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What Is a Dual Diagnosis?

by Landmark Recovery

May 14, 2020
A man looking up what a dual diagnosis is

When substance abuse and mental health intersect in unfortunate ways, it’s known as a dual diagnosis. Understanding addiction is almost as complex a matter as a mental health disorder in itself so let’s provide some brief background first. We’ll also discuss the most effective treatment for dual diagnosis. This knowledge will be valuable for those seeking to understand the nuances of comparing dual diagnosis vs co-occurring disorders.

What Is a Dual Diagnosis?

What is a dual diagnosis

As we mentioned, dual diagnosis (or co-occurring disorder) refers to a mental health disorder happening at the same time as a substance use disorder. In 2018, 9.2 million adults were suffering from a dual diagnosis. Sadly, there are probably far more people than this struggling without being diagnosed. An addiction can occur as a result of a mental health disorder, or a mental illness can result from an addiction. They can also occur simultaneously. Mental health symptoms can sometimes become so unbearable that someone will turn to alcohol or drugs to obtain some relief. Unfortunately, this can fuel a vicious cycle where a person can feel worse after taking drugs and alcohol, thus aggravating mental health symptoms. And so the cycle continues.

What is the Most Effective Treatment for Dual Diagnosis?

The most effective treatment for dual diagnosis is an integrated treatment approach. This approach recognizes the interplay between mental health disorders and substance use disorders, understanding that these conditions often reinforce and exacerbate each other. Therefore, treating both conditions simultaneously is crucial for achieving lasting recovery.

In an integrated treatment approach, the first step is typically a comprehensive assessment to understand the individual’s specific needs and challenges. This involves diagnosing both the mental health disorder and the substance use disorder, usually using standardized criteria such as those in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The treatment team can then create a personalized treatment plan that addresses both conditions.


Psychotherapy, or talk therapy, is a cornerstone of this integrated approach. Therapies such as Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) are commonly used. These therapies help individuals develop healthier coping strategies by understanding the relationship between their:

  • Thoughts
  • Feelings
  • Behaviors


Medication management is another important component of dual diagnosis treatment. Medications can help manage symptoms of mental health disorders, assist with the detoxification and withdrawal process, and support long-term recovery. However, it’s essential to note that medications are not a standalone solution; they should be part of a broader treatment plan that also includes therapy and lifestyle modifications.

Peer Support

Peer support, often in the form of group therapy or support groups, is also integral to dual diagnosis treatment. Sharing experiences, challenges, and successes with others who are going through similar struggles can be incredibly validating and empowering.

Lifestyle Modifications

Lastly, lifestyle modifications, such as improvements in diet and exercise, stress management techniques, and building healthy sleep habits, can also play a critical role in supporting recovery and promoting overall health.

An integrated treatment approach also includes comprehensive aftercare planning to support long-term recovery. To help individuals navigate the challenges of life after treatment, this may involve:

  • Ongoing therapy or counseling
  • Support group meetings
  • Continued medication management
  • other resources

Mental Health Disorders

Mental Health Disorders

It’s often not clear which comes first, the mental health disorder or the addiction. Mental health disorders are complex enough even when there is no substance use disorder. An accurate diagnosis is vital in treating dual diagnosis. The difficulty is, those with dual diagnosis are more treatment-resistant and typically have a harder time getting on top of their addiction. An effective treatment center skilled in diagnosing and treating dual diagnosis is central to a fruitful and sustained recovery. A misdiagnosis can lead to inappropriate treatment which is both wasteful and unproductive.

Anxiety and Mood Disorders

Over half of those with an anxiety or mood disorder also suffer from a substance use disorder. Those who are diagnosed and treated appropriately for anxiety or mood disorders have a good chance of staying clear from drugs later on. Medication and cognitive behavioral therapy can replace substance use as an effective coping mechanism.


Children with ADHD are treated with medications such as Adderall and Methylphenidate to reduce symptoms like restlessness and problems concentrating. While it has been suggested that treating minors with stimulants could increase their chances of abusing drugs later on, research has not conclusively proven this.


Abuse of alcohol, nicotine, and other drugs is particularly high in people with schizophrenia. This is likely due to substances acting as a coping mechanism for anxiety. Marijuana is known to trigger psychotic episodes in schizophrenic patients. So, while it’s used to self-medicate, it’s more detrimental than helpful in the long run.

How To Treat A Dual Diagnosis?

How to treat a dual diagnosis

How, then, do we go about unraveling the tangled complexities of childhood trauma, mental health, and addictive behavior; how can we gain some clarity on how to treat a co-occurring disorder? Well, the two treatment areas are quite different in terms of culture. Mental health disorders are treated by a completely different part of the health service than the area that treats addiction. Treatment of dual diagnosis requires a holistic approach. There are many types of mental health illnesses and myriad forms of addiction. Many people also suffer from more than one mental health disorder. They might suffer from schizophrenia and bipolar, and use alcohol or drugs to self-medicate. It’s crucial to seek out proper advice from a reputable addiction center that can effectively treat mental health disorders and addiction.


Due to a lack of research, it’s not well known which medications are most suited to treating people with dual diagnosis. However, some FDA-approved medicines for substance use disorder can help with the management of cravings for certain types of substances. For instance, the smoking cessation drug Zyban can help to efficiently reduce symptoms of depression. Zyban can also mitigate cravings for crystal methamphetamine. Further research into medication is essential.

Behavioral Therapy

group of individuals in drug and alcohol rehab sitting together

Behavioral therapy is the most effective way to treat someone with a dual diagnosis. There are many different approaches including:

  • Multi-Systemic Therapy (MST)
  • Brief Strategic Family Therapy (BSFT)
  • Cognitive Behavioral Therapy (CBT)
  • Exposure Therapy

Multi-Systemic Therapy (MST)

MST is mainly used to help adolescents to cope with the pressures of life that can lead them to abuse substances. This type of therapy focuses on peer pressure and antisocial behavior.

Brief Strategic Family Therapy (BSFT)

Dysfunctional family dynamics can exacerbate an adolescent’s drug use. Family therapy helps family members to understand each other better and to more effectively deal with oppositional behavior.

Cognitive Behavioral Therapy (CBT)

CBT is an evidence-based therapy that encourages the person to examine negative thought patterns and behaviors in order to devise healthier coping strategies in times of stress. CBT helps prevent relapse in people with substance abuse disorder.

Exposure Therapy

Exposure therapy is commonly used to help sufferers of PTSD to overcome their anxiety through continual exposure to traumatic experiences in a controlled and supportive environment. This form of treatment helps sufferers to confront their fear and pain and, in doing so, become desensitized to those painful memories.

Comprehensive, Continuous, Integrated System of Care Model

The treatment of dual diagnosis is an area that urgently needs more research. Every dual diagnosis case is unique and complex and it takes a highly trained medical professional to accurately diagnose and treat this crippling combination. Dr. Kenneth Minkoff, Clinical Assistant Professor of Psychiatry at Harvard Medical School, pioneered a new approach incorporating mental health treatment with addiction treatment called the Comprehensive Continuous Integrated System of Care (CCISC) Model. This unique care model provides a framework for medical professionals to follow in order to match dual-diagnosis cases with the appropriate support. Hopefully, Dr. Minkoff’s work on the treatment of dual diagnosis will continue to impact the delivery of services.

Find a Treatment Center for Dual Diagnosis

Today, there are many addiction treatment centers that can treat dual diagnoses. If you’re struggling with a drug or alcohol addiction and a mental health disorder all at once, don’t go at it alone. Pick up the phone and call 888-448-0302  to speak to a recovery specialist at Landmark Recovery. One of our team members is available 24/7 to provide you with more information on dual diagnoses, and also talk you through the admissions process. Visit our locations page to find a treatment center near you.

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About the Author

Landmark Recovery

Landmark Recovery

Landmark Recovery was founded with a determination to make addiction treatment accessible for all. Through our integrated treatment programs, we've helped thousands of people choose recovery over addiction and get back to life on their own terms. We're on a mission to save one million lives over the next century. We encourage all those struggling with substance use to seek professional help.