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Understanding Dual Diagnosis

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5 min read


Dual diagnosis, also known as the co-occurring disorder, is a condition where an individual suffers from both substance dependence and a mental health disorder.

Written by

Dr. Kirti Maan

Medically reviewed by

Dr. Vishal Anilkumar Gandhi

Published At September 20, 2022
Reviewed AtSeptember 20, 2022

What Is Dual Diagnosis?

Dual diagnosis is defined as a disorder in which an individual has a substance dependence or abuse problem (such as alcohol and drugs) along with mental health illnesses. It may include various conditions like:

Patients with chronic mental illness find substance dependence and drug abuse psychologically relieving. However, accepting and dealing with substance abuse or dependency is difficult; asking for help is the hardest step towards sobriety. In dual diagnosis, substance addiction and mental illnesses have specific symptoms that hamper one’s ability to lead a healthy life. Worsening the condition, substance abuse, and mental health disorders can also affect each other. For example, when the mental health disorder worsens or goes untreated, it increases substance dependency. Similarly, when substance abuse intensifies, the severity of mental health issues also increases.

What Is the Reason Behind Dual Diagnosis?

After intensive research and experiments, the exact known cause of dual diagnosis is yet to be known; however, substance abuse can trigger certain mental illnesses. There is evidence supporting that opioid addiction causes psychosis and seasonal affective disorder. The use of cannabis can cause hallucinations and similar other mental illnesses (including psychosis and schizophrenia). Dual diagnosis is pretty common among people with serious mental health disorders. Depression and anxiety disorders are the common factors causing dual diagnosis.

What Are the Symptoms of Dual Diagnosis?

The mental health problems commonly associated with a dual diagnosis or substance abuse are anxiety disorder, depression, and bipolar disorder.

Common Symptoms of Depression in Dual Diagnosis Are:

  • Feelings of helplessness.

  • Loss of interest and concentration in daily activities.

  • Inability to stay happy.

  • A drastic change in appetite.

  • Sleep disorders.

  • Loss of energy or low level of energy.

  • Feelings of worthlessness, guilt, or remorse.

  • Anger, agitation, withdrawal symptoms, physical pain, and reckless behavior.

Common Symptoms of Anxiety in Dual Diagnosis Are:

  • Excessive tension.

  • Feeling restless or jumpy.

  • Irritability.

  • Shortness of breath.

  • Nausea, vomiting and trembling.

  • Dizziness and lightheadedness.

  • Muscle tension.

  • Headaches.

  • Trouble concentrating.

  • Insomnia.

  • Night terrors.

Common Symptoms of Bipolar Disorder in Dual Diagnosis Are:

  • Feelings of euphoria.

  • Feeling extremely irritable.

  • Unrealistic beliefs.

  • Decreased need for sleep or sleep deprivation.

  • Increased energy.

  • Rapid speech and talkativeness.

  • Racing thoughts.

  • Impaired judgment.

  • Impulsivity.

  • Hyperactivity.

  • Anger or rage.

What Are the Common Mental Health Disorders Associated With Substance Abuses?

Certain mental health disorders are commonly associated with substance abuse or vice versa. For example, an addict may develop a mental illness, or individual suffering from a mental condition might develop an addiction. Some of the commonly linked mental health conditions and substance abuse are:

  1. Attention-Deficit Hyperactivity Disorder (ADHD): In most cases, an individual with substance abuse is at risk of suffering from attention-deficit hyperactivity disorder. This makes the case more severe and the treatment more difficult. Attention-deficit hyperactivity disorder is a neurological disorder wherein the child suffering has difficulty concentrating, talking, and continuing with daily activities. Studies have proven individuals suffering from attention-deficit hyperactivity disorder tend to crave drugs. Turning to substance addiction is because individuals with ADHD are often social outcasts, which is not a happy feeling in a young adult. Hence, in retaliation, they turn to substance dependence and abuse. Since the sufferer is already addicted to drugs and often medication (due to easy availability), psychotherapy and non-stimulant drugs are often prescribed to help the patient.

  2. Autism Spectrum Disorder: Autism or autism spectrum disorder is a developmental disorder that affects the communication and behavior skills of the suffering individual. In a condition such as ADHD where the individual is strongly compelled to take up substance dependence, whereas autism, on the other hand, does not make up a strong case with substance abuse. The reason for the said perseverance is because the characteristic features of autism, such as introverted nature, anti-social behavior, and isolated nature, make it harder for the individual to develop a sense of substance. However, in rare cases, it is observed that alcohol dependence worsens the case of autism or the symptoms of autism.

  3. Gambling: An addiction to gambling or pathological gambling has clinical symptoms which are often similar to other mental illnesses and substance abuse disorders.

What Is the Treatment of Dual Diagnosis?

The treatment of dual diagnosis should not and cannot focus on one condition only; the treatment plan should simultaneously include both the mental illness and the substance abuse disorder.

Treatment Plan Suggested for Treating Mental Health Disorder Includes:

  • Medicinal therapy.

  • Psychotherapy (or counseling).

  • Self-help groups and measures.

  • Lifestyle adjustment.

  • A support group or peer support.

Treatment Plans Suggested to Treat Substance Abuse Disorders Are:

  • Detoxification.

  • Proper management of withdrawal symptoms.

  • Behavioral and psychotherapy.

  • Support group.

  • Relapse therapy.

As much as treatment is suggested and is necessary, sometimes the treatment of one can coincide and help the other, but there have been cases reported where the treatment of one hinders the recovery of another. Such as, in the case of an individual suffering from an anxiety disorder or psychosis, anti-anxiety medications or antipsychotics are prescribed in order to ease up the symptoms, which in the case of drug addiction can be harmful as an individual already addicted to drugs might easily become addicted to these medications as some of them shows the same result (that is, a drug high or a state of the semi-conscious or unconscious mind).

