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Co-Occurring Substance Use and Mental Health Disorders

A person struggling with a substance use disorder (SUD) may experience significant barriers to recovery that may range from social support to lack of quality treatment options. One common barrier is a lack of dual diagnosis treatment when necessary. The Substance Abuse and Mental Health Services Administration (SAMHSA) states that a third of substance use admissions in 2017 involved a co-occurring mental health disorder. When a person suffers from two behavioral health conditions simultaneously, failure to effectively address them both with evidence-based treatment could affect the recovery process. Here’s how dual diagnosis treatment can help.

What Is Dual Diagnosis Treatment?

A dual diagnosis is the term used to describe a person who struggles with a mental health condition and a substance use disorder at the same time. Either condition – the SUD or the mental health disorder – can develop first. In some cases, a person who is experiencing negative symptoms from a mental health disorder may turn to alcohol or other symptoms in order to self-medicate. In others, the side effects of prolonged exposure to alcohol or other substances may lead to the development of the mental health disorder; this is especially true for mood disorders such as major depression or generalized anxiety disorder.

SUD and mental illness treatment are two distinct fields with different cultures, standards of care, and treatment. As such, it can require effort to find a treatment center that has successfully integrated dual diagnosis and treatment into its practice. Given the prevalence of dual diagnosis in the United States, however, co-occurring disorder treatment is essential. According to the National Survey on Drug Use and Health, an estimated 7.9 million people in the U.S. have both an SUD and a mental health disorder. Men are slightly more likely to experience a dual diagnosis than women.

Symptoms and Warning Signs of Co-Occurring Disorders

Dual diagnosis can exist in many different combinations – as such, the symptoms of a co-occurring disorder may vary widely. Many treatment clinics offer alcohol and substance use screening tools to determine if patients receiving mental health services are at risk for a SUD.

In general, signs of a SUD include:

  • Withdrawal from social activities, friends, and family
  • Engagement in risky behaviors
  • Development of a high tolerance for drugs or alcohol
  • Loss of control over use of alcohol or drugs
  • Onset of withdrawal symptoms after abstaining from drugs or alcohol
  • “Needing” a substance in order to function
  • Unable to fulfill responsibilities because of drug or alcohol use

The symptoms of mental health conditions vary widely depending on the type of disorder, and some mental illnesses share symptom and overlap with SUD. General warning signs of a mental health disorder include sudden or extreme changes in mood, issues with concentration or cognition, avoidance of friends or social network, sleeping issues (too much or too little), and suicide ideation.

Common Co-Occurring Disorders

A person with a dual diagnosis may suffer from any number of mental health conditions. Mental illnesses range from mood disorders and phobias to dissociative conditions that make it difficult to function under everyday circumstances.


One of the most commonly occurring mood disorders in the world, major depression, affects an estimated 300 million internationally. People with depression experience a general feeling of unhappiness that persists over time. They may also have a lack of interest in social activity, isolate themselves from friends and family, and struggle with feelings of guilt or low self-worth. Insomnia or excessive sleepiness is also hallmarks of the disorder.


Anxiety disorder affects an estimated 40 million Americans in a given year, and depression and anxiety often co-occur. The symptoms of an anxiety disorder may be so debilitating that it is difficult for the person experiencing them to fulfill their obligations such as school or work. They may turn to substances in an effort to quell their symptoms, but research shows that it actually makes them worse.

Bipolar Disorders

Bipolar disorder is a prominent mood disorder that features both manic and depressive episodes. A person may sway from feelings of intense unhappiness to hyperactivity and inflated self-esteem. Substance use may be a method for the person affected to reach homeostasis, but drugs and alcohol will inflate the symptoms, creating a vicious cycle.

Post-Traumatic Stress Disorder

PTSD occurs after experiencing a traumatic event such as a natural disaster, car accident, military combat, or physical or sexual assault. A person with PTSD will experience intense disturbance from flashbacks and vivid memories of the trauma. Other symptoms include mood swings, irritability, emotional disturbance, and insomnia. Substance use is a common form of self-medication for PTSD sufferers.

Schizophrenia and Other Psychoses

Psychoses such as schizophrenia are severe mental illnesses that affect 23 million adults worldwide. A person suffering from psychosis may experience extreme emotional disturbances, distorted perceptions of reality, and inaccurate representations of the self and others.

