What is a dual diagnosis?

Dear Alice,

What is the meaning of "dual diagnosis" in regards to a drug addict?

Dear Reader, 

This is a really great question! A "dual diagnosis" is the clinical term used to classify people who have co-occurring substance use disorders (physical or psychological dependence on tobacco, prescription/illicit drugs, or alcohol) and one or more diagnosed mental health disorders. For instance, a person living with schizophrenia who has an addiction to cocaine is someone who could qualify for a dual diagnosis. Of the one in five adults who may meet the criteria for a mental health disorder at some point in their lives, approximately half may also do so for a substance use disorder at the same time. For many people, it may be difficult to identify which disorder started first, as each may contribute to the other. It’s generally recommended that individuals with dual diagnoses receive treatment for both disorders at the same time — whether through inpatient or outpatient services, therapy, support groups, or medications.  

Just like the chicken and the egg, it’s difficult to know which disorder in the dual diagnosis came first. Part of the reason for this may be because mental health disorders and substance use disorders share similar risk factors, such as genetics, stress, and trauma. For some people, mental health disorders may contribute to problems with substance use. This phenomenon, known as "downward drift," occurs when people with mental health disorders "self-medicate" with alcohol and other substances or find themselves in environments that promote substance use as a result of their mental illness. On the other hand, those who use substances heavily may experience a change in their brain chemistry that’s associated with developing mental health disorders, such as depression or anxiety.  

The generally inadequate care that dual diagnosis patients receive occurs in part because of the complexity of their conditions — their needs don't fit perfectly into the mental health or substance abuse treatment systems. A lack of research on effective treatments and interventions and a lack of training for health care providers on these issues also all contribute. In many cases, one condition (mental illness or substance abuse) may be overlooked, and studies have shown that unless both are addressed simultaneously, neither are being fully treated. Treatment plans for individuals with a dual diagnosis are considered integrated care, which includes a combination of medical treatment, counseling, and support services that encourage behavioral and cognitive skill development to manage each condition. These plans may include a combination of the following: 

  • Residential treatment programs or rehabilitation facilities 
  • Outpatient treatment 
  • Individual or group therapy 
  • Medications (e.g., antidepressants, antipsychotics, or anti-anxiety) 
  • Support groups

For additional information on how to find substance use treatment facilities that also provide mental health services, you could check out the Substance Abuse and Mental Health Administration’s (SAMHSA) Substance Abuse Treatment Facility Locator

Although more resources may be required for treating individuals with a dual diagnosis, treatment options are available. It can feel stigmatizing to be diagnosed with a mental health disorder in addition to a substance use disorder, but with the right treatment plan, symptoms of both may be easier to manage. For more information about treatment plans for a dual diagnosis, health care providers or mental health professionals are great resources to discuss options that may be specific to individual preferences and lifestyles. If you’re interested in learning more about substance use or mental health, check out the Go Ask Alice! Alcohol & Other Drugs and the Emotional Health archives.  

Last updated Jul 16, 2021
Originally published Aug 12, 2010

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