can often mimic common mental health issues like anxiety and depression. It can also cause symptoms seen in both like insomnia. However, addressing an addiction without screening for co-occurring mental disorders can lead to ineffective treatment. Without addressing the underlying mental issues, relapsing back into addiction is more likely, even if you go through full addiction detox and treatment. Unresolved mental issues will eventually lead to negative emotional, cognitive, and behavioral issues that may have originally led you to drugs or alcohol in the first place.

Dual diagnosis is incredibly common in addiction treatment. According to the Substance Abuse and Mental Health Services Administration’s (SAMHSA) 2014 National Survey on Drug Use and Health, an estimated 7.9 million people qualify for both a mental health disorder and a SUD at the same time. Because it is so common, addiction treatment services have developed ways to address the issue of dual diagnosis. There are a variety of treatment options and facilities that are equipped to treat addiction with common mental illnesses. And when mental illnesses are severe, like severe schizophrenia, the case may be referred to a specialist that can help.

Learn more about dual diagnosis, what causes it and how it can be treated!

What Is Dual Diagnosis Treatment?

The phenomenon of a mental health issue occurring at the same time as a substance use disorder (SUD) is referred to as a dual diagnosis, and the simultaneous mental health issue is called a co-occurring mental disorder. When you seek assistance for a dual diagnosis case, it can often be difficult to determine which came first, the mental health issue or the SUD. Alcohol and drug use can cause symptoms of anxiety and depression, especially after drug dependence develops. It can also worsen these symptoms in people who have preexisting anxiety and depression. Dual diagnosis treatment involves focusing on both issues at the same time rather than trying to target one and not the other or treating them one after the other.

Common Dual Diagnosis

Dual diagnosis can occur with any number of mental health issues and if you enter a treatment program your personal and family history with mental health can offer insight into your best treatment option. However, there are a few mental health problems that seem to be closely tied to drug abuse, dependence, and addiction.

Here Are Some of the Most Common Mental Health Issues That Occur Alongside Drug and Alcohol Addiction:

  • Depression
  • Generalized anxiety disorder
  • Bipolar disorder
  • Borderline personality disorder
  • Obsessive-compulsive disorder
  • Panic disorders
  • Eating disorders
  • Personality disorders
  • Schizophrenia
  • Post-traumatic stress disorder

Major depressive disorder and generalized anxiety disorder are some of the most common mental disorders in the United States, affecting 16.1 and 6.8 million people respectively. They are also the most common mental health issues to overlap with addiction.

Depression can come in a few different forms: major depressive disorder, persistent depressive disorder, bipolar depression, seasonal affective disorder, and more. Depression is characterized by varying periods of time in which you feel a loss of interest or pleasure, lethargy, sleep issues, feeling worthless or guilty, trouble concentrating, and thoughts of suicide. Seasonal affective disorder (SAD), which is a form of depression that is initiated by a change in the seasons. Abusing chemical substances alongside a depressive disorder can increase your risk of suicidal actions, addiction, and other consequences associated with drug use. Nervous system depressants, like alcohol and certain sleep aids, are especially dangerous with depression. They can offer temporary relief to certain depressive disorders but they are ultimately made worse by drug use.

Anxiety disorders can range from feelings of worry to full panic disorders. They are usually characterized by insomnia, lack of concentration, racing thoughts, worry, and restlessness. Anxiety is also a common symptom of drugs like cocaine and other stimulants. They can mask an anxiety disorder or make it worse. According to the ADAA, about 20 percent of people diagnosed with an anxiety disorder are also struggling with an addiction to alcohol. If someone is treated only for their alcohol addiction, then it will not be long before the symptoms of anxiety rear their head and cause the individual to relapse.

Post-traumatic stress disorder (PTSD) is another disorder that is common in dual diagnosis. PTSD can occur as a result of a past mental, physical, or emotional trauma. It’s common among military veterans, a population in which illicit drug use is rare but alcoholism is significant. However, PTSD can also occur as a result of childhood trauma, sexual assault, car accidents, and any other traumatic event. Trauma symptoms include flashbacks from the event, agitation, irritability, anxiety, self-destructiveness, and depressed mood.

The PTSD Alliance lists the following statistics regarding substance abuse among people with PTSD:

  •  Drug abuse is three times more common among people with PTSD compared to people without PTSD
  •  Nicotine dependence is two times more common among people with PTSD compared to people without PTSD
  •  About half of all people with PTSD abuse alcohol

It is estimated that among people who seek treatment for a substance use disorder, about 40.6 percent of them also receive a diagnosis of PTSD, according to research published in the Health Science Journal. Because of this, it is theorized that PTSD makes someone more vulnerable to addiction, but also that addiction may increase a person’s risk of developing PTSD. However, more research is necessary to determine how one disorder affects someone’s development of the other.