Theories Underlying Dual Diagnosis Treatment

Extensive research supports the fact that co-occurring disorders have a synergistic effect. In other words, the presence of one disorder makes the other worse, creating a vicious cycle of addiction and mental instability. For example, a person may self-medicate their anxiety with alcohol, but studies of brain chemistry show that alcohol stimulates the production of cortisol, a stress hormone that exacerbates the symptoms of anxiety. Lesser known, however, is why co-occurring disorders are more likely to occur in some individuals over others. Several theories may explain dual diagnosis.


Research shows that genetic makeup may make some people more likely to have a substance use disorder or mental health condition. Both conditions tend to run in families, and a person who has a family member with a diagnosed SUD or mental illness is more likely to experience one themselves. Some people are at higher risk for depression because of a lack of dopamine; this same deficit may lead them to abuse drugs in order to chase a “high.”

Environmental Triggers

Some may be at an increased risk for mental health disorders or substance use, but an environmental trigger brings the condition to fruition. Examples of environmental triggers include trauma, dysfunctional family roles, and the presence of childhood abuse. Other factors, such as battling a physical illness or loss of a family member or friend, can serve as triggers for SUD or mental illness.

Structural Abnormalities in the Brain

A growing body of research suggests that abnormalities in brain chemistry or structure may lead to the development of mental illnesses or substance abuse. For example, the brains of people who suffer from schizophrenia have an increased sensitivity to dopamine, but also abnormalities in the dopamine reuptake system. This may help explain the distorted perceptions of reality, but also this population’s drive to attempt to use substances to self-medicate.

The Benefits of Dual Diagnosis Treatment

Treatment of co-occurring disorders requires an integrated approach. There is no standard treatment option that works for everyone who has a dual diagnosis. Treatment requires an individualized approach, and the relationship between mental health disorders and substance use is a complex interaction between genetics, brain chemistry, and the environment. As such, each integrated treatment plan should be tailored to the individual and then monitored for success. In general, a dual diagnosis treatment plan will contain several components.


The first step in any dual diagnosis treatment is to determine what conditions require treatment. A provider may provide assessments using standardized tools for substance abuse and mental health conditions. The evaluation process also involves a process of history-taking, including medication lists, and any family history of mental illness and substance abuse. This personalization in assessment should run congruent with the entire treatment process, though it may not and depends on where dual diagnosis treatment is sought.


One of the first and most important steps of treating the SUD and co-occurring mental health condition is medically-supervised detox. This allows the patient to wean off the substance(s) in a safe environment, ofetn with medications to ease withdrawal symptoms, if necessary.


Two types of rehabilitation programs exist: inpatient and outpatient. In some cases, a SUD or mental health condition may be severe and require consistent monitoring and support. Others do well in an outpatient setting with regular check-ins. The right program will depend on the patient’s diagnosis, other health conditions and risk factors, as well as personal preferences.

Due to the nature and sensitivity of dual diagnosis, privacy in all dealings is preferred. While many treatment facilities provide therapies that require group participation, this does little to support people who want anonymity in their dual diagnosis care.

Many people are able to manage their mental health condition and substance addiction through an outpatient program. By using the services offered by a licensed, experienced, and renowned professional who specializes in both areas of medicine, dual diagnosis treatment can be provided in a way that suits the individual throughout the process of recovery.

Through compassionate and guided one-on-one outpatient therapy, a psychiatrist can truly meet the patient where they are in recovery and integrate a level of flexibility, unavailable in other dual diagnosis treatment facilities. In addition, with the added layer of privacy and confidentiality that a private practice can offer, the doctor-patient relationship builds trust more readily, allowing for a more seamless and effective treatment progression.


Most dual diagnosis treatment programs involve evidence-based interventions such as psychotherapy. These treatments help the patient understand the factors that play a role in their co-occurring disorders and provide compensatory strategies to minimize symptoms and improve overall quality of life quality.


Many people who suffer from mental health disorders, particularly severe ones, benefit from medications to control symptoms. Finding the right medication for a mental health disorder can take time and requires supervision from a licensed professional.

Integrated Treatments Streamline Recovery

In order to make recovery effective and sustainable, people with a dual diagnosis require an integrated treatment approach that addresses both the mental health condition and substance use disorder.

The industry renowned practitioners at Fifth Avenue Psychiatry offer dual diagnosis treatment utilizing evidence-based practices to improve quality of life for individuals who are experiencing co-occurring disorders. Learn more about leading mental health and substance abuse treatment here.

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