Dual diagnosis emerged as a diagnosis more than 20 years ago. What is dual diagnosis? Why is it so important for drug and alcohol addiction treatment?

Dual diagnosis refers to an individual who suffers from both an addiction disorder and a mental illness. It is also known as co-occurring disorders.

How common is dual diagnosis?

SAMSHA reports substance use disorders are more common in individuals who struggle with mental health disorders.1 In fact, the National Alliance on Mental Illness (NAMI) reports that about a third of people who suffer from mental illness also deal with addiction issues.2 This is no small problem. The 2010 National Survey on Drug Use and Health (NSDUH) estimates that 9.2 million Americans suffer from co-occurring disorders.3Thus, many individuals seeking treatment for substance also suffer from mental illness.

Percentage of those with mental illness who also are addicts

Past Year Substance Use among Adults Aged 18 or Older, by Any Mental Illness: 2010 – SAMHSA.gov

Sadly, only a small percentage receive appropriate treatment. The NSDUH estimates only 7.7% of those with co-occurring conditions receive appropriate dual diagnosis treatment.3

The range of psychiatric disorders that can accompany drug or alcohol abuse is vast. These illnesses include depression, schizophrenia, bi-polar disorder, borderline personality disorder, anxiety, mood disorders and many others.

Simultaneous treatment is necessary

Since both disorders often can mirror and overlap one another, it is important that individuals receive treatment that addresses both their mental health and substance use problems. An effective treatment plan requires a proper diagnosis. It is important that clients are not overly medicated in early recovery as this can make a correct diagnosis harder. Symptoms of alcoholism and drug abuse are similar to mental health symptoms.

Treatment must deal with both illnesses. Addiction treatment, with little to no attention given to mental health, is rarely effective. Wellness is obtained by addressing both disorders. A personalized treatment plan must manage the delicate balance of treating each disorder.

Treatment of co-occurring disorders requires both psychiatric and medical staff

Comprehensive treatment requires a team comprised of both medical and clinical professionals. Medical staff should include both physicians and nurses. Clinical staff should be an equal combination of both master’s level clinicians and chemical dependency personnel.

The majority of sufferers fare best from an inpatient rehabilitation center that provides 24/7 monitoring of both their physical and mental health.

Providers should incorporate numerous areas into treatment. Therapies and counseling should address mental health and emotional regulation, physical health and nutrition, spiritual engagement or personal enrichment, life skill cultivation and relationship skills.

A plan for ongoing support is important

Inpatient treatment is only the beginning of treating and caring for those suffering from both addiction and mental health illness.  Since co-occurring disorders may exacerbate one another, continued care for these should be sought. Post-treatment care and monitoring decrease the chances of relapse of substance use and mental health symptoms. Many patients benefit from a residential extended care or sober living program.

While many people find much relief from the 12step work, others require additional support and care. Patients benefit from psychotherapy that provides the individual with an understanding of how their behaviors and beliefs impact both illnesses. Cognitive behavioral therapy (CBT) is particularly effective for dual diagnosis patients as they learn new coping strategies, as well as shift ineffective thought patterns.

In conclusion

SAMSHA’s statistics indicate that most patients entering into addiction treatment have co-occurring disorders. Thus it is important for the client to obtain an accurate diagnosis. An effective treatment program treats both illnesses concurrently. Focus on 12-step work, emotional and therapeutic work, as well as mental health treatment, are all essential parts of a dual diagnosis treatment program. Treatment centers must have appropriately skilled personnel and a treatment program that provides exceptional care for all individuals.



Center for Behavioral Health Statistics and Quality. (2015). Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health (HHS Publication No. SMA 15-4927, NSDUH Series H-50). Retrieved from http://www.samhsa.gov/data/

2  Dual Diagnosis. National Alliance on Mental Illness. Retrieved from: https://www.nami.org/Learn-More/Mental-Health-Conditions/Related-Conditions/Dual-Diagnosis

3 Substance Abuse and Mental Health Services Administration. (2012). Results from the 2010 National Survey on Drug Use and Health: Mental Health Findings, NSDUH Series H-42, HHS Publication No. (SMA) 11-4667. Rockville, MD: Substance Abuse and Mental Health Services Administration. Retrieved from: http://archive.samhsa.gov/data/NSDUH/2k10MH_Findings/2k10MHResults.htm#Ch4