Alcohol and drug abuse are common in individuals diagnosed with borderline personality disorder (BPD). Addiction, particularly involving alcohol, is often a result of repeated and excessive substance abuse. This could in part be related to the fact that poor impulse control is one of the symptoms of BPD. Individuals who struggle with the disorder are less likely to think through the consequences of their actions and, therefore, are more apt to drink or use drugs to excess. Drug use and binge drinking are examples of risk-taking behaviors that are often noted in someone with BPD. Parts of the brain that are related to reward processing and decision-making may be dysfunctional in someone prone to addiction and also those who have BPD, both of which are heritable and have a genetic link.

According to the Mayo Clinic, schizophrenia is a severe mental disorder where people interpret reality abnormally. The condition may lead to a combination of delusions, hallucinations, and extremely disordered thinking.  Unfortunately, it can impair daily functioning, and it’s often disabling. Schizophrenia isn’t a condition that you can take medicine and move on; it requires lifelong treatment. Early treatment can help get symptoms under control before more severe complications develop. Fortunately, it may also improve the long-term prognosis. The symptoms of schizophrenia vary from cognition problems to behavior and emotions.

Researchers have studied the relationship between ASD and substance abuse.  They theorized that individuals diagnosed with some kind of autism (including Asperger’s Syndrome) are more likely to abuse alcohol or drugs.  Early on, they didn’t find much correlation. But soon, more studies found links between ASD and substance use disorder (SUD). According to the Journal of Alcoholism & Drug Dependence, one study showed that almost 7 percent of individuals in treatment for SUD had been diagnosed with ASD (as compared to 1 percent of the general population). Researchers Elizabeth Kunreuther and Ann Palmer of the University of North Carolina have also studied the correlation between ASD and SUD. Their findings report that individuals diagnosed with autism are almost twice as likely to abuse alcohol or drugs. They’ve written a book called Drinking, Drug Use, and Addiction in the Autism Community, which explores this relationship between autism and substance abuse further.

What Causes Dual Diagnosis

Dual diagnosis is difficult to detect if you aren’t looking for it. In many cases, you may not even realize that you have a co-occurring mental health issue. SUDs and mental health problems will often exist with blurred lines. It’s difficult to pinpoint what came first and which one caused the other. In some cases, a SUD causes or contributes to a mental health issue. Overuse of certain drugs can lead to anxiety or depression. Active addiction can also lead to several serious life consequences that can exacerbate these issues.

Mental health issues as a result of addiction are often short-term, but in some cases, they can cause lasting effects. Common mental health effects of addiction can even include paranoia, hallucinations, and aggression, according to the National Institute on Drug Abuse (NIDA). Certain drugs, like meth, can cause long-lasting mental health issues like confusion, anxiety, insomnia, and hallucinations.

In some cases, dormant mental health issues are triggered by drug abuse. In these situations, it can be mistakenly assumed that the drug caused a mental disorder that was actually pre-existing. Drugs and alcohol alter your brain chemistry and addiction changes the way you perceive substance use. With such a profound effect on the brain, it is no wonder how addiction can awaken or worsen mental health issues that weren’t noticeable before.

In a greater number of cases, a mental health issue noticeably predates a substance use disorder. Mental disorders and a history of mental illness are risk factors for addiction and it may be among the first things you explore in addiction treatment. Sometimes, in an attempt to alleviate troublesome symptoms or ease painful memories, people will turn to drugs or alcohol.


Using substances that are not designed or prescribed for medical use as a treatment for physical or mental health issues is a practice called self-medication. Though some illicit drugs and alcohol offer effects that can alleviate some of the symptoms of certain mental health issues, the way they affect brain chemistry often lead to more severe imbalances.

Alcohol and other central nervous system depressants, like benzodiazepines and barbiturates, are common drugs in self-medication. They work in the brain’s communication system to bind to receptors that are responsible for causing feelings of anti-anxiety and relaxation and they can promote sleep. However, when self-medication turns into chemical dependence, your brain will become used to the effects of the drugs, throwing off your normal brain chemistry.

After a period of dependence, your brain will stop producing its own calming chemicals. If you have a depression disorder, you may exasperate your already unbalanced brain chemistry. If you have an anxiety disorder, the effects of CNS depressant withdrawal can make symptoms worse.

Other illicit drugs work in the brain differently but they can have similar negative effects on existing mental health issues. Even improper use of prescription drugs can be dangerous when mixed with a mental health problem.

Similar Risk Factors

In some cases, a SUD and a mental health issue can develop simultaneously. Both addiction and mental health issues share some of the same risk factors, so someone who is at high risk for a mental disorder like depression may also be a high risk for alcoholism. Here are some of the risk factors that are shared by both SUDs and mental illness:


Your family history is an important factor in the development of either disorder. A family history of mental illness has proven to increase your likelihood to experience mental issues of your own. Researchers have also discovered links to parents and grandparents with addiction to children who also have substance abuse disorders. By studying twins and adopted children, they can also rule out the possibility that a history of addiction is completely due to upbringing.