Different Treatment Approaches Suggested to Tackle Drug Dependence Are:

  1. Partial Treatment: Partial treatment is in which the disorder that appeared first or is considered primary is the main focus of the treatment and is suggested to be treated.

  2. Sequential Treatment: Sequential treatment is the treatment plan in which both the disorders are first diagnosed based on their onset of action or symptoms, and then, depending on that, it is then titled as either a primary disorder or a secondary disorder. Primary disorders are designated to be treated first, followed by treatment of the secondary disorder.

  3. Parallel Treatment: Parallel treatment consists of individuals receiving mental illness treatment first and from a different source and then substance misuse treatment from a different source.

  4. Integrated Treatment: Integrated treatment consists of blending treatment protocols into a single plan that manages to treat both substance misuse and mental illnesses. With this plan, both disorders are given priority.

What Are the Complications Due to Dual Diagnosis?

The dual diagnosis affects an individual more in comparison to suffering from either one. An individual suffering from mental health disorder already suffers from the side effects or consequences of the said illness. An addict, on the other hand, has difficulty maneuvering their daily life due to an addiction to a substance. Both, when combined, have a severe impact on both the physical and mental health of the individual. Some of the complications seen in an untreated and severe case of dual diagnosis are:

  • Violent tendencies.

  • Suicidal behavior.

  • A severe infection or other physical health issues.

  • Socially outcasted or rejected.

  • Anti-social behavior.


Dual diagnosis is a complicated disorder that includes both a mental illness and an addiction (to either drugs or alcohol or both); it strings the individual along the treatment line. Treating dual diagnosis is essential and crucial so as to absolve an individual of the symptoms faced by them every day. These conditions portray both physical and mental symptoms. Treating dual diagnosis as a whole can be a difficult task; however, tackling one situation at a time has proven to be helpful and effective. Treating an individual for mental illness and also treating the same individual for their addiction can increase the mental and physical health and abilities of the individual.

Frequently Asked Questions


What Is Dual Diagnosis?

A condition where a person has a substance dependence or substance abuse along with a mental condition is called a dual diagnosis. Examples of substance dependence or substance abuse can include alcohol or drug abuse. Studies show that about half the population with mental disorders has drug abuse or dependency. Usually, mental illness comes first, while drug dependence comes as a result of methods to cope with stress.


What Is an Integrated Approach to Dual Diagnosis?

An integrated approach is the best for a dual diagnosis. This is a method where both drug dependence and mental illness are treated simultaneously. Drug dependence must be stopped first. Behavioral therapies and medicines can be used. Support from family and friends can provide social and emotional support.


What Are the Criteria for Dual Diagnosis?

For a dual diagnosis, there must be two conditions. It is usually a mental illness and a drug dependence or drug abuse. Usually, a person with mental illness will start drug dependence for self-soothing. Both are interlinked and worsen the condition.


What Are Three Possible Associated Factors for Why a Person Has Dual Diagnosis?

Studies show that there are three associated factors that make a person have a dual diagnosis. The common risk factors can contribute to their emotional and mental health. They include genetics, stress, and trauma. Mental disorders can add to substance abuse.


What Is the Treatment Model for Dual Diagnosis?

The integrated dual disorder treatment (IDDT) model is used for dual diagnosis. It is an evidence-based approach used in patients with a dual diagnosis. In a person with a dual diagnosis, a mental illness and associated drug abuse is evident. The treatment modality combines services to prevent drug abuse and improve mental health.


What Are the Risks Associated With Dual Diagnosis?

Research shows that people with dual diagnosis have a higher rate of severe illness when compared to those with a single disease. The chances of relapse are also higher. They tend to be more violent and show suicidal tendencies. They are more prone to many physical illnesses and health issues.


When Was the Beginning of Dual Diagnosis?

The dual diagnosis was first identified in the late 1980s. The complexities of several medical conditions were brought under a simple term. More attention was given to substance abuse in mentally ill patients. The biological and pharmacological aspect of the condition was also studied.


How Frequent is Dual Diagnosis?

Research shows that about fifty percent of those with substance abuse disorder have associated mental illness. The most commonly used abusive substance was alcohol and tetrahydrocannabinol (THC). Attention-deficit hyperactivity disorder (ADHD) and conduct disorders ranked higher than anxiety and mood disorders.


Does Dual Diagnosis Affect a Family?

Dual diagnosis does affect families. A person with the condition will empty all their emotions and frustrations on the members of the family. As a result, family members who are not conditioned to adapt will also undergo emotional stress. It can also ruin families if the condition is left undiagnosed.


Which Are the Two Disorders Where Symptom Overlap?

Symptom overlap is usually seen in mental illness. Schizophrenia and bipolar disorder are two conditions that have symptom overlap. Both disorders share the symptoms like delusions and avolition. This makes the diagnosis of the conditions difficult.


Is ADHD an Example of Dual Diagnosis?

Yes, attention deficit hyperactivity disorder is considered a dual diagnosis. People with ADHD have one or more associated symptoms. Depression, substance abuse disorder, learning disabilities, etc., can be some of them. This makes the diagnosis of the condition more complex.


Which Is the Hardest Mental Illness to be Treated?

‘Borderline personality disorder’ is a mental disorder that is hard to treat. People with these symptoms find it hard to manage their intense emotions like happiness or sadness. It is hard to diagnose the condition as there can be a mixture of symptoms. They find it hard to manage intense emotions.
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Dr. Vishal Anilkumar Gandhi
Dr. Vishal Anilkumar Gandhi



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