Substance use disorders — the repeated misuse of alcohol and/or drugs — often occur simultaneously in individuals living with mental health conditions, usually to cope with overwhelming symptoms. The combination of these two illnesses has its own term: dual diagnosis, or co-occurring disorders. Either disorder (substance use or mental illness) can develop first.
According to the National Survey on Drug Use and Health, 17 million U.S. adults experienced both mental illness and a substance use disorder in 2020.
Mental illness and substance use disorders are involved in 1 out of every 8 emergency department visits by a U.S. adult (estimated 12 million visits)
Roughly half of individuals who experience a substance use disorder during their lives will also experience a co-occurring mental disorder and vice versa. Co-occurring disorders can include anxiety disorders, depression, attention-deficit hyperactivity disorder (ADHD), bipolar disorder, personality disorders, and schizophrenia, among others. For more information, please see the National Institute on Drug Abuse (NIDA)’s Common Comorbidities with Substance Use Disorders Research Report.
Because many combinations of dual diagnosis can occur, symptoms vary widely. Mental health clinics are starting to use alcohol and drug screening tools to identify people at risk. Symptoms of substance use disorder may include:
- Withdrawal from friends and family
- Sudden changes in behavior
- Engaging in risky behaviors
- Developing a high tolerance and withdrawal symptoms
- Feeling like you need a drug to be able to function
Symptoms of a mental health condition can also vary greatly. Warnings signs, such as extreme mood changes, confused thinking or problems concentrating, avoiding friends and social activities and thoughts of suicide, may be reasons to seek help.
Treatment and Resources
The best treatment for dual diagnosis is integrated intervention, when a person receives care for both their diagnosed mental illness and substance use disorder. The idea that “I cannot treat your depression because you are also drinking” is outdated — current thinking requires both issues be addressed.
You and your treatment provider should understand the ways each condition affects the other and how your treatment can be most effective. Treatment planning will not be the same for everyone, but here are a few common elements:
Detoxification. The first major hurdle that people with a substance use disorder will have to pass is detoxification. Inpatient detoxification is generally more effective than outpatient for initial sobriety and safety. During inpatient detoxification, trained medical staff monitor a person 24/7 for up to seven days. The staff may administer tapering amounts of the substance or its medical alternative to wean a person off and lessen the effects of withdrawal.
Inpatient Rehabilitation. A person experiencing a mental illness and dependent patterns of substance use may benefit from an inpatient rehabilitation center where they can receive medical and mental health care 24/7. These treatment centers provide therapy, support, medication and health services to treat the substance use disorder and its underlying causes.
Psychotherapy is usually a large part of an effective treatment plan. In particular, cognitive behavioral therapy (CBT) helps people with dual diagnosis learn how to cope and change ineffective patterns of thinking, which may increase the risk of substance use.
Medications are useful for treating mental illness. Certain medications can also help people experiencing substance use disorders ease withdrawal symptoms during the detoxification process.
Supportive Housing, like group homes or sober houses, are residential treatment centers that may help people who are newly sober or trying to avoid relapse. Sober homes have been criticized for offering varying levels of quality care because licensed professionals do not typically run them. Please do some research before making a selection.
Self-Help and Support Groups. Dealing with a dual diagnosis can feel challenging and isolating. Support groups allow members to share frustrations, celebrate successes, find referrals for specialists, find the best community resources and swap recovery tips. They also provide a space for forming healthy friendships filled with encouragement to stay clean. Here are a few groups to check out:
- Double Trouble in Recovery is a 12-step fellowship for people managing both a mental illness and substance use disorders.
- Alcoholics Anonymous and Narcotics Anonymous are 12-step groups for people recovering from alcohol or drug addiction. Be sure to find a group that understands the role of mental health treatment in recovery.
- Smart Recovery is a sobriety support group for people with a variety of addictions that is not based in faith.
Substance Abuse Prevention and Control for Youth
Millions of young adults are living with a mental or substance use disorder and many either do not realize they have one or are not paying attention to the signs and not seeking help. In fact, of the 8.9 million young adults who reported having a mental illness in 2018, more than 2 in 5 went untreated and of the 5.1 million with a substance use disorder, nearly 9 in 10 did not get treatment. (Source: Substance Abuse and Mental Health Services Administration)
Prevention and Control (Los Angeles Department of Public Health)
Know the Risks of Using Drugs (Substance Abuse and Mental Health Services Administration)
Mental Illness and Substance Use in Young Adults (Substance Abuse and Mental Health Services Administration)
Tips on Talking to a Friend Who May Be Abusing Substances (Substance Abuse and Mental Health Services Administration)