Though addiction and mental health may not solely have to do with your childhood upbringing, it is a significant factor. The earlier children are exposed to alcohol or drug use, the more likely they are to develop a substance use disorder later in life. Because of this, children that grow up in homes that permit alcohol use or normalize excess drinking are at a greater risk of developing alcoholism later in life. This can often collide with genetic factors when a child grows up with an alcoholic parent. Likewise, development has a large bearing on how a person learns to cope with stress. Poor coping can lead to mental health problems.


Outside factors apart from your childhood development can also influence your mental health and addiction risk. Advertisements, peers, and culture can have a serious impact on you mentally and emotionally. For instance, constant beer advertisements can normalize the idea of alcohol as a social lubricant. This may have some responsibility in the fact that the culture sees college binge drinking almost as a rite of passage. Likewise, culture can stigmatize mental health problems and prevent people from getting early treatment.

Head/ Brain Injury

Head injuries have the potential to lead to mental disorders like PTSD, depression, learning and memory problems, and more. This is often observed as a result of military service and head injuries among servicemen and women increase the likelihood of both mental health issues and SUD.

How To Treat Dual Diagnosis

Addiction treatment is complex on its own. There are a variety of potential underlying issues that have to be explored. When a co-morbid mental health issue is also present, it can be even more of a challenge. Before we began to develop modern addiction treatment methods, a dual diagnosis was often seen as too difficult to treat. When addiction was seen as a bad habit and moral failing, doctors may have even refused to treat a patient who was also drinking or using drugs. If they did decide to treat the patient, they would ignore or work around the substance use disorder. But treating one without addressing the other often leads to relapse.

However, with a significant number of people that attending addiction treatment, clinicians and addiction treatment specialists need to be able to address both disorders effectively. Today, we understand that properly treating addiction requires addressing multiple needs. According to NIDA, being able to address medical, psychological, social, vocational, and legal issues is a principle for effective treatment. The presence of a mental health disorder falls into the category of important problems to address alongside treatment, not before or after.

When you enter a treatment program, you will go through a process typically referred to as intake and assessment. During this time, you will talk to clinicians and answer some basic questions about your personal and family history with mental health. Then you will sit down with a therapist for a session designed to get to the root of your addiction.

Man with his head on a counter with pills by his handsThey will most likely go through a questionnaire called biopsychosocial, which is an in-depth look at your biological, psychological, and social history and current issues.

Through this process, your therapist will start to gain a better picture of the factors that may be at the root of your addiction.

If you have a co-occurring mental health problem, it will start to become apparent through this session.

From there, you and your therapist will form your treatment plan.

If it’s clear that you have a specific disorder like depression, one of the goals of your plans might be to address and learn to deal with depression through specific therapy options. If your current mental health is unclear, a goal may be to further explore how your potential mental disorder might be affecting a SUD.

There are a variety of therapy options in addiction treatment and some are ideal for treating dual diagnosis. There is no single addiction treatment option that will work for every person, but certain behavioral therapies are designed to address a wide variety of issues. Here are some excellent therapies for dual diagnosis:

Cognitive Behavioral Therapy (CBT)

One of the most popular addiction therapy options, CBT is designed to examine why thoughts lead to actions. Addressing poor coping mechanisms in your thinking can help you avoid addictive and destructive behaviors.

Twelve-Step Programs

Support groups like Alcoholics Anonymous are commonly used in conjunction with addiction treatment. However, there are also support groups for people dealing with mental disorders and some that specifically help with dual diagnosis.

Family Therapy

Addiction is sometimes called a “family disease” because of the way it affects the people in your life. Everyone in your family can play a role in helping or hurting your road to recovery and your addiction may be causing difficulties for them as well.

Other Psychotherapies

Some mental health disorders will need therapies to target specific issues. For instance, eye movement desensitization and reprocessing (EMDR) is specifically geared toward addressing trauma disorders and PTSD. Other behavioral therapies like motivational enhancement therapy can help people who don’t believe they need treatment or are otherwise unmotivated to seek abstinence and dual diagnosis recovery.

Through a variety of evidence-based options, your addiction treatment plan should be tailored to your specific needs. And your therapist and clinicians can help you formulate a plan that addresses both your need for drug and alcohol abstinence and recovery and your mental health.

Starting Dual Diagnosis Recovery Today

Addiction and co-occurring disorders are difficult to deal with on your own and they often feed into one another, preventing you from overcoming either one. However, with addiction treatment and evidence-based therapy, you can learn to deal with a dual diagnosis and live a life free of addiction.

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