What Is a Dual Diagnosis? The Shocking Truth About Mental Health and Substance Abuse

A dual diagnosis is categorized as having a mental illness as well as an issue with substance abuse. Either one can be difficult to treat on their own but having both requires a special treatment center.

Most individuals end up either treating only one of their issues or, going to two different treatment centers to cover both problems.

A dual diagnosis rehab center is where someone could get the help they need for both of these conditions. There are few treatment centers around the world that are designed to help those with a dual diagnosis.

What is a Dual Diagnosis?

This is a relatively new term and it refers to someone who either had a mental illness and then began abusing drugs or other substances, or was abusing drugs and developed a mental illness issue such as depression or anxiety.

In most cases, it is hard to tell which came first. Since this is a newer diagnosis, there is not much research on the subject. But examples might include someone who has been doing cocaine for many years and then has a psychotic episode. Or it could be someone who has severe depression and begins to drink alcohol to “self-medication”.

Reasons Dual Diagnosis May Have Been Missing

Because it can be unclear which issue is more severe, a diagnosis can be difficult.

An individual with a mental illness is typically treated only when they have a severe problem. Mild depression, anxiety, eating disorders, mood disorders, or post-traumatic stress disorder, often go untreated. If an individual does seek treatment for any of these, their substance abuse is seen as a minor side effect.

Experiences of Someone with a Dual Diagnosis

·         May be homeless

·         May move residents a lot

·         Has been taken to the emergency room often

·         Starts a lot of fights

Characteristics of Someone with a Dual Diagnosis

·         Overly emotional

·         Sudden changes in mood

·         Severe psychiatric issues

·         Loss of control over substance use

·         Won’t cooperate with doctors or family

·         Alienates themselves from family and friends

Outdated Thinking

It used to be that therapists and psychiatrist would not treat someone with depression or anxiety if they were also drinking or doing drugs. This is outdated and now the approach is for integrated treatment.


Your treatment provider, along with your input, can come up with a treatment management plan to address both issues at the same time.

Detoxification – the first thing for treatment is to stop the drugs and/or drinking. This can best be done as an inpatient for at a treatment center, a person is monitored 24/7.

Coming off any type of drug is difficult and to preserve sobriety and for the individual’s safety, it is best to go inpatient rather than attempt “cold turkey” at home. The trained staff at a reputable behavioral health facility can administer drugs that help to wean a person off their drugs without severe withdrawal symptoms.   

Rehabilitation – an inpatient rehabilitation center is recommended for someone who is suffering from both a substance abuse and a mental illness.

As an inpatient resident, an individual will receive the round-the-clock care they need for both of their problems. Medical staff will help them adjust to life without their drugs and a psychiatric staff will help them with whatever mental illness they are suffering from.

They will also be introduced to group therapy, something they may not have been involved with before. Group therapy will be something the individual will continue once they leave the inpatient hospital setting.

A typical stay as an inpatient lasts anywhere from 30 to 45 days or longer depending on how well the patient reacts to treatment, and which treatments are working that can be transferred to use outside of the hospital setting.  

Supportive Living – this includes housing where a person can readjust to life outside of the rehabilitation center and still have the structure it offered like therapy groups and medication reminders.

An individual will get the help they need to reenter society as a sober and mentally healthy person. This includes talking with family and friends about their dual diagnosis and any issues they previously had.

Medications – certain medicines can be helpful in easing the symptoms of various mental illnesses. There are also medications that will lessen the severity of withdrawal symptoms when an individual stops taking the drug they have been consuming for a long period of time.

A small amount of these medications overlaps and can be taken for both issues, but the dosage and side effects vary from person to person. A doctor who treats dual diagnosis patients would know which medication works and how much to administer for the best results.

Psychotherapy – it is important for an individual to continue their therapy once they have left the rehabilitation center. One of the best therapies for dual diagnosis is CBT (cognitive behavioral therapy). This type of therapy helps a person to change the patterns that are hurting them and to deal with core beliefs that may have contributed to their substance abuse and/or mental illness.  

Ongoing therapy is recommended so that a person can adjust to different issues as they arise as well as any relapse.

Support Groups – some people may feel isolated when dealing with a dual diagnosis. Attending a support group can help a person feel less alone. There may be someone in the group that has a different way of dealing with issues that could work for you, but you never thought of it before. They may also have several resources that can be of help.

Support groups can also be a safe place for those who are struggling and simply need someone to listen to them. It can also be a source of new friendships.

Most treatment centers are for substance abuse or mental illness, not both. If you or a loved one has a substance abuse problem, or a mental health issue, seek help. If you feel you could be suffering from a dual diagnosis, speak up and ask for additional help.

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