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Co-Occurring Disorders and Substance Abuse

People who have co-occurring disorders alongside their substance use disorder often need the assistance of a dual-diagnosis treatment facility to achieve recovery.

Rather than treating their substance use in a vacuum, a dual-diagnosis rehab will treat mental issues simultaneously, ensuring that the full spectrum of mental health and substance use problems is addressed.

Dual Diagnosis Meaning

“Dual diagnosis” describes a person experiencing mental illness alongside a substance use disorder. These mental illnesses may include depression, anxiety, or schizophrenia, or a variety of other mental conditions.

People’s struggles with mental health and substance use are often linked together, with one problem affecting the other in a destructive downward spiral.

Statistics on Dual Diagnosis

The prevalence and impact of dual diagnosis make a compelling case for targeted dual-diagnosis treatment. Recent research has shown that:

  • 9.2 million adults in the United States have co-occurring disorders alongside substance use disorders1 
  • Of all adults who have a substance use disorder, 38% also have a mental illness 2 
  • Of all adults who have a mental illness, 18% also have a substance use disorder
  • Roughly 23% of people with anxiety or depressive disorders will use substances to self-medicate 3 

In addiction treatment, clinicians have realized that treating dual diagnosis clients is the norm, not the exception. Public awareness and the de-stigmatization of mental illness have increasingly shown that treating dual diagnosis symptoms is essential to addiction recovery and is a valuable tool for addiction treatment centers.

Managing Dual Diagnosis

What Causes Dual Diagnosis?

Dual Diagnosis

Dual Diagnosis

There’s no single cause for dual diagnosis. Mental illness and substance use are both complex disorders with varied causes, including genetics, environmental factors, and neurological differences. There are, however, several risk factors for developing dual diagnosis symptoms.

Common Risk Factors

The most common risk factors for dual diagnosis are:

  • Family history of substance use disorders
  • Family history of mental illness
  • Exposure to traumatic events
  • Chronic stress levels

While none of these problems is guaranteed to result in a substance use disorder or mental illness, they can increase the likelihood of developing a problem.

Mental Health Problems and Substance Use: What Comes First?

Dual diagnosis disorders can happen in either direction. People can start misusing substances before ever noticing any mental health problems or develop a substance use disorder well after their mental health symptoms first appear.

Yet, for many people, mental health issues occur first. The symptoms of a mental illness often lead to substance use, as people commonly use drugs and alcohol to manage their mental health symptoms. This scenario is known as the “self-medication hypothesis.”

Pattern of Substance Use Disorders

According to this hypothesis, people develop substance use disorders due to using drugs to cope. The pattern is generally as follows:

  • People experiencing mental issues look for ways to mitigate their problems
  • They discover that using substances can temporarily reduce their symptoms
  • After the effects of the drug wear off, their symptoms return, often in greater severity
  • They use more drugs to overcome the stronger symptoms

This quickly turns into a destructive spiral. While people may get some short-term relief by using drugs or alcohol, the benefits quickly wear off, and people are left dealing with an addiction to substances.

A Deeper Look at Substance Use Disorders

Common Mental Health Problems Linked to Substance Use Disorders

Several mental health problems co-occur alongside substance use disorders. These mental illnesses can lead people to substance use for different reasons, which we explain in detail below.

Attention-Deficit Hyperactivity Disorder (ADHD)

Globally, ADHD affects roughly 2.8% of all adults. ADHD frequently co-occurs with substance use disorders, often because people go undiagnosed for years. Several drugs have similar effects to ADHD medication, and people who don’t know they have mental illness can feel intense relief from using these drugs. 4

In short, drugs such as methamphetamine are closely related to ADHD medications like Adderall or Vyvanse. In people with ADHD, these drugs have a calming effect — the opposite reaction to neurotypical people.

This opposite effect can result in people affected by ADHD finally feeling as though they can focus and be more productive, though the harms of using substances can quickly add up.

Bipolar Disorder

Bipolar disorder causes people to experience sudden swings in their emotional states. They may feel intensely depressed for weeks, then suddenly get a large burst of energy and happiness, referred to as a manic episode.

These intense emotional swings can be incredibly distressing, and many people with bipolar disorder will turn to substance use to cope. They either use substances to overcome long periods of depression, or they engage heavily in drug and alcohol use during manic phases.

By treating the root cause of their bipolar disorder, typically with mood-stabilizing medications, people can get off the emotional rollercoaster ride and feel profoundly relieved.

Borderline Personality Disorder

People with borderline personality disorder (BPD) are regularly diagnosed with a co-occurring substance use disorder. One of the key diagnostic criteria of BPD is impulsivity, and this impulsivity is thought to be the primary reason that dual diagnosis is so prevalent in this population.

Seeking treatment for BPD and substance use disorders typically involves entering a dual-diagnosis treatment program that offers services such as Dialectical Behavioral Therapy (DBT). DBT was developed specifically to treat BPD and is rapidly becoming a mainstay in addiction treatment.


Studies suggest that one-third of all people with a major depressive disorder also have a substance use disorder.5 People living with depression will often use substances to cope with their negative symptoms. 6

On the other hand, people with substance use disorders will often experience depressive symptoms due to their substance use. Depression is a common withdrawal symptom across multiple types of substance use disorders and can make it particularly difficult for people to recover.

For people who use substances to manage their depression, treating the root cause of their substance use is often identical to treating the depression itself.

There are several evidence-based treatment methods for helping people overcome the symptoms of depression, and any dual-diagnosis treatment center is equipped to handle these issues when you enter care.

Generalized Anxiety Disorder (GAD)

Anxiety disorders and substance use disorders frequently occur together. The notion of using substances to overcome anxiety is even prevalent in popular culture: The idea that drinking is a cure for social anxiety promotes using alcohol to cope and likely plays a part in developing substance use disorders for people with anxiety.

Post-Traumatic Stress Disorder (PTSD)

After a traumatic event, many people remain on high alert even though the danger has passed. When such symptoms persist for a long time, you’ve likely developed PTSD.

PTSD and substance use have a strong connection. The effects of PTSD often include intrusive thoughts, reliving the traumatic event over and over, and frequent nightmares. Many people turn to drug or alcohol use to overcome these symptoms, which frequently results in substance use disorder. 7

Dual Diagnosis Symptoms

Dual Diagnosis

Dual Diagnosis

People with a dual diagnosis may show signs of a substance use disorder, mental health issues, or both. It can be challenging to determine the result of substance intoxication and the underlying problem, mainly while they’re still using. 

To assess which co-occurring disorders are happening, the person needs to achieve abstinence first.

Signs and Symptoms of Substance Use Disorder

While the effects of specific drugs differ, the signs of a substance use disorder are typically the same. People struggling with substance use usually show signs such as: 8
  • Cravings for drugs
  • Loss of interest in activities outside of substance use
  • Increased tolerance — they need to take more substances to achieve the same effect
  • Withdrawal — symptoms appear if drug use stops suddenly
  • Multiple unsuccessful attempts to stop using on their own
  • Continued drug use despite harmful consequences
  • Loss of a job, relationship, or responsibilities due to substance use
  • Spending an excessive amount of time using, recovering from, and seeking their substance of choice

In addition, people with a substance use disorder may show significant personality changes to hide or obscure their drug use.

Signs and Symptoms of Mental Issues

The symptoms of mental illness have large variations but could include signs such as:

  • Persistent feelings of hopelessness
  • Chronic fatigue
  • Constantly being on high alert
  • Visual or auditory hallucinations
  • Delusional beliefs
  • Sleep difficulties

With dual diagnosis, it’s often difficult to differentiate whether a person is experiencing severe mental health symptoms or the short-term effects of drug use. Drugs like methamphetamine can mimic several effects of mental illness, such as anxiety, hallucinations, and sleep difficulties.

Determining whether these are drug effects or mental health problems requires that the person first achieve abstinence.

Dual Diagnosis Treatment

Dual Diagnosis

Dual Diagnosis

Dual-diagnosis treatment emphasizes treating mental illness and substance use disorders concurrently. With a team of multidisciplinary providers and clinicians working together, people can find relief from both problems.


The first step in recovery is typically a short stay at a medical detoxification facility. A detox is a safe place to withdraw from drugs and offers medical treatments that can ease your symptoms. 9

A medical team will observe you around the clock to ensure your safety and comfort, and support professionals will prepare you for the next phase of the recovery process.

Inpatient Rehabilitation

After detox, it’s highly recommended that people attend inpatient rehabilitation. These programs provide intensive therapies and close work with counseling professionals to teach people how to overcome their substance use problems. You’ll also meet regularly with psychiatric professionals who can help diagnose and treat mental illness.

At an inpatient center, you typically live on-site with peers trying to recover from substance use problems. This arrangement provides a solid and lasting support network, as people working toward the same goal are often the best suited to support each other in achieving it.

Treatments occur during the day, typically for several hours. Inpatient rehab is meant to be intensive — the early period of sobriety is where most people relapse, so providing a strong sense of structure and support can help them through.


During treatment, you will likely go to several psychotherapy sessions and groups. These behavioral treatments have been shown to help people recover from substance use disorders and mental illnesses time and again and include therapies such as: 10
  • Cognitive-behavioral therapy
  • Dialectical behavior therapy
  • Group therapy
  • Family therapy
  • Motivational interviewing
  • Individual therapy

Multiple studies show that these treatments help people stay abstinent, reduce mental health symptoms, and repair social connections damaged during a substance use disorder.


In addition to behavioral therapies, many people will benefit from targeted medications. Medication-assisted treatment can benefit both substance use problems and mental health issues and is vital in the recovery toolkit.

Medicating a mental illness can, in some cases, be enough to achieve total remission. For others, it’s a simple way of reducing symptoms significantly. In ideal circumstances, medications are paired with psychotherapeutic treatments, creating the best possible chances for recovery.

Supportive Housing

After completing residential treatment, many people can benefit from moving into sober, supportive housing. These “sober houses” can help people stay accountable by keeping them surrounded by other people in recovery. This is a valuable way to get long-term support for your recovery.

Self-Help and Support Groups

Self-help and support groups have long been the backbone of the recovery community. Groups such as Alcoholics Anonymous (AA), SMART Recovery, and Refuge Recovery are self-sustaining groups committed to helping people overcome substance use problems.

People attend these groups to share their common struggles, help each other, and build new friendships and connections in recovery.

The power of these groups cannot be understated. People who regularly attend 12-Step or alternative support group meetings are much more likely to stay sober, feel they have a sense of purpose, and enjoy life in sobriety. 11

There are even dual diagnosis AA meetings for people with co-occurring disorders.

The Dangers of Self-Medication

Dual Diagnosis

Dual Diagnosis

As mentioned previously, self-medication is a common reason mental illness leads to substance use disorders. Self-medication can be dangerous for your physical and mental health and is not a viable solution to mental health problems.

Why Do People Self-Medicate?

There are several reasons why people self-medicate. The symptoms of a mental health disorder are often too much for people to bear without help, whether they know they have a disorder or not. Substance use is an easy short-term solution but leads to lasting problems.

Why Is It Dangerous?

The danger of self-medication is twofold. First, using substances to cope can hinder your ability to develop healthier strategies, holding you back from reaching your full potential. Second, using drugs to self-medicate can have unwanted side effects and consequences.

These unintended effects, including developing a substance use disorder, can quickly spiral out of control. You can avoid catastrophic events like accidental overdose by seeking professional help for your mental illness instead of figuring it out on your own.

Consequences of Self Medication

Why Should You Seek Professional Treatment?

Working with a psychiatrist and clinical team to treat your dual diagnosis symptoms provides expert medical advice and a supportive team that wants to see you succeed. 

With psychiatric medicine, you can appropriately treat mental health problems with targeted drugs and medications obtained legally, free from contaminants, and have fewer side effects.

Professional addiction treatment can help you overcome your substance use disorder and finally achieve recovery.

Treatment for Dual Diagnosis at Anew Treatment Center

Anew Treatment Center proudly serves people with co-occurring disorders. Our integrated dual-diagnosis treatment facility recognizes that for people to achieve and maintain their recovery, they need holistic mental health care that treats the whole person. 

Substance use disorder doesn’t occur in a vacuum, and it shouldn’t be treated in one.

Our Dual Diagnosis Services

Our program has several services designed specifically for people with dual diagnosis symptoms. This includes dual diagnosis group therapy, psychiatric staff who work directly alongside substance use counselors, and specialized treatment protocols for specific mental illnesses.

Our Therapies

Therapies offered at our facility include:

  • Cognitive-behavioral therapy
  • Dialectical behavior therapy
  • Dual-diagnosis residential treatment
  • Trauma-informed therapy
  • Medication management
  • Group therapy
  • Family therapy
  • 12-Step facilitation

In addition to these, we offer many more therapies to suit your individual needs.

Contact Us Today

If you’re ready to treat both your substance use problems and your mental illness, contact the team at Anew Treatment center today.

Dual diagnosis recovery is attainable with the help of a trained team of mental health and substance use professionals. 

You don’t have to do this alone. When you’re ready to seek care, the team at Anew will be here to help.

Learn More About Our Treamtment Programs

Our team is ready to discuss your treatment options with you. Your call is confidential with no obligation is